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Does PSA number correlate to severity/aggressiveness of Pca

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User
Posted 29 Aug 2023 at 15:54

Hello all,

I've been scouring these forums for the last few days and have found them so helpful.

My husband is only 50 and we have 2 young children (I'm slightly younger and we started late!).

He has had 3 PSA tests, each a month apart- 4.5, 4.5, 4.2. No lumps were felt upon DRE but it is enlarged and firm.

His MRI has come back with bilateral PIRADS 5 lesions.

He is awaiting a biopsy. I'm really struggling. Imagining the worst etc, obviously I'm sure you've all been there.

I just wondered if there is any significance in the lowish PSA numbers, ie- is it more likely to be a slow growing cancer/still contained with the prostate with those figures? I'm desperately trying to be level headed but I'm completely panicked and inside I'm distraught.

Thanks so much.

User
Posted 29 Aug 2023 at 16:37

The psa test is just a indication you will only find out your Gleason score after a biopsy I was diagnosed Gleason 9 with a psa off 24.9   4 year's on from radiotherapy and hormone therapy I have a psa off 0.01 and  still working as I did all the way through treatment there is light at the end of the tunnel if diagnosed gaz 👍

User
Posted 29 Aug 2023 at 17:53

PSA level isn't a good indication of aggressiveness or spread, except if it's in the hundreds or more the chances of metastatic spread is much higher. The chances of incurable spread with a PSA of 4.5 and a large prostate is low, but none of us can give you any assurance. Also, a large prostate is nothing to do with prostate cancer but something that happens with many men, and may even mean his PSA is normal for his large prostate size. The firm prostate and PIRADS 5 is concerning, but neither of these is a diagnosis of cancer - you need the biopsy result to know that.

This is a period when you don't know what the situation is, and you've been thrown in to this which you weren't expecting, and can't imagine how it will pan out. This usually causes high levels of anxiety. Unfortunately, it is just a case of waiting until you get the test results. Even after the biopsy, there may be more scans to do before you can choose a treatment option.

Wishing you the best possible outcome.

 

 

User
Posted 29 Aug 2023 at 18:02

PSA is not a very good test. I would say for about 70% of the population, low PSA means low cancer and high PSA means high cancer. But for the other 30% of the population the PSA and level of cancer don't tally at all.

So if he is in the 70% majority of the population a PSA of less than 10 is low grade easily treatable cancer and a PSA greater than 50 is advanced and will eventually lead to death after about a decade. If he's in the other 30% the PSA could mean absolutely anything, from zero cancer to cancer spread all over body. You don't know which group your in until you're fully diagnosed.

So if I were a betting man I would bet it was low risk, but not with much confidence.

 

Dave

User
Posted 29 Aug 2023 at 22:25

For what it is worth, I had a very enlarged prostate with a PSA of 20. Gleeson was 3+4, cancer contained within the capsule and slow growing. The initial consultant said off the cuff, a bit difficult to know what would happen if it was left alone and do nothing. I had surgery to remove the prostate 15mths ago. As already been alluded to, with a PSA of 4.5 it is not likely to be an aggressive one. Incidentally, my bother has a PSA of 10, done a biopsy and no cancer. He is on AS though.

User
Posted 29 Aug 2023 at 22:47
I know this isn't directly related to the question, but we can expect some pretty major advances in detection over the coming years with AI.

https://www.ox.ac.uk/news/2023-03-10-prostate-cancer-ai-diagnosis-tool-begins-evaluation-oxford

There may come a day when the whole process can be completed on the day and prevent a great deal of anguish.

There is a view that AI is going to reduce the development time of drugs and medical procedures by decades. We can only hope there are major breakthroughs in PCa in particular.

User
Posted 29 Aug 2023 at 23:04

Three west London Trusts: Epsom and St Helier University Hospitals NHS Trust in partnership with The Royal Marsden NHS Foundation Trust, Imperial College Healthcare Trust, and St George’s University Hospitals NHS Foundation Trust are all running a rapid diagnostic pathway trial called RAPID - MRI, and transperineal fusion biopsy if required on the same day. This means many patients get the tests and all-clear in one day.

Imperial (and maybe the others too, I'm not sure) opened this up to any patient diagnosed in England through one of the Graham Fullford Charitable Trust PSA tests (which do most of the charity PSA tests in the country), because some NHS trusts were refusing to take referrals resulting from red letters from charity PSA tests. The catch is of course, you might not live in easy traveling distance of these London hospitals, but you can ask your GP to refer you there if you wish.

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User
Posted 29 Aug 2023 at 16:37

The psa test is just a indication you will only find out your Gleason score after a biopsy I was diagnosed Gleason 9 with a psa off 24.9   4 year's on from radiotherapy and hormone therapy I have a psa off 0.01 and  still working as I did all the way through treatment there is light at the end of the tunnel if diagnosed gaz 👍

User
Posted 29 Aug 2023 at 17:53

PSA level isn't a good indication of aggressiveness or spread, except if it's in the hundreds or more the chances of metastatic spread is much higher. The chances of incurable spread with a PSA of 4.5 and a large prostate is low, but none of us can give you any assurance. Also, a large prostate is nothing to do with prostate cancer but something that happens with many men, and may even mean his PSA is normal for his large prostate size. The firm prostate and PIRADS 5 is concerning, but neither of these is a diagnosis of cancer - you need the biopsy result to know that.

This is a period when you don't know what the situation is, and you've been thrown in to this which you weren't expecting, and can't imagine how it will pan out. This usually causes high levels of anxiety. Unfortunately, it is just a case of waiting until you get the test results. Even after the biopsy, there may be more scans to do before you can choose a treatment option.

Wishing you the best possible outcome.

 

 

User
Posted 29 Aug 2023 at 18:02

PSA is not a very good test. I would say for about 70% of the population, low PSA means low cancer and high PSA means high cancer. But for the other 30% of the population the PSA and level of cancer don't tally at all.

So if he is in the 70% majority of the population a PSA of less than 10 is low grade easily treatable cancer and a PSA greater than 50 is advanced and will eventually lead to death after about a decade. If he's in the other 30% the PSA could mean absolutely anything, from zero cancer to cancer spread all over body. You don't know which group your in until you're fully diagnosed.

So if I were a betting man I would bet it was low risk, but not with much confidence.

 

Dave

User
Posted 29 Aug 2023 at 22:25

For what it is worth, I had a very enlarged prostate with a PSA of 20. Gleeson was 3+4, cancer contained within the capsule and slow growing. The initial consultant said off the cuff, a bit difficult to know what would happen if it was left alone and do nothing. I had surgery to remove the prostate 15mths ago. As already been alluded to, with a PSA of 4.5 it is not likely to be an aggressive one. Incidentally, my bother has a PSA of 10, done a biopsy and no cancer. He is on AS though.

User
Posted 29 Aug 2023 at 22:47
I know this isn't directly related to the question, but we can expect some pretty major advances in detection over the coming years with AI.

https://www.ox.ac.uk/news/2023-03-10-prostate-cancer-ai-diagnosis-tool-begins-evaluation-oxford

There may come a day when the whole process can be completed on the day and prevent a great deal of anguish.

There is a view that AI is going to reduce the development time of drugs and medical procedures by decades. We can only hope there are major breakthroughs in PCa in particular.

User
Posted 29 Aug 2023 at 23:04

Three west London Trusts: Epsom and St Helier University Hospitals NHS Trust in partnership with The Royal Marsden NHS Foundation Trust, Imperial College Healthcare Trust, and St George’s University Hospitals NHS Foundation Trust are all running a rapid diagnostic pathway trial called RAPID - MRI, and transperineal fusion biopsy if required on the same day. This means many patients get the tests and all-clear in one day.

Imperial (and maybe the others too, I'm not sure) opened this up to any patient diagnosed in England through one of the Graham Fullford Charitable Trust PSA tests (which do most of the charity PSA tests in the country), because some NHS trusts were refusing to take referrals resulting from red letters from charity PSA tests. The catch is of course, you might not live in easy traveling distance of these London hospitals, but you can ask your GP to refer you there if you wish.

 
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