All’s well for the moment

Saw Mr Singh this morning and he confirmed the PSA result as 0.04. Although this is double the reading of 6 weeks ago he was not concerned, In fact the level can bobble about a bit and until it reaches 0.1 there is no concern and at that point then they will consider further treatment, Typically it would be years before this happens and in 50% of cases it doesn’t happen at all. In the cases where it does this is called biochemical recurrence. Even then it can be 3 to 5 years before any evidence of clinical recurrence, the visibility with scans of any tumours. My Gleason score was 7 which indicates a comparatively slow growing cancer so all should be well.

If the PSA level reaches 0.1 then radiotherapy is considered. Given that it could take 5 years before clinical recurrence this won’t automatically be offered. If for instance a biochemical recurrence is detected in a 78 year old with a life expectancy of 84 then the return of the cancer may not reduce life expectancy anyway and any problems and side effects of further treatment are worth it. Dr Singh assured me the decision to offer further treatment would be made on a case by case basis. I was concerned that life expectancy varies with socio-demographic group and individual characteristics of health and fitness. My next appointment is for 3 months time.

I had a chance to speak to the research nurse for the trial I have been offered and have pretty well made up my mind not to enter it. She’ll ring on Monday for a final answer.

I am in danger of  suffering from what is called PSA anxiety but I found the following on the internet that is encouraging

PSA Anxiety:

The Downside of Ultra- Sensitive Tests

You’ve had the radical prostatectomy, but deep down, you’re terrified that it didn’t work. So here you are, a grown man, living in fear of a simple blood test, scared to death that the PSA- an enzyme made only by prostate cells, but all of your prostate cells are supposed to be gone — will come back. Six months ago, the number was 0.01. This time, it was 0.02.

You have PSA anxiety. You are not alone. This is the bane of the hypersensitive PSA test: Sometimes, there is such a thing as too much information. Daniel W Chan, Ph.D., is professor of pathology, oncology, urology and radiology, and Director of Clinical Chemistry at Hopkins. He is also an internationally recognized authority on biochemical tumor markers such as PSA, and on immunoassay tests such as the PSA test. This is some of what he has to say on the subject of PSA anxiety:

The only thing that really matters, he says, is: “At what PSA levels does the concentration indicate that the patient has had a recurrence of cancer?” For Chan, and the scientists and physicians at Hopkins, the number to take seriously is 0.2 nanograms/milliliter. “That’s something we call biochemical recurrence. But even this doesn’t mean that a man has symptoms yet. People need to understand that it might take months or even years before there is any clinical physical evidence.”

On a technical level, in the laboratory, Chan trusts the sensitivity of assays down to 0. 1, or slightly less than that. “You cannot reliably detect such a small amount as 0.01,” he explains. “From day to day, the results could vary — it could be 0.03, or maybe even 0.05” — and these “analytical” variations may not mean a thing. “It’s important that we don’t assume anything or take action on a very low level of PSA. In routine practice, because of these analytical variations from day to day, if it’s less than 0. 1, we assume it’s the same as nondetectable, or zero.”

Trial decision

Went to see Dr. Owen at 4.00pm on the 3rd November to discuss the trial I’m invited to join. I qualify as I have positive margins, i.e. cancer cells in the tissue around the prostate where the tumour was pressing against the surface, a low PSA level of 0.02 and am fully continent. All this was as described in my last post Today’s post prostatectomy consultation. My feeling at the moment is not to go in for the trial and stick with the default position of PSA monitoring and only having further treatment if needed. Hopefully this won’t be necessary but if it is my levle of fitness and health over the next few years will mean I will be able to cope with it.

I went for a blood test on Monday of this week and phoned for the result this morning. My PSA level is now 0.04 but I was assured this was not significant. It is expected that it will bobble about a bit and only of a pattern of regular increase and approaching or going past 0.1 will they be concerned. I’m seeing Mr Singh tomorrow (at 8.45!) so I’ll wait to see what he has to say before I make a final decision on the trial. I need to find out how much longer they will give me to decide. I think it is supposed to be withing 12 weeks of the operation but I might be wrong. It’s been 15 already. I was supposed to get a follow up call from Dr. Owens’ research assistant after my meeting with her but it never came. She may have decided from that interview that I was unlikely to accept.