19th December 2007
[QUOTE=rstarre;3347877]This issue is very confusing. In reading Web MD and other sites like it, I read where having a small prostate with an elevated PSA is cause for concern. Then I read that if there is cancer present, PSA levels never go down. They stay the same or gradually go up. I do have a cyst above my testicle that has been hurting quite often. Urologist said it was nothing to worry about. He gave me anti inflammatories and the pain went away. He didn't think that is what caused the PSA levels to rise. He did give me antibiotics though. Can that be the reason my PSA levels dropped?
I must have overlooked your post until Lilacs and Lillies quoted part of it. Here are several points to consider.
About size of the prostate and PSA - Since normal prostate cells release some PSA into the blood, prostates that are larger due to non-cancerous BPH will produce more PSA than a normally sized prostate. On the other hand, you can see why a smaller than normal prostate that is producing a normal amount of PSA or more would be a concern, though not necessarily a case of prostate cancer. The rule-of-thumb is that prostates produce about .066 ng/ml of PSA for every cc of prostate (from "A Primer on Prostate Cancer - The Empowered Patient's Guide," p. F4). Unfortunately, though doctors can make a rough estimate of prostate volume from a DRE, it takes an ultrasound exam or biopsy to get an accurate size. One of the best known prostate cancer doctors and PSA researchers, Dr. Stamey of Stanford U, turned against screening several years ago basically because he felt there was so much BPH around that many men were getting unnecessary biopsies. (Many of us, including me, think his position is profoundly faulty, though we agree that going off half-cocked on the basis of a single PSA test without considering the trend usually makes little sense.)
You wrote: "Then I read that if there is cancer present, PSA levels never go down." I hope you did not read that in WebMD, because the statement is flat out wrong, and I would hope the editors of WebMD would know better! We have a man in our support group following an Active Surveillance strategy (for about 3-4 years now and doing very well) whose PSA goes up and down a bit, and he has biopsy-proven cancer. Also, a patient can easily get around a 15% variation in PSA just from his own day-to-day personal variation. A man may have mild prostate cancer but also an infection or inflammation, and if the latter two recede or go away, the PSA is likely to decline. Hormonal blockade drugs will obviously make the PSA drop except in rare instances, but even mild drugs like finasteride (aka Proscar) and Avodart will usually drop the PSA by 50% or more. In fact, if a man does have prostate cancer but does not know it yet, failure to achieve at least a 50% drop with finasteride is a strong (but not conclusive) indicator of prostate cancer, according to what I have read and heard.
Regarding antibiotics, if the doctor picks the right one, which is often chancy, they can knock out an infection and that will eliminate the PSA that was associated with the infection. That can amount to a large PSA reduction.
Take care,
Jim
I must have overlooked your post until Lilacs and Lillies quoted part of it. Here are several points to consider.
About size of the prostate and PSA - Since normal prostate cells release some PSA into the blood, prostates that are larger due to non-cancerous BPH will produce more PSA than a normally sized prostate. On the other hand, you can see why a smaller than normal prostate that is producing a normal amount of PSA or more would be a concern, though not necessarily a case of prostate cancer. The rule-of-thumb is that prostates produce about .066 ng/ml of PSA for every cc of prostate (from "A Primer on Prostate Cancer - The Empowered Patient's Guide," p. F4). Unfortunately, though doctors can make a rough estimate of prostate volume from a DRE, it takes an ultrasound exam or biopsy to get an accurate size. One of the best known prostate cancer doctors and PSA researchers, Dr. Stamey of Stanford U, turned against screening several years ago basically because he felt there was so much BPH around that many men were getting unnecessary biopsies. (Many of us, including me, think his position is profoundly faulty, though we agree that going off half-cocked on the basis of a single PSA test without considering the trend usually makes little sense.)
You wrote: "Then I read that if there is cancer present, PSA levels never go down." I hope you did not read that in WebMD, because the statement is flat out wrong, and I would hope the editors of WebMD would know better! We have a man in our support group following an Active Surveillance strategy (for about 3-4 years now and doing very well) whose PSA goes up and down a bit, and he has biopsy-proven cancer. Also, a patient can easily get around a 15% variation in PSA just from his own day-to-day personal variation. A man may have mild prostate cancer but also an infection or inflammation, and if the latter two recede or go away, the PSA is likely to decline. Hormonal blockade drugs will obviously make the PSA drop except in rare instances, but even mild drugs like finasteride (aka Proscar) and Avodart will usually drop the PSA by 50% or more. In fact, if a man does have prostate cancer but does not know it yet, failure to achieve at least a 50% drop with finasteride is a strong (but not conclusive) indicator of prostate cancer, according to what I have read and heard.
Regarding antibiotics, if the doctor picks the right one, which is often chancy, they can knock out an infection and that will eliminate the PSA that was associated with the infection. That can amount to a large PSA reduction.
Take care,
Jim