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Any other methods Better than PSA to monitor prostate cancer?
I've attached my PSA scores since they started saving in EPIC in 2000. While you can seen a marked increase around 2017, my Family Medicine Dr. said it was age related and well within the norms. Having read other's numbers, you could make a case that my numbers have always been low. We decided on an MRI in 2022 just for 'sh*** and grins' so to speak. I couldn't accept the PI-RADS 5 result and followed up with a confirming MRI shortly thereafter. My faith in PSA, as a solid indicator of PCa, was badly shaken.
My TPUS revealed G: 4+3=7 in one core with some risk factors and I began a tri-modal treatment plan (Orgovyx 4 months; Cyberknife Boost and VMAT). The later treatment is currently underway, 5/25 completed.
I continue to query Drs. and other sources about how to monitor progress and determine if any cancer will be remaining after the conclusion of my treatments. The only answer that I'm hearing is that
we'll be monitoring my PSA. You've probably guessed my question by now. I have very little faith in PSA and wish that I discovered my cancer years earlier. Has anyone heard of other methods to know the state of our PCas, hopefully zero, post treatment? I'm thinking I might have to buy a Ouija Board;-) Kindly advise.
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Cool, I liked Dr. Scholz's medical advice, in technical terms, "Take it to the bank'.
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1 ReactionAccording. To Dr Eugene Kwon of Mayo and the Prostrate Cancer ResearchInstitute a Pet Scan will show cancers that are not reflected on a PSA score. Blood test are cheap and easy and the opposite applies to Pet Scans. However, usually PSA is instructive to your urologist
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3 ReactionsIn my experience, the PSA indicator didn't serve as an effective tool. Despite my PSA levels remaining between 2.2 and 2.6 for years, I experienced no notable issues, apart from common aging discomforts like occasional incomplete voiding. It was incidental that my doctor recommended a visit to a Urologist after discovering urine retention over 150 ml on a USG. Subsequently, following my first Digital Rectal Examination, my diagnosis escalated to Gleason 8 with metastasis to several lymph nodes, bladder neck and seminal vesicles. From my personal standpoint, I believe a DRE stands as the gold standard for detecting Prostate Cancer.
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1 ReactionA DRE is an useful tool in the toolbox in terms of detecting PC. However, I question whether it is the gold standard for detecting Prostate Cancer. I would place much more reliance on the PSA as it reflects what is happening over time and establishes a trend.
You're likely correct, but in my situation, if it hadn't been for the incidental abdominal ultrasound (USG) I underwent, my cancer might have been advancing without my awareness, considering my seemingly normal PSA levels.
You are correct as well. That is why my annual physical examination by my family doctor always included the PSA and a DRE but it was the rising PSA that triggered the referral to the Urologist and although his DRE didn't detect anything abnormal, the subsequent biopsy did generate a Gleason 6.
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2 ReactionsDetecting previously undiscovered prostate cancer, and following cancer after treatment are two different medical problems. In the latter case, PSA is the first line of defense.
You should check out Dr. Kwon’s (Mayo doctor) videos. I believe they are on YouTube and the Prostate Cancer Research Institute. He is a big believer in scans to monitor post treatment cancer. It’s not necessarily “mainstream” thinking, but his reasoning makes sense. Not all cancer expresses PSA. Part 5 which he just put out last fall addresses this.
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1 ReactionHi, my name is Rich. My Urologist performed biopsies after going from PSA of 4 to 6. Results were 2A PSc in 2 of 4 quadrants. His best recommendation was to have Prostatectomy. He said I could do radiation but if it came back later would be more difficult to treat. Proton Beam therapy was about 6 hrs away and required 8-10 weeks M-F treatments. My research indicated it was the least invasive and had very good results. I decided to take it out and be rid of it. Had undetectable PSc for 3 years. Then it doubled for 3 straight qtrs and settled at .15. It is now .31. Dr ordered PSMA/PET scan from head to groin & NO cancer was detected. Dr said I must be against the rule as a very high % with BCR would have shown cancer. We're now back to 3 month PSA tests. COMMENT: All throughout this journey I honestly don't & have never felt like I had caner.
@seasuite
If the question is: "do I still have any remaining cancer?", there is no way to get 100% assurance there is no cancer remaining after any treatment. PSA is more sensitive to that possibility than anything else I'm aware of, but it won't provide a definitive yes/no answer to that question. And it can be confusing after radiation and ADT, because if the PSA is rising over time, there *may* be some remaining normally functioning prostate cells after the treatment, OR there may be some multiplying cancer cells producing the antigen. Or both.
As to the UCLA study you linked, I don't think it should be read as an indictment of using PSA post-treatment to follow disease progression. The authors' conclusion reads: "the results of the study indicates that it (biochemical recurrence) should not be the main focus or primary measure in future clinical trials for localized prostate cancer."
What they are suggesting is not that doctors shouldn't use PSA to follow and make clinical decisions for their prostate cancer patients. Rather, they are saying that studies about the efficacy of any treatment (in regards to things like disease-free survival, metastases, etc) should not use PSA as a surrogate endpoint for how successful the treatment is.
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