Re: BPH story of a PCa patient

ron wrote:
Hi Ralph...I thought that when Leonard said, "It is interesting that
your PSA has dropped significantly"; he meant this in the sense that we
track PSA as a monitor of prostate and tumor volume, and that in this
sense there was a significant change.

My original thought was that some portion of his orininal PSA was from BPH rather than from prostate cancer. In that case, it would be true that the PSA drop didn't indicate any significant change in the prostate cancer. The good part of that, if it were true, would be that his PSA, due to prostate cancer, was pretty low to start, which would have been another argument for trying watchful waiting in a man his age with a small tumor and Gleason 6. I didn't think and certainly never would suggest that his teatment actually caused the cancer to regress. But so far at least, there doesn't seem to be any strong reason to believe that WW is beginning to fail for him.

Often we operate under the
assumption that PSA level correlates with prostate size and tumor size,
and usually that's a fair assumption for tracking purposes. However,
sometimes when certain drugs are administered (for example avodart,
some LHRH agonists, etc.) the PSA level can change significantly
without a corresponding change in prostate / tumor volume. In the case
of avodart it is known that it will reduce the pre-avodart PSA level by
about 50%; but the prostate and tumor volume haven't decreased 50%.
The avodart has probably reduced the PSA level by affecting some
protein, enzyme, etc involved in PSA expression so that the same cells
are now simply expressing less PSA. The net result is that the PSA has
dropped "significantly" but for PSA tracking purposes (again, the way I
thought Leonard was using the term), the PSA remains, for all intents
and purposes, unchanged...Ron

Actually, that was what I meant in my original comment. The important thing was that there was no reason to believe, based on PSA, that his cancer was growing significantly.

.

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