So, we have a wife who's writing in on behalf of her husband. Her husband's 68 years old,
and a year ago his PSA was 2.0; he was getting screened. A year later,
recently, he's been diagnosed with a PSA of 4.0, and then apparently he did a scan
and there was five metastatic lesions that they found, and she's saying he's athletic,
he's done everything correctly, how did this happen? How does it jump in a year? He's 68
and all of a sudden there's metastatic lesions when we thought we were fine.
Well, I think this speaks very much to the case of should men have digital rectal exams?
There are thousands of different types of prostate cancer. Fortunately,
most of them make substantial amounts of PSA, and it's extremely unusual to find someone with a PSA
of four who has metastatic disease, and when I say unusual, I mean less than 1%—it's very rare—but
there's 200,000 men that are diagnosed with prostate cancer every year, and
I don't know my numbers that well, but 1% of 200,000 is what? 2,000 people that are going to
have these unexpected and unusual presentations, and this is an example of someone that might have
gotten diagnosed a lot earlier if he had a digital rectal exam rather than simply
doing PSA screening. Just a good example of how many different types of prostate cancer exist.
And let's just say in the scenario he did get a digital rectal exam and they didn't feel anything,
is this just maybe the prostate lesion being on the back of the prostate? Like what would...
Yes, that's certainly another possibility. No guarantee that a digital rectal would have found
this at a diagnosable stage, but my experience most of the men that have metastatic disease
who are presenting for the first time they will have palpable
abnormalities in their prostate, but not all. Some will have anterior lesions which are more rare,
and again, giving an example of how many different types of prostate cancer there are.
So, you know, in our previous question, when it comes to the PSA one year being 2.0 and
the next year being 4.0, can you talk about PSA velocity? What is the meaning of it? Why is it
important to patients and what they should be paying attention to?
In men that have had previous surgery and and some that have had previous radiation,
if their PSA is rising and if we conclude that it is from the cancer coming back, then how quickly
the PSA is rising tells us indirectly how quickly the cancer is growing, and that's a very important
indicator of how serious the situation is. PSA doubling times that are, you know, if the PSA goes
from two to four, and it's taken more than a year, the prognosis for that individual is actually
excellent and their survival is going to be excellent. If the PSA doubles in a month, then
you have a situation where the disease is much more aggressive and clearly they're going to need
aggressive treatment. Where people get confused is they want to extrapolate those facts and those
realities to people that have never been diagnosed or people that are on active surveillance that
have a an intact prostate that's untreated, and in those individuals the lion's share of
the PSA is coming from the prostate gland not from the prostate cancer, and that means that
PSAs going up and down are much more likely to be due to prostatitis, inflammation, not from
the cancer itself, and active surveillance studies have clearly shown that you shouldn't use a rise
in PSA as a trigger for going off of active surveillance. Men that are that have low grade
cancers that are being watched, so PSA velocity or PSA doubling time ,these are interchangeable
terms, are almost irrelevant in monitoring or screening. That doesn't mean to say that if
you have a PSA of 4 it doesn't matter; it just — what it says is that if it was 1.0 last year
or if it was 1.0 five years ago, you just take it as a PSA of 4.0. A PSA of 4 is a borderline
normal PSA depending on how big the prostate is, and probably needs to be at least further
investigated to make sure it's not a problem, but if it rose to 4.0 quickly or if it rose slowly, it
doesn't have any power to tell you whether or not you have cancer or what kind of cancer you have.
Hey everybody, it's me Alex and our mascot here, Hunter. He's obviously licking my hands because
we have lots of treats for him today, but yeah, we just wanted to let you know to go ahead and
subscribe to our YouTube channel; we come up with new prostate cancer videos every week,
and go ahead and check him out on Instagram at SirHuntertheDal. Also, check out our website
pcri.org for more information about prostate cancer; we hope it helps.