Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
Is PSA A Good And Reliable Indicator Of Metastasis?
Question: Dear Dr XXXXXXX
Thanks for your expert advice re. my previous thread
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=198524
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=205955
We had follow up consultation with our oncologist. My father’s latest PSA reading in mid November is 3.8, as compared to his previous reading of just 0.05 on 6 July 2015. My father’s PSA history is re-produced below
12 July 2014 (20.9),
16 Oct 2014 (16.7),
26 Nov 2014 (18),
2 March 2015 (0.06, after 1st ADT shot on 18 December 2014),
20 April 2015 (0.03),
30 May 2015 (0.03)
6 July 2015 (0.05)
13 Nov 2015 (3.8)
It seems to me a very significant rise from 0.05 to 3.8 within four months, ie. a rise of 76 times. Our oncologist said that since my father had not continued with ADT, it is predictable that his PSA will rise . Our doctor said it is difficult to tell the future rate of PSA rise because the current rise is due to discontinuation of our earlier intervention of ADT, and it may not be the actual increase rate due to his disease progression without intervention. At our request to continue monitoring, doctor arrange another PSA check and consultation in April next year, ie. 5 months later.
My questions are –
1. Is the PSA rise from just 0.05 to 3.8 in 4 months alarming? What are the implications of such an increase rate? Does it shed light on the future PSA rising rate in coming few months? Given such a rapid increase, does it mean that it will soon progress to metastatic disease?
2. Is PSA a good and reliable indicator of metastasis? If so, what is the usual PSA level (threshold) that probably indicate metastasis ? (I know every patient are different, but is there a PSA level (say > 50?) which in general may probably indicate metastasis?
3. Is it possible that my father’s first ADT shot has changed the biology of his cancer cells such that his subsequent discontinuation of ADT has made his cancer cells more aggressive and spread faster?
4. My father’s Hgb remain more less the same as before, i.e. cannot rise back to pre-ADT level -
16 Oct 2014, i.e. pre -ADT( 14.5)
18 Feb 2015 (9.6) [post 1st ADT shot in mid Dec 2015]
2 Mar 2015 (10.1)
11 Apr 2015 (11.4)
20 Apr 2015 (10.1)
30 May 2015 (12.1)
6 July 2015 (11.1)
13 Nov 2015 (11.7)
His platelets remain round 90k to 100k
5. It seems that his anemia problem may not be due to ADT since its stoppage could not reverse the drop in Hgb. Do you think it may be bone marrow problem causing the drop? If ADT does not cause bone marrow problem, is it possible that my father has a genetic tendency to bone marrow disease and ADT is a triggering point that trigger the onset of bone marrow disease?
We do not know what we should do at this stage which would be in my father’s best interest. Could you give us some suggestions?
Best regards,
Thanks for your expert advice re. my previous thread
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=198524
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=205955
We had follow up consultation with our oncologist. My father’s latest PSA reading in mid November is 3.8, as compared to his previous reading of just 0.05 on 6 July 2015. My father’s PSA history is re-produced below
12 July 2014 (20.9),
16 Oct 2014 (16.7),
26 Nov 2014 (18),
2 March 2015 (0.06, after 1st ADT shot on 18 December 2014),
20 April 2015 (0.03),
30 May 2015 (0.03)
6 July 2015 (0.05)
13 Nov 2015 (3.8)
It seems to me a very significant rise from 0.05 to 3.8 within four months, ie. a rise of 76 times. Our oncologist said that since my father had not continued with ADT, it is predictable that his PSA will rise . Our doctor said it is difficult to tell the future rate of PSA rise because the current rise is due to discontinuation of our earlier intervention of ADT, and it may not be the actual increase rate due to his disease progression without intervention. At our request to continue monitoring, doctor arrange another PSA check and consultation in April next year, ie. 5 months later.
My questions are –
1. Is the PSA rise from just 0.05 to 3.8 in 4 months alarming? What are the implications of such an increase rate? Does it shed light on the future PSA rising rate in coming few months? Given such a rapid increase, does it mean that it will soon progress to metastatic disease?
2. Is PSA a good and reliable indicator of metastasis? If so, what is the usual PSA level (threshold) that probably indicate metastasis ? (I know every patient are different, but is there a PSA level (say > 50?) which in general may probably indicate metastasis?
3. Is it possible that my father’s first ADT shot has changed the biology of his cancer cells such that his subsequent discontinuation of ADT has made his cancer cells more aggressive and spread faster?
4. My father’s Hgb remain more less the same as before, i.e. cannot rise back to pre-ADT level -
16 Oct 2014, i.e. pre -ADT( 14.5)
18 Feb 2015 (9.6) [post 1st ADT shot in mid Dec 2015]
2 Mar 2015 (10.1)
11 Apr 2015 (11.4)
20 Apr 2015 (10.1)
30 May 2015 (12.1)
6 July 2015 (11.1)
13 Nov 2015 (11.7)
His platelets remain round 90k to 100k
5. It seems that his anemia problem may not be due to ADT since its stoppage could not reverse the drop in Hgb. Do you think it may be bone marrow problem causing the drop? If ADT does not cause bone marrow problem, is it possible that my father has a genetic tendency to bone marrow disease and ADT is a triggering point that trigger the onset of bone marrow disease?
We do not know what we should do at this stage which would be in my father’s best interest. Could you give us some suggestions?
Best regards,
Brief Answer:
No I don't see too much cause for concern at this point
Detailed Answer:
Hi
Thanks for followup.
My answers to your queries..
1. Is the PSA rise from just 0.05 to 3.8 in 4 months alarming?
A. This is definitely a rise but still not to alarming levels. The 76 times calculation is a bit fallacious. It does not signify that the disease is becoming metastatic but yes, definitely it means that disease is increasing or becoming more active.
2. Is PSA a good and reliable indicator of metastasis? If so, what is the usual PSA level (threshold) that probably indicate metastasis ? (I know every patient are different, but is there a PSA level (say > 50?) which in general may probably indicate metastasis?
A. It is one of the indicators of metastasis but definitely not 100% sensitive or specific. In general, if PSA is more than 20, likelihood of metastases is high.
3. Is it possible that my father’s first ADT shot has changed the biology of his cancer cells such that his subsequent discontinuation of ADT has made his cancer cells more aggressive and spread faster?
A. No this is not biologically plausible. if this were true, intermittent ADT patients would have survived less than continuous ADT patients in trials but this is not the case.
4. My father’s Hgb remain more less the same as before, i.e. cannot rise back to pre-ADT level -
A. yes, it has not gone back to that level but it is maintaining at 11-12 gm/dl level, which is very much acceptable. Platelets are also holding, which is good.
5. It seems that his anemia problem may not be due to ADT since its stoppage could not reverse the drop in Hgb. Do you think it may be bone marrow problem causing the drop? If ADT does not cause bone marrow problem, is it possible that my father has a genetic tendency to bone marrow disease and ADT is a triggering point that trigger the onset of bone marrow disease?
A. Yes, it does not appear that the anemia is entirely due to ADT. Platelets are also bit low, which is not explained by ADT. There may be some subtle bone marrow insufficiency underlying, not necessarily genetic. ADT might have triggered it, but thankfully it is not progressing.
If I had a similar patient, I would repeat the PSA in couple of months time, and I would consider restarting ADT when PSA reaches approx 10 ng/ml.
Hope this helps.
Regards
No I don't see too much cause for concern at this point
Detailed Answer:
Hi
Thanks for followup.
My answers to your queries..
1. Is the PSA rise from just 0.05 to 3.8 in 4 months alarming?
A. This is definitely a rise but still not to alarming levels. The 76 times calculation is a bit fallacious. It does not signify that the disease is becoming metastatic but yes, definitely it means that disease is increasing or becoming more active.
2. Is PSA a good and reliable indicator of metastasis? If so, what is the usual PSA level (threshold) that probably indicate metastasis ? (I know every patient are different, but is there a PSA level (say > 50?) which in general may probably indicate metastasis?
A. It is one of the indicators of metastasis but definitely not 100% sensitive or specific. In general, if PSA is more than 20, likelihood of metastases is high.
3. Is it possible that my father’s first ADT shot has changed the biology of his cancer cells such that his subsequent discontinuation of ADT has made his cancer cells more aggressive and spread faster?
A. No this is not biologically plausible. if this were true, intermittent ADT patients would have survived less than continuous ADT patients in trials but this is not the case.
4. My father’s Hgb remain more less the same as before, i.e. cannot rise back to pre-ADT level -
A. yes, it has not gone back to that level but it is maintaining at 11-12 gm/dl level, which is very much acceptable. Platelets are also holding, which is good.
5. It seems that his anemia problem may not be due to ADT since its stoppage could not reverse the drop in Hgb. Do you think it may be bone marrow problem causing the drop? If ADT does not cause bone marrow problem, is it possible that my father has a genetic tendency to bone marrow disease and ADT is a triggering point that trigger the onset of bone marrow disease?
A. Yes, it does not appear that the anemia is entirely due to ADT. Platelets are also bit low, which is not explained by ADT. There may be some subtle bone marrow insufficiency underlying, not necessarily genetic. ADT might have triggered it, but thankfully it is not progressing.
If I had a similar patient, I would repeat the PSA in couple of months time, and I would consider restarting ADT when PSA reaches approx 10 ng/ml.
Hope this helps.
Regards
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
