Falling pretreatment PSA and risk grouping

[Treat]

Hi all

In the situation where the PSA falls on repeat testing, before any treatment is instituted, do you then use the lower value or the original one in determining the risk grouping? Assuming that it'll be different depending on which one you use...

---

Members don't see this ad.

 

[seper]

I personally use the lowest value, thinking that the higher readings were due to infection.

 

[Treat]

Thanks Seper! That's what i do as well, but would like to know how mainstream this approach is. Any others care to share what they do?

 

[busy body]

make sure patient didn't get started on finasteride because it will be falsely low. I wondered this question often and have found no good evidence.

 

[evilbooyaa]

To me as long as patient has truly initiated no therapy, I use the lowest number prior to any treatment as well. It's not like true cancer is going to magically stop producing PSA (unless maybe part of the tumor de-differentiates, but that's more of a circumstantial argument). This has never changed my treatment plan, however, and I'm not sure what I would do if it did (say pushed somebody from intermediate to low risk or something)

 

[medgator]

I always figured higher because you don't want to deprive the patient of more aggressive tx if it is warranted (like adding ADT). But the infection thing is a solid concern

 

[Brim]

I echo the above. If the PSA falls on its own (without therapy), I use the lower value for staging.

 

[Palex80]

I also use the lower PSA level if I suspect inflammation which caused a higher previous value. You can often see that in the histology too.

On thing to remember is that our patients often resort to alternative therapies after diagnosis and before we get to see them. There are a number of herbs or substances that will lead to decreased PSA levels. It's a good idea to ask if they had taken any, because if the PSA dropped because of that, you should still treat according to the initial value.

 

[danibrittany]

One must not jump to conclusions without the repeated testing. However, sometimes even more tests do not reveal the real reasons behind the problem. However, in this situation, most use the lower value as a general approach. But some also use the higher value since they want to treat the patients on an aggressive basis.