Cancerous Prostate

Question:

On March 17, dan wrote, referring to a series of PSA tests with results of <0.1: Even though our local lab doesn’t do the ultrasensitive assay, I’m keeping my fingers crossed that this qualifies for the 12 months of undetectable that Strum references.

I’m truly sorry to say so, but it does *not* qualify. Strum is quite clear on this point in his book and, I recall, on the PCRI website: "Undetectable" is <0.05 ng/ml. Just March 15, he wrote this to a patient on P2P: "PSA of 0.1 is NOT undetectable.  Using ultra-sensitive PSA assays we have documentation that PSA values greater than 0.01 are of concern in the setting post RP." The "local lab" is practicing third-world medicine, or maybe Dan’s medic is. I have to say that I am incredulous that such a thing is tolerated. Regards, Steve J

Response:

Just March 15, he wrote this to a patient on P2P: "PSA of 0.1 is NOT undetectable.  Using ultra-sensitive PSA assays we have documentation that PSA values greater than 0.01 are of concern in the setting post RP." The "local lab" is practicing third-world medicine, or maybe Dan’s medic is. I have to say that I am incredulous that such a thing is tolerated.

I am curious as to the benefit.  For instance, my ultra-sensitive tests came back bouncing around between .05 and .08 and I fretted each rise and became overly confident at each fall.  Yet, it meant nothing until my 0.132 reared its ugly head and that really won’t mean much until it happens twice more. Each of which would have registered on a 3rd world assay. — Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA  .1  .1  .1  .27  .37  .75 PSA  .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA  .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum

Response:

Regarding ultrasensitive PSA tests, Steve Kramer replied to me on March 18: I am curious as to the benefit.  For instance, my ultra-sensitive tests came back bouncing around between .05 and .08 and I fretted each rise and became overly confident at each fall.  Yet, it meant nothing until my 0.132 reared its ugly head and that really won’t mean much until it happens twice more. Each of which would have registered on a 3rd world assay.

The best resource for an answer would be the PCRI website search function at: http://www.prostate-cancer.org/index.html And I too have fretted over meaningless "twitches" in test results. I get over it. Basically, it is my understanding is that use of US testing permits the patient and his medic to detect changes in his PSA that would not appear on standard assays, which do not report results that are <0.1 ng/ml. Frex, a rise from 0.01 to 0.09 would not be reported by the standard assay. I think I’d want to know about something like that. Regards, Steve J

Response:

Frex, a rise from 0.01 to 0.09 would not be reported by the standard assay. I think I’d want to know about something like that.

Oops. In that scenario, the standard assay would report 0.1. My misnake. Regards, Steve J

Response:

Regarding ultrasensitive PSA tests, Steve Kramer replied to me on March 18: I am curious as to the benefit.  For instance, my ultra-sensitive tests came back bouncing around between .05 and .08 and I fretted each rise and became overly confident at each fall.  Yet, it meant nothing until my 0.132 reared its ugly head and that really won’t mean much until it happens twice more. Each of which would have registered on a 3rd world assay. Frex, a rise from 0.01 to 0.09 would not be reported by the standard assay. I think I’d want to know about something like that.

Yes, that is my point.  Well, no…  it’s the argument to my point. I agree with you that ultrasensitive testing seems to have proven itself reliable at the sub-decinanogram (is that a word?) level.  However, aside from "knowing", what good is it?  I don’t think any doc subscribes to acting on it at that level. — Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA  .1  .1  .1  .27  .37  .75 PSA  .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA  .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum

Response:

On March 18, Steve Kramer, responding to me, wrote in pertinent part: I agree with you that ultrasensitive testing seems to have proven itself  reliable at the sub-decinanogram (is that a word?) level.  However, aside from "knowing", what good is it?  I don’t think any doc subscribes  to acting on it at that level.

I want to *know* what’s going on. Knowledge, as I keep saying (maybe too often) is Life. Get the facts rather than exist in ignorance. *Then* decide what, if anything, to do. But if one does not know the facts, one cannot make a rational decision. *That* is the utility of "knowing." Regards, Steve J "What are the facts? Again and again and again — what are the facts? Shun wishful thinking, ignore divine revelation, forget ‘what the stars foretell,’ avoid opinion, care not what the neighbors think, never mind the unguessable ‘verdict of history’ — what are the facts, and to how many decimal places? You pilot always into an unknown future; facts are your single clue. Get the facts!" –Lazarus Long

Response:

On March 18, Steve Kramer wrote aside from "knowing", what good is it?  I don’t think any doc subscribes  to acting on it at that level. I want to *know* what’s going on. Knowledge, as I keep saying (maybe too often) is Life. Get the facts rather than exist in ignorance. *Then* decide what, if anything, to do. But if one does not know the facts, one cannot make a rational decision. *That* is the utility of "knowing."

Ultrasensitive PSA is not "knowing" anything, because adding decimal places does not necessarily add accuracy. But … BUT … if those extra decimal places ARE valid information,  and we chose to pay some attention to them real time, we’re ahead of the game. For example, I’m paying more attention to SRT threads and factoids than I would be if my PSA hadn’t crept — twice in a progressive row — from the third decimal point to the second decimal point. That extra attention has, rather effortlessly, led me to two quite useful factoids IF those changes continue: SRT may be useless for me due to my SVI, and if I did choose to accept it, the timing could be great; what the heck ELSE am I gonna do when winter sets in in in the gray Pacific  NW US? I.P.

Response:

On March 17, dan wrote, referring to a series of PSA tests with results of <0.1:

  (snip) The "local lab" is practicing third-world medicine, or maybe Dan’s medic is. I have to say that I am incredulous that such a thing is tolerated. Regards, Steve J

Been away for a few days, just now playing catch up. All I have to say is *ouch*.  Dude, take it easy, I prefer to think that I live in a rural community, not a third world country.  It’s my choice to have the testing done here at our local Quest lab (Bayer assay), rather than driving 30 to 40 minutes to have it done in the "big city" next to us.  And after following this ng for over a year now, I’m not sure the ultrasensitive assays do much other than raising the anxiety levels of pts.  Gotta go, it’s time to take the lizard’s tongue and frog eyes prescribed by my third world medic. Just kidding Steve, I appreciate all the knowledge that you’ve contributed to this group. God bless and take care to all, Dan — PSA = 2.2 , 03/05/2003 Biopsy, 11/10/2004, G9(5+4) (multiple cores) (6 of 8 cores positive), T1C Casodex (daily), begin. 11/16/2004 Zoladex, 12/23/2004, 03/10/2005, 06/14/2005, 09/14/2005, 12/14/2005, 03/14/06 PSA, 0.1, <0.1, <0.1, <0.1, <0.1

Response:

On March 21, Dan replied, in pertinent part, to my post dated March 17: It’s my choice to have the testing done here at our local Quest lab (Bayer assay), rather than driving 30 to 40 minutes to have it done in the "big city" next to us.  And after following this ng for over a year  now, I’m not sure the ultrasensitive assays do much other than raising  the anxiety levels of pts.

Anxiety levels can be dealt with, as I know from experience. As I’ve said elsethread, I want to know the facts so that I can make a rational decision as to what, if anything, to do. Here’s an abstract of a clinical study that is on point, and supports use of the ultrasensitive test:  From J Urol. 1997 Apr;157(4):1335-6. PMID: 9120931 "Sensitive prostate specific antigen measurements identify men with long disease-free intervals and differentiate aggressive from indolent cancer recurrences within 2 years after radical prostatectomy. Witherspoon LR, Lapeyrolerie T. Department of Nuclear Medicine, Ochsner Clinic, New Orleans, Louisiana, USA. PURPOSE: Commonly available prostate specific antigen (PSA) assays have detection limits of greater than 0.05 ng/ml., limiting their ability to identify residual or recurrent prostate cancer after radical prostatectomy or to provide prognostic information within the first several years after surgery. We investigated the ability of a sensitive PSA assay to identify residual prostate cancer and men at risk for early recurrence after radical prostatectomy. MATERIALS AND METHODS: We measured PSA in 1,037 serum samples obtained serially from 127 men after radical prostatectomy using the IMMULITE third generation PSA assay. RESULTS: The IMMULITE PSA assay has an analytical sensitivity of less than 0.002 ng./ml. and a clinically useful decision threshold of 0.01 ng./ml. With this assay our patients were classified into 3 groups: 1) 50 with a postoperative baseline PSA of less than 0.01 ng./ml. that did not change during an average of 36 months postoperatively, 2) 66 with increasing PSA that exceeded 0.01 ng./ml. in all cases by 30 months postoperatively (20 with clinical cancer recurrences) and 3) 11 with slowly increasing PSA of greater than 0.01 but less than 0.02 ng./ml. at an average of 36 months postoperatively. CONCLUSIONS: The IMMULITE PSA assay provides clinically useful information not previously available from PSA assays with conventional sensitivity, which is highly predictive of cancer activity in patients within 2 years after radical prostatectomy." Regards, Steve J

Response:

assays do much other than raising the anxiety levels of pts.  Gotta go, it’s time to take the lizard’s tongue and frog eyes prescribed by my third world medic.

Remember the Ginger!!!!   Dan, don’t forget the ginger!

Response:

– Hide quoted text — Show quoted text – Tom, Laughed so hard, I’ve still got tears in my eyes.  F”’ng hilarious. Thanks so much for sharing. Dan, PS.  I too would offer a reward if anyone knows the wherabouts of my testicles. — PSA = 2.2 , 03/05/2003 Biopsy, 11/10/2004, G9(5+4) (multiple cores) (6 of 8 cores positive), T1C Casodex (daily), begin. 11/16/2004 Zoladex, 12/23/2004, 03/10/2005, 06/14/2005, 09/14/2005, 12/14/2005, 03/14/06 PSA, 0.1, <0.1, <0.1, <0.1, <0.1

Nice try in sneaking by us your good news, Dan. Congratulations on your last PSA(s)!!! — Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA  .1  .1  .1  .27  .37  .75 PSA  .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA  .07 .05 .06 .09 .08 .132

Response:

ONLY A GUY WOULD DO THIS. Pocket Taser Stun Gun, a great gift for the wife./BIG SNIP

Tom I loved it. But please stop being mysterious. What are these ‘testicle’ things  you guys keep talking about finding? Kind regards MikeHi or whatever I am today

Response:

Thanks Steve, Even though our local lab doesn’t do the ultrasensitive assay, I’m keeping my fingers crossed that this qualifies for the 12 months of undetectable that Strum references.  Even after a year of this, I still sweat bullets, sitting alone in the exam room awaiting the results. Take care, and God Bless all of you providing support to this group. Dan, — PSA = 2.2 , 03/05/2003 Biopsy, 11/10/2004, G9(5+4) (multiple cores) (6 of 8 cores positive), T1C Casodex (daily), begin. 11/16/2004 Zoladex, 12/23/2004, 03/10/2005, 06/14/2005, 09/14/2005, 12/14/2005, 03/14/06 PSA, 0.1, <0.1, <0.1, <0.1, <0.1

– Hide quoted text — Show quoted text – Tom, Laughed so hard, I’ve still got tears in my eyes.  F”’ng hilarious. Thanks so much for sharing. Dan, PS.  I too would offer a reward if anyone knows the wherabouts of my testicles. — PSA = 2.2 , 03/05/2003 Biopsy, 11/10/2004, G9(5+4) (multiple cores) (6 of 8 cores positive), T1C Casodex (daily), begin. 11/16/2004 Zoladex, 12/23/2004, 03/10/2005, 06/14/2005, 09/14/2005, 12/14/2005, 03/14/06 PSA, 0.1, <0.1, <0.1, <0.1, <0.1 Nice try in sneaking by us your good news, Dan. Congratulations on your last PSA(s)!!! — Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA  .1  .1  .1  .27  .37  .75 PSA  .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA  .07 .05 .06 .09 .08 .132

Response:

tom – that one is a "keeper"  :)) oh, does the phrase, "hey, gang, watch this" mean anything in a case like this?  ~ curtis knowledge is power – growing old is mandatory – growing wise is optional     "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc

Response:

Sure does, right along with, "Hold my beer, I’m gonna try somethin." Tom

– Hide quoted text — Show quoted text – tom – that one is a "keeper"  :)) oh, does the phrase, "hey, gang, watch this" mean anything in a case like this? ~ curtis knowledge is power – growing old is mandatory – growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc

Response:

Tom, Laughed so hard, I’ve still got tears in my eyes.  F”’ng hilarious.  Thanks so much for sharing. Dan, PS.  I too would offer a reward if anyone knows the wherabouts of my testicles. — PSA = 2.2 , 03/05/2003 Biopsy, 11/10/2004, G9(5+4) (multiple cores) (6 of 8 cores positive), T1C Casodex (daily), begin. 11/16/2004 Zoladex, 12/23/2004, 03/10/2005, 06/14/2005, 09/14/2005, 12/14/2005, 03/14/06 PSA, 0.1, <0.1, <0.1, <0.1, <0.1

– Hide quoted text — Show quoted text – I’m sure we all know someone who could have written this as a personal account. Tom ONLY A GUY WOULD DO THIS. Pocket Taser Stun Gun, a great gift for the wife. Last weekend I saw something at Larry’s Pistol &  Pawn Shop that sparked my interest. The occasion was our 22nd anniversary and I was looking for a little something extra for my wife Toni. What I  came across was a 100,000-volt, pocket/purse-sized taser. The  effects of the taser were suppose to be short lived, with no long-term  adverse affect on your assailant, allowing her adequate time to retreat to  safety…. WAY TOO COOL! Long story short, I bought the device and brought  it home. I loaded two triple-a batteries in the darn thing and pushed the  button. Nothing! I was disappointed. I learned, however, that if I pushed the button AND pressed it against a metal surface at the same  time; I’d get the blue arch of electricity darting back and forth between the  prongs. Awesome!!! Unfortunately, I have yet to explain to Toni what  that burn spot is on the face of her microwave. Okay, so I was home alone with this new toy,  thinking to myself that it couldn’t be all that bad with only two triple-a  batteries,… right? There I sat in my recliner, my cat Gracie looking  on intently (trusting little soul) while I was reading the directions and  thinking that I really needed to try this thing out on a flesh & blood moving target. I must admit I thought about zapping Gracie (for a  fraction of a second) and thought better of it. She is such a sweet cat.  But, if I was going to give this thing to my wife to protect herself  against a mugger, I did want some assurance that it would work as advertised.  Am I wrong? So, there I sat in a pair of shorts and a tank top  with my reading glasses perched delicately on the bridge of my nose,  directions in one hand, taser in another. The directions said that a one-second burst would shock and disorient your assailant; a two-second burst was  supposed to cause muscle spasms and a major loss of bodily control; a  three-second burst would purportedly make your assailant flop on the ground  like a fish out of water. Any burst longer than three seconds would  be wasting the batteries. All the while I’m looking at this little device  measuring about 5" long, less than 3/4 inch in circumference; pretty cute  really and loaded with two itsy, bitsy triple-a batteries) thinking to myself, "no possible way!" What happened next is almost beyond description,  but I’ll do my best….. I’m sitting there alone, Gracie looking on with her  head cocked to one side as to say, "don’t do it master," reasoning that a  one-second burst from such a tiny little ole thing couldn’t hurt all that bad…. I decided to give myself a one-second burst just for the heck of  it. I touched the prongs to my naked thigh, pushed the button, and  HOLY MOTHER, WEAPONS OF through the  side door, picked me up in the recliner, then body slammed us both on the  carpet, over and over and over again. I vaguely recall waking up on my side  in the fetal position, with tears in my eyes, body soaking wet, both nipples on fire, testicles nowhere to be found, with my left arm tucked under  my body in the oddest position, and tingling in my legs. The cat was standing over me making meowing sounds I had never heard before, licking my face, undoubtedly thinking to herself, "do it again, do it again!" Note: If you ever feel compelled to "mug" yourself  with a taser, one note of caution: there is no such thing as a one-second  burst when you zap yourself. You will not let go of that thing until  it is dislodged from your hand by a violent thrashing about on the  floor. A three second burst would be considered conservative. SON-OF-A-…. that hurt like hell!!! A minute or so later (I can’t be sure, as time was a relative thing at that point),  I collected my wits (what little I had left), sat up, and surveyed the landscape. My bent reading glasses were on the mantel of the fireplace. How did they up get there??? My triceps, right thigh and both nipples were still twitching. My face felt like it had been shot up with Novocain, and my bottom lip weighed 88 lbs. I’m still looking for my testicles? I’m  offering a significant reward for their safe return. Still in shock, John

Response:

I’m sure we all know someone who could have written this as a personal account. Tom ONLY A GUY WOULD DO THIS. Pocket Taser Stun Gun, a great gift for the wife. Last weekend I saw something at Larry’s Pistol &  Pawn Shop that sparked my interest. The occasion was our 22nd anniversary and I was looking for a little something extra for my wife Toni. What I  came across was a 100,000-volt, pocket/purse-sized taser. The  effects of the taser were suppose to be short lived, with no long-term  adverse affect on your assailant, allowing her adequate time to retreat to  safety…. WAY TOO COOL! Long story short, I bought the device and brought  it home. I loaded two triple-a batteries in the darn thing and pushed the  button. Nothing! I was disappointed. I learned, however, that if I pushed the button AND pressed it against a metal surface at the same  time; I’d get the blue arch of electricity darting back and forth between the  prongs. Awesome!!! Unfortunately, I have yet to explain to Toni what  that burn spot is on the face of her microwave. Okay, so I was home alone with this new toy,  thinking to myself that it couldn’t be all that bad with only two triple-a  batteries,… right? There I sat in my recliner, my cat Gracie looking  on intently (trusting little soul) while I was reading the directions and  thinking that I really needed to try this thing out on a flesh & blood moving target. I must admit I thought about zapping Gracie (for a  fraction of a second) and thought better of it. She is such a sweet cat.  But, if I was going to give this thing to my wife to protect herself  against a mugger, I did want some assurance that it would work as advertised.  Am I wrong? So, there I sat in a pair of shorts and a tank top  with my reading glasses perched delicately on the bridge of my nose,  directions in one hand, taser in another. The directions said that a one-second burst would shock and disorient your assailant; a two-second burst was  supposed to cause muscle spasms and a major loss of bodily control; a  three-second burst would purportedly make your assailant flop on the ground  like a fish out of water. Any burst longer than three seconds would  be wasting the batteries. All the while I’m looking at this little device  measuring about 5" long, less than 3/4 inch in circumference; pretty cute  really and loaded with two itsy, bitsy triple-a batteries) thinking to myself, "no possible way!" What happened next is almost beyond description,  but I’ll do my best….. I’m sitting there alone, Gracie looking on with her  head cocked to one side as to say, "don’t do it master," reasoning that a  one-second burst from such a tiny little ole thing couldn’t hurt all that bad…. I decided to give myself a one-second burst just for the heck of  it. I touched the prongs to my naked thigh, pushed the button, and  HOLY MOTHER, WEAPONS OF the  side door, picked me up in the recliner, then body slammed us both on the  carpet, over and over and over again. I vaguely recall waking up on my side  in the fetal position, with tears in my eyes, body soaking wet, both nipples on fire, testicles nowhere to be found, with my left arm tucked under  my body in the oddest position, and tingling in my legs. The cat was standing over me making meowing sounds I had never heard before, licking my face, undoubtedly thinking to herself, "do it again, do it again!" Note: If you ever feel compelled to "mug" yourself  with a taser, one note of caution: there is no such thing as a one-second  burst when you zap yourself. You will not let go of that thing until  it is dislodged from your hand by a violent thrashing about on the  floor. A three second burst would be considered conservative. SON-OF-A-…. that hurt like hell!!! A minute or so later (I can’t be sure, as time was a relative thing at that point),  I collected my wits (what little I had left), sat up, and surveyed the landscape. My bent reading glasses were on the mantel of the fireplace. How did they up get there??? My triceps, right thigh and both nipples were still twitching. My face felt like it had been shot up with Novocain, and my bottom lip weighed 88 lbs. I’m still looking for my testicles? I’m  offering a significant reward for their safe return. Still in shock, John

Response: