Sam
Wells and Lynne live in California, USA He was 63 when he was diagnosed on December
02, 2002 His initial PSA was 3.8 ng/ml, his Gleason Score was 3+3= 6 and he was
staged T1c. His choice of treatment was Radical Prostatectomy. Here is his story:
My
PSA jumped from the year before from 1.8 ng/ml to 5.6 ng/ml in August 2002. Over
the next two months it dropped to 3.8 ng/ml and the Free PSA was 7% which indicates
>50% odds that I had Prostate Cancer.
My
Urologist's reaction was that I was being a hypochondriac since the PSA was under
4.0 ng/ml and the Free PSA didn't count since it was only statistically significant
if the total PSA was over 4.0 ng/ml. He ignored the fact my brother also had PCa
and clearly doesn't understand statistics.
After the Biopsy proved I had
PCa I evaluated all the options for local treatment and the doctors skill. I settled
on Surgery as it fit my personality to know within weeks if the tumor was contained.
That was 3 1/2 years ago and my PSA has stayed at 0.004 ng/ml at last measiure.
The PSA jumped up to 0.025 ng/ml in September 2005 and then down over the next
6 months to 0.004 where it has remained.
I was however one of the unfortunate
few who ended up incontinent. The Artifical Sphincter was installed after about
1 1/2 years following surgery and has made me whole again.
I
have been exercizing 4 to 5 days per week for both cardio and strength. While
the strange wanderings of the Ultra sensative PSA have once again landed on zero
(Oct 19, 2006) other failing parts have visited me since my first posting. I was
treated for Atrial Flutter and am hoping for some treatment for what appears to
be the early or mid stage of Age Related Macular Degeneration. Concluded that
no one is ever out of the woods.
Sam
mailed me to say he had sent in an update, but I seem to have mislaid it and have
asked him to re-send. He is well although he worries a little about some small
variances in his ultra-sensitive PSA
He
says : "2 1/2 years after my RP my PSA went from 0.00 to 0.026 for a few
months and then wandered down to 0.00 again. At almost 5 years out it went up
to 0.01, then to 0.02 for four months before dropping the other day to 0.01 again.
These
meanderings caused me untold hours of anxiety and would have been avoided and
the results would be the same if I stuck with the <0.1 level of measurement.
I've become a PSA junkie. I rationalize however, that it's better to use ultrasensative
to spot an upward trend beyond 0.05 early so I can begin lining up an oncologist.
It
has been 6 years from Feb 2003 since my Radical Prostatectomy. My PSA remained
at 0.00 for the first two years and then began to bounce up and down between 0.00
adn 0.02 for years three and four. It then climbed up to 0.02 where it has remained
for the last two years (years 5 and 6) until this past month when it moved to
0.04.
Given
the OFFICIAL definition of Bio Chemical recurrence is 0.2**1,
I am a long way away from that, however, the PSA is moving in that direction however
slowly which causes me anxiety. I don't like to sit and watch the PSA reach the
stage of official recurrence without having a plan to handle it. To that end my
wife and I met with Dr. Peter Carroll of the University of California San Francisco
(UCSF) Med School on February 28, 2009 to help me understand what is going on
and devise a plan of treatment if needed.
Step one was to re-examine the slides from the original pathology. The review
by UCSF showed that no cancer cells were present in the margin but benign prostate
cells/tissue was present in the margin (according to Dr. Carroll most labs only
report cancer cells in the margin and not benign prostate cells). It was therefore
assumed that some benign prostate tissue may have been left outside of
the margin.
A
sonagram by Dr. Shinohara, also of UCSF, identified a small object or particle
that they believed may be prostate tissue. This object has a small dimension of
3x3x7mm.
Dr.
Carroll's conclusion was:
1.
The low PSA numbers I am seeing may be due to the cells in the object which could
be either benign or cancerous.
2.
Because of the margins, there is a possibility that these cells are benign prostate
cells He assured me that benign cells can grow and emit more PSA without the prostate
gland itself. (UCSF is doing research on benign cells following treatment and
he said that most of the questions about them he can answer a year from now)
3.
If the there are cancer cells present he believed there were high odds that they
are a low grade variety rather then a high grade or aggressive type since
