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
