PSA density

[juliob]

I am 52 and was recently diagnosed with prostate cancer via needle biopsy. My initial reaction was relatively mild because I understood all signs pointed to generally low risk, i.e. PSA 6.3, cancerous cells in only 7% of one core out of 12. During my interview with the urologist I learned about PSA density. In my case, my prostate volume was estimated to be 20 cc, so a PSA of 6.3 yields PSAD of 0.315. My doctor told me this was high and elevated my risk. At home I searched the web for information on PSAD and what I found and was able to partially understand has worried me tremendously. I'm now afraid I have a much more serious disease than I had initially thought.

Surgery was recommended, but has a wait time of 6-8 weeks. I am also worried that with a small prostate the risk of extra-capsular extension is higher. Should I receive imaging to determine if there has extra-capsular extension? If there is would surgery still be the best course and is waiting 6-8 weeks a problem?

[Nathan.R PCRI]

Hello JulioB: Elevated PSA Density >> .15 may raise the risk of having a positive biopsy, and weighs in the decision to biopsy. PSA is not a perfect indicator of risk, although in general higher PSA is higher risk. I am not aware of any published research that relates PSA Density to reduced survival.

You may take comfort in the biopsy evidence that you have minimal disease in the prostate with only 7% of only one core. That is probably more indicative of what is going on in your prostate.

Regarding prostatectomy delay; Dr. Freedland published data that, for men with low risk PC, a six month delay does not increase the statistical risk of prostatectomy failure http://www.ncbi.nlm.nih.gov/pubmed/16515984 . In fact, the PIVOT clinical trial showed that prostatectomy in low risk men did not statistically improve survival after 10 years of median follow up. http://www.ascopost.com/articles/january-15-2012/data-on-watchful-waiting-for-low-risk-prostate-cancer-may-swing-focus-to-higher-risk-tumors/ That result may cause more men with low risk disease to consider Active Surveillance, especially now with better MRI for monitoring any progression.

New MRI imaging with "multiparametric technique" and the latest technology 3 Tesla magnet machines appears to be the best imaging method for prostate cancer. See the article by Dr. Margolis http://prostate-cancer.org/pcricms/sites/default/files/PDFs/Is13-4_p8-13.pdf Most insurance will pay for this MRI. MRI can detect tumor on the top (called the base), bottom (called the apex), and in the front (called the anterior) of the prostate that is often not detected with the DRE (digital rectal exam) or with the biopsy needle. MRI can help rule out more advanced disease.


Before choosing any local therapy with intent to cure, suggest you read the article by Dr. Peter Grimm ' Which PC Therapy Has the Best Long Term PSA Control?' http://prostate-cancer.org/pcricms/sites/default/files/PDFs/Is14-2_p3-11.pdf


See the Newly Diagnosed section of our web site http://prostate-cancer.org/pcricms/node/126

If you need any assistance with any of the above, or want to discuss your situation, please call the Helpline at 800-641-PCRI or 310-743-2110.

-

Nathan Roundy, Helpline Associate

Prostate Cancer Research Institute * Email: nroundy@pcri.org
T. 310.743.2116 * F. 310.743.2113
5777 W. Century Blvd. 800
Los Angeles, CA 90045


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[juliob]

Thanks Nathan,
The information helps. In my case the doctor believes the high PSAD makes surgery preferable to active surveillance. I've checked some on-line nomograms, and low prostate volume with my other numbers does seem to reduce the likelihood of "indolent" cancer, something like 33% vs 20% assuming 50 cc vs 20 cc. Maybe I've misused the nomogram, but with those odds I'd still be inclined towards surgery either way.