What is the actionable level of PCA3?

[ZofiaZ]

Hello:

My husband (58 year old, otherwise healthy, normal weight, somewhat enlarged prostate, 1 visit to the bathroom per night, steady PSA of 0.8 for the last couple of years, family history of aggressive prostate cancer and other types of cancer) had his annual screening 6 months ago. The doctor suggested doing the new test, the PCA3, because of his family history. It came back at 45. After discussing the results with the doctor and upon my insistence we scheduled another screening in 6 instead of 12 months. We were disappointed to find out that the number jumped from 45 to 59. The doctor suggests now to wait again. If the changes in the prostate keep the same pace we are probably to see an 80 in the next 6 months.

I am afraid we are wasting time. My reasoning is this: watchful waiting may be the best course of action for older men or those with slow growing/benign cancer, however, in case of my husband - his father died of a metastasized and aggressive prostate cancer that spread very quickly to the bones and brain at the age of 65, and his 69 yo brother is fighting an advanced prostate cancer now - it is pretty much given my husband will follow in their footsteps. BTW, my father-in-law had a misleading low PSA until it was too late.

Therefore, I believe, the best course of action that gives us nearly 100% chance is to act ASAP. I searched the net for most effective treatments in early stages and came across "nerve sparing prostatectomy with reconstruction".
There are risks involved but if we are bound to deal with them in the next couple of years anyway isn't it better to go under knife when one is healthy, younger and not compromised by the disease? Also, the earlier such surgery is done the better chances for preserving potency and continence.

And so, I believe that passive waiting decreases my husband's shot at getting rid of this cancer and increases the chances cancer cells will move to neighboring lymph nodes, and then to other organs.

It seems the doctors have this routine of rectal exam, PSA, PCA3, biopsy, another biopsy... going. With abnormal PCA3 they wait until the PSA jumps as if to ensure that the biopsy is positive. But, what if the cancer spreads before PSA jumps enough to justify the biopsy? I can't agree to wait just to accommodate the imperfections in our diagnostic tools. Besides each case is different. If the high risk patient is willing to skip the waiting for the benefit of the immediate surgery he should have a choice and be allowed to act accordingly.

I have read anything I could about interpreting the PCA3 results. None address very low PSA, elevated PCA3 and most importantly what to do with such patients. I hope to hear from others in a similar situation and, of course, from the physicians as to the best course of action. Please be specific, example: monitor every 6 months, if the PCA3 get to be above ...(100?, 200?) or PSA jumps by....,whichever first, do a .... biopsy? surgery and.... or...
I am looking for a hands on advice. Something I can apply. Thank you so very much!!!!

[ZofiaZ]

Thank you, K, for the info and kind words. My best wishes to you, your Dad and the entire family. Hope all works out well!

I have spoken to my husband's doctor again about a week ago. He understands my anxiety over my husband's low PSA , borderline free PSA % of 17 and yet increasing PCA3 of 59. He said that this is somewhat typical for the most aggressive type of cancer. He agreed to do an MRI this week. I hope that the images will help to pinpoint the suspect areas in the gland for the subsequent biopsy. Also, once we have the MRI results we will seek the second opinion from a known surgeon in our state who has mastered the most advanced athermal robotic surgery technique with nerve sparing and full reconstruction. Will your father's insurance cover the costs of the surgery of will they treat it as elective procedure and wash their hands off?

What worries me is the lack of survival rate statistics for the most aggressive type of cancer that was treated early on. Is it because no treatment really helps/makes a difference in case of aggressive type?

[Latte_Love]

I'm sorry that I can't be of more help with your questions as we are just entering this journey ourselves. I did want to pass on the information for the doctor my dad contacted:

http://www.drbrianmiles.com/

Dr. Miles was very helpful and called my dad after an inquiry via email about his diagnosis.

There is also a book that you may find helpful:

Guide to Surviving Prostate Cancer by Dr. Patrick Walsh

My dad found this book extremely helpful. He watched his father suffer a horrible death from an aggressive prostate cancer that was "let's keep our eye on this" rather than treated early enough. My dad is choosing to undergo the robotic treatment now rather than watch and see what happens. He is mid-60's and in decent health.

Hope this helps.

Blessings,

K