High PSA

My father (77 yrs old) has Prosate Cancer.  A slow urine flow initiated him going for a PSA test,.. the PSA was a high 58.

He follewed up with a digtial exam, and then a Biopsy.

The results were as follows:

Clinical stage (T stage): T2b
Gleason grades: 3(primary), 4(secondary)
PSA level in ng/mL: 58

He has just started hormone therapy.

His question is this:  "What I really want to discover, but have been unable to find on the net, is are there any figures relating PSA levels to degree of tumour spread. I know from the biopsy that I'm at least T2b and Geason 3+4 (7) but the decision not to operate is based entirely on the high PSA which they claim suggsts the tumour may be more than a T3b."

Look forward to your input.

[Kevin Pho, MD]

Here is a quote from UptoDate that answers the question:
"The preoperative concentration of serum PSA provides important predictive information for the likelihood of finding organ-confined disease (i.e. disease confined within the prostate -ed). As PSA levels increase, the likelihood of extracapsular (i.e disease outside the prostate -ed) disease rises. In one series, men with a preoperative serum PSA concentration of <10 ng/mL had a 70 to 80 percent likelihood of organ confined disease, compared to 50 percent for men with serum PSA >10 ng/mL, and 25 percent with serum PSA >50 ng/mL."

This would suggest that yes, the degree of PSA elevation is correlated to the spread of the cancer.  That being said, most treatment decisions on prostate cancer is based on the stage of the cancer, rather than solely on the PSA level.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

Bibliography:
Klein.  Early stage prostate cancer: Predicting the pathologic extent of disease.  UptoDate, 2004.