Latest PSA and PET Scan Results - 052
I met with my radiation oncologist and had labs drawn, including a prostate-specific antigen (PSA). I wasn't extremely nervous about the results this time, but I always get anxious each time I have them done.
He didn't order a complete blood cell count (CBC) because I had a normal one in Switzerland as part of the INUSpheresis workup. Three days later, he called me with my lab results. My comprehensive metabolic panel was normal, with an alkaline phosphatase (ALP) of 64.
I mention the ALP because bone metastases can elevate this lab value. Extensive bone metastases can also result in anemia if tumor cells infiltrate the bone marrow. None of that was evident in my labs.
PSA and doubling time
My PSA, on the other hand, has been steadily rising since January 2019, when it was 0.9 ng/mL after prostatectomy and radiation to my pelvis. Once you've been diagnosed with prostate cancer, it's the PSA doubling time (PSADT) that represents a prognostic marker indicating the aggressiveness of the disease.
The PSADT represents the time for the PSA level to double. A shorter PSADT is associated with metastasis-free survival, shorter overall survival, and a three-fold higher risk of death when metastases develop.
Generally, a PSADT of less than 12 months requires immediate attention and imaging. A PSADT of less than 7.5 months independently predicts metastasis risk, and a PSADT of less than 6 months shows the highest positive predictive value for distant metastases and prostate cancer mortality.
As of October 18, 2024, my PSA is
Was I shocked at this number? No, but I was disappointed. If you've read the entire chronology of my journey on Substack, I wrote about when my PSA dropped from 57.7 to 54.7 over two-and-a-half months in 2022. So, anything is possible.
PSADT calculator
Based on my PSA levels since January 2019, using the Memorial Sloan Kettering Cancer Center PSADT calculator, my current PSADT is
Posluma
When I met with my radiation oncologist, we discussed the type of positron emission tomography (PET) to perform, and he recommended a Posluma scan. Posluma is a type of prostate-specific membrane antigen (PSMA) PET scan.
As I've discussed in other newsletters, different types of PET scans are used depending on the tumor metabolism or tumor marker you might detect. PSMA PET scans look for a protein called a prostate-specific membrane antigen on the cell surface of prostate cancer cells.
My radiation oncologist chose the Posluma scan because it offers better visualization of the pelvis and prostate bed due to lower bladder excretion than other PSMA PET scans. He felt one of the most likely places to find evidence of prostate cancer in my body would be the prostate bed where my prostate used to be.
In clinical trials, Posluma has a 97% detection rate of prostate cancer with a PSA greater than or equal to 2 ng/mL. That's a very high detection rate, especially considering the low cutoff.
PSA and PET CT scan results
Look at my last two PET scan results and PSA levels.
I've been beating the odds with negative PET scans. Granted, these have all been PSMA PET scans. A high PSA and negative PSMA PET scans indicate that the tumor cells no longer express PSMA.
But that still doesn't account for otherwise normal labs and normal full-body (mid-thighs up) CT scans. No soft tissue or organ masses, bony lesions, or enlarged lymph nodes are on any of the scans.
Surely, my luck will run out this time with a PSA of 308.
As my radiation oncologist displayed the scan on his computer screen, I felt a sudden peace, like I knew it would be normal again. He scrolled up and down, clicking on the icons of organs, soft tissue, and bones, and we searched every nook and cranny of my body—nothing!
Yet another normal PET CT scan. Keep in mind that the January 2024 Pylarify was performed and read at a different facility than my radiation oncologist’s office.
Scientifically, it's hard to explain. My radiation oncologist theorized that the tumor cells in my body are so spread out that the CT scans are not able to pick anything up.
AI’s opinion
I used Perplexity AI Pro to pose the following question. This AI search engine scours the internet for results and coalesces the available information to provide an answer.
Question:
What is the likelihood of having a normal full-body PSMA PET CT scan with prostate cancer, an absent prostate, and a PSA greater than 300?
Answer:
Based on the available evidence, it would be exceptionally rare, to the point of being virtually impossible, to have a normal PSMA PET CT scan with these parameters (absent prostate and PSA > 300).
Miracles
"Virtually impossible" means my normal PET scan is a miracle.
Am I annoyed by the rising PSA? Yes, but the rising PSA makes the normal PET scans even more miraculous. I view it as my body showing me what it's capable of. I'm impressed!
I'll be even more impressed when my body drops my PSA to zero.
Is it a coincidence that I write about unexplained medical phenomena, such as how the body can memorize the physiologic response to a medication and reproduce that response when a person takes a placebo they think is the medication? Or when a person has cancer and undergoes spontaneous regression of that cancer despite no treatment.
The body doesn't read medical textbooks. It simply does what it's capable of, and it is capable of incredible things.
I will not give up on the idea that I'm on my way to spontaneous regression because if I do, I will lose my faith and hope in that possibility. If it has happened to others, why can't it happen to me?
I'm here to remind you to keep your faith because amazing things can happen in your life. I can't wait to write about when my PSA normalizes.
Every day, look for small miracles in your life. The colorful butterfly fluttering by that was once a homely creature without wings. The brand new baby born into your family. And the magnificent sunsets that change color before your very eyes.
The more I recognize and appreciate the small ones, the more I experience the bigger ones.
Next steps
I told my radiation oncologist that I would see him in six months and that next time we should do a PET scan that’s not based on detecting PSMA. That will be the real test.
In the meantime, I plan to double down on what I’ve been doing because it appears to be having favorable effects.
Until the next one, I wish you good health and happiness.
Much love,
Keith
Have you experimented with alternative methods? Ivermectin, Fenbenzadole, ways to reduce cysteine and methionine?