Friday, April 25, 2014

PSA anxieties post first line treatments

I will post some extracts from our ongoing new project to research and write a second booklet A Journey to Victory on prostrate cancer. This booklet will specifically be for prostrate cancer survivors and will address their PSA anxieties post initial first line treatments.

PSA anxiety is allayed with knowledge and known results determined from the first biopsy and through the course of treatments. It is important to keep all medical reports, screenings and tests results. A personal medical diary is very useful.
Key factors for PSA recurrence post treatments are positive lymph’s nodes, positive surgical margins, positive seminal vesicles and a high Gleason score.

It is natural to be anxious about rising PSA. However there are other factors that affects PSA levels namely:
a.     Prostate trauma. (eg. DRE, massage, biopsy, and transurethral resection (TURP).
b.     Prostate treatments.(drugs usage).
c.      Ejaculation. (raised false PSA reading).
d.     Acute urinary retention. (inability to urinate).
e.     Prostatitis. (infection of the gland).

Guidelines and key determinants to appraise your current status
a.     PSA should drop to an undetectable level under 0.02 after surgery and should NOT increase over time. PSA is considered stable at 0.5 ng/dL after ERBT.
b.     General treatment failure is deemed when the incident for PSA recurrence at local site is more than 2 years and distant site within 2 years.
c.      General treatment failure is deemed when the PSA Double Time (PSADT) for local site is more than12 months and distant site is under 6 months.
d.     Failure of EBRT is deemed when the PSA value of 2 ng/mL is greater than the absolute nadir it represents.
e.     Biochemical recurrence post ERBT is seen in having more than 3 consecutive PSA risings after achieving PSA nadir.
f.      Biochemical recurrence post surgery can vary from 0.2 to 0.4ng/mL
g.     Treatment failure is deemed when Standard PSA velocity is less than 0.75 ng/mL/year for local site and more than 0.75 ng/mL/year for distant site.

Please note that your doctor may not necessarily agree with the above guidelines and determinants for want of evidence based studies. However these guidelines and determinants should not prejudice the fact for worrisome PSA activities.

Cancer recurrence is deemed to be present if PSA is greater than 0.2ng/mL after surgery.
For radiation treatments, Cancer recurrence is deemed to be present if PSA rises three consecutive times , taken three months apart, after it reaches nadir point.
The Phoenix Definition for cancer recurrence is nadir point plus 2 ng/mL. The definition is valid only after two years PSA test past radiation treatment. Nadir point is the lowest PSA reading after treatment. It is reached at 12 to 42 months after treatment should be under 0.5ng/ml and no further rise.
(Phoenic definition. An annual conference of Oncologist defines cancer recurrence.)
A PSA bounce usually occurs within 12 months after treatment. PSA reading should return to nadir after a few months. No further treatment is needed after bounce.

Take care
Allen Lai

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