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Cancer: Prostate Message Board

Cancer: Prostate Board Index


You previously wondered:

[QUOTE][COLOR="darkgreen"]Just a parting thought: you may not have recurred, even with that positive margin. Have you thought of insisting on an ultrasensitive PSA test to substitute for that conventional test your doctor is using? Personally, with your history, I'm not impressed that the doctor chose to monitor with a conventional test. :( However, please remember that I lack medical credentials.[/COLOR][/QUOTE]

I did some research today to help me better understand an issue related to PSA and aggressive PCa. The main reason my oncologist does not want to wait for a rise in PSA is his claim that PCa can turn aggressive without a significant rise in PSA. At first, I took that statement at face value, and my initial research seemed to confirm it.

But today I looked closer. I found this statement at the Prostate Cancer Research Institute site in the article: "What Every Doctor Who Treats Male Patients Should Know:"

[QUOTE]Aggressive variants, in general, have high PSAs (over 10) OR very low PSAs associated with very aggressive, high Gleason score [(4,3), (4,4), (4,5), (5,4), (5,5)] cancers. These variants are very dangerous, often escaping investigation for long periods of time because the PSAs appear to be in the so-called normal range. Investigating all PSAs of 2.0 and over will help to catch these aggressive prostate cancers while they are still organ-confined and treatable with local therapies such as surgery and radiation. The probability of detecting these low PSA/high Gleason score cancers is enhanced if patients and doctors monitor even very low PSA levels over time to note any persistent increases.

High Gleason score cancers often have reverted to an embryonic state in which PSA secretion into the blood is markedly reduced.
Checking the serum for abnormal elevations in markers such as CGA (Chromogranin A), NSE (Neuron Specific Enolase), CEA (Carcino- Embryonic Antigen) and PAP (Prostatic Acid Phosphatase) is important to discern PC activity secondary to these de-differentiated tumor cell populations. Therefore, in cases such as this, the normal guidelines for PSA velocity and doubling time may not be applicable. HOWEVER, the concept of slope or trend in a biomarker of disease activity remains valid, and any biomarker elevation should be tracked at regular intervals to determine the presence of abnormal growth of primitive (embryonic) tumor cell clones.[/QUOTE]

It is clear from this statement that even this kind of aggressive cancer does produce PSA, just at reduced levels. Thus, even if my PCa were to be this type, I would see a trackable rise in PSA, especially if the ultra-sensitive test were used. Any suspicion of recurrence could be followed up with tests for the other markers of such cancers. So, as you said, I could just wait for a while to see if I in fact have a recurrence before taking drastic measures. It's nice to have another option.

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