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Cancer: Prostate Message Board


Cancer: Prostate Board Index


Re: Psa numbers
Dec 29, 2008
[QUOTE=eddief1;3831952]thanx iadt2000 iread somewhere that you said if the prostate is normal size the pc
would be a 1 my prostate is enlarged so if i have pc what would it be[/QUOTE]

Hi Eddie,

I see you already got an excellent reply from daff. I'll give you a few more facts from a different angle.

Highly respected prostate cancer surgeon/researcher William Catalona, MD, has had research published showing that the following PSAs are [U]average[/U] for men with no clinical evidence of prostate cancer:

ages 40 to 49: PSA averages .7;
ages 50-59: PSA averages 0.9;
ages 60 to older: PSA averages 1.4.

Dr. Catalona said that men with a PSA score at the average or lower value for their age group had a very low risk of prostate cancer.

(IMPaCT Conference, September 2007, Program book, page 40).

Size of the prostate is fairly well related to PSA. The book "A Primer on Prostate Cancer - The Empowered Patient's Guide," says on page F4 that the volume of the gland times 0.066 tells how much normal, benign PSA a prostate is expected to produce. Normal prostates are often about 20 to 30 cubic centimeters (cc) in size, so a 20 cc gland would produce 20 times 0.066 PSA units, which calculates to 1.32 of PSA from normal cells. A gland of 30 cc would produce 30 times 0.066 PSA units, which calculates to 1.98 of PSA from normal cells. You get the idea. If your prostate is enlarged and you know the size in cc, which your urologist can probably tell you, you can estimate the amount of PSA that would be from normal cells. If that's close to or more than your actual PSA, it's a helpful indicator that you are less likely to have cancer.

However, the guideline of 0.066 per cc of prostate gland is not exact - more of a rule of thumb. One thing that makes a difference is the Gleason Score, which you would not know unless you had a positive biopsy and were diagnosed. Patients with a lot of high Gleason cancer, especially in the 8 to 10 range, often have somewhat lower PSAs than we would otherwise expect because the cells are so broken down by cancer that they no longer can produce as much PSA, even though lower Gleason cancers produce much more PSA than normal cells do.

All that said, if you know your PSA and the size of the prostate, which urologists can estimate pretty well, you have a fairly good idea if there is cancer present and can get some idea of how much is there (you can subtract the expected normal PSA from the total PSA and then roughly estimate the volume of cancer.

I know this is a bit complicated, but I hope it helps more than confuses.

Take care,

Jim
Re: Psa numbers
Apr 11, 2009
[QUOTE=eddief1;3952221]update in november at my urologyst office my psa was 3.2 freepsa was 29%
at my reg dr office late december it was 3.5 the hosipital had a free test in feb it was 5.5 last week back at my urologyst office it was 3.1 free psa was 28% urologyst said i have a med enlarged prostate and he believes that is causing my psa number and that they do there own blood work . It is a large place with several doctors. what size in cc would a med enlarged prostate be?[/QUOTE]

Hi Eddie,

I see it the way daff does: way to go! :D Here are a few more points.

Your PSA has been quite stable except for that test at the hospital, and that is despite the fact that you've had three different places doing the testing. That can make a difference, as research indicates that there can easily be around a 15% daily variation in PSA even at the same lab with the same brand of PSA test as I recall, and there can be at least that much variation when different labs and possibly different brands of PSA tests are used. PSA tests are not all designed the same; different tests may use a different part of the PSA molecule to measure, and the results differ a little just because of this. If you think about it, 15% of a PSA of 3.2 is .48, nearly half a point, so you can see that your scores of 3.2, 3.5, and 3.1 are all in the same small zone, probably indicating an essentially steady PSA. That 5.5 at the hospital was probably influenced by some stray factor - different brand of test, your own activities prior to the test, or a DRE before the test (if that was done) would all be usual suspects.

It's significant that you have gone for nearly half a year with a steady PSA, arguably a falling PSA. That pattern is not consistent with prostate cancer, especially prostate cancer that is at least fairly aggressive, though it does not rule it out 100%. But that PSA pattern nearly does along with the other facts. One of those, of course, is that free PSA value - nice and high at around 29%, and steady, and another is what I assume is a negative DRE for cancer. You're making the rest of us envious. ;)

You could call your urologist and get his estimate of the size in cubic centimeters of your prostate; it won't be as exact as if he were measuring it with an ultrasound image, but these guys do DRE's frequently and then see a lot of ultrasound images and biopsies, so they get pretty good at estimating size based on just the DRE. Daff's figure of 50 is certainly in the range for what the urologist described in words. There is a rule-of-thumb established by research that each cubic centimeter of healthy prostate tissue will generate about 0.066 ng/ml of PSA. If you multiply 50 cc, daff's suggestion, by 0.066, you get 3.3 - bingo! (That rule of thumb is stated on page F4 of the wonderful book "A Primer on Prostate Cancer - The Empowered Patient's Guide.)

About medications for shrinking the prostate - finasteride is generic (also known by the brand name Proscar), and it not only shrinks the prostate but has been proven by a very large, gold-standard type clinical trial to reduce the risk of prostate cancer. Follow-up analysis has boosted the degree of protection to about 30%, and that analysis has also virtually proven that finasteride is safe, that it does [I][U]not[/U][/I] foster more aggressive cancer in 1% of patients who do get cancer! (What it does is make high grade cancer easier to detect.) Finasteride also makes interpretation of PSA scores and trend lines more effective, and it also makes DRE exams more effective.

However, we are on the verge of getting clinical trial results of Avodart for prevention of prostate cancer (the REDEEM and REDUCE trials), with results expected this spring. Early results suggested that Avodart is one and a half to twice as effective as finasteride in preventing prostate cancer, and it is probably also more potent in shrinking enlarged prostates. A few men cannot benefit from Avodart due to genetics, but that should be obvious pretty quickly based on the way a patient responds to the drug. As I understand it as a savvy layman, such men can benefit from finasteride.

Both drugs have a long track record, especially finasteride, and both are pretty mild for most of us, with the main noticeable side effect being the growth of more hair in the male-pattern-baldness areas :D :cool: for many of us(me). In about 10% to 20% of men, libido is decreased and ED increased, but the rest of us may even do somewhat better in those departments. The side effects - wanted (hair) and unwanted are reversed when the drugs are stopped. Dr. Charles "Snuffy" Myers, an expert medical oncologist practicing in Virginia who specializes in prostate cancer, has stated that men interested in these drugs who still want to have children should consider a sperm bank; that's because ejaculate is somewhat reduced for many of us.

I recommend you break out some champagne for your great medical news! :jester: :D :cool: :angel:

Take care, :wave:

Jim





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