9/24/2012 Posted by Arthur H Krugler

TESTING FOR PROSTATE CANCER

THE PSA TEST – BIOPSIES
CONTROVERSY & CONFUSION

Doctors and Medical Researchers do know a lot; then why the confusion? and fear?
CONFUSION !
What does the PSA test result actually mean?
Is high equal to cancer? Is low safe?
Should an expensive biopsy be recommended? Especially if greater than 4?
Is a needle biopsy 100% foolproof and without error?
Should radiation treatment with its uncertain outcome be started
immediately??
Should surgery be recommended?
Or, watch and wait?
Or, for the elderly with very high readings, “ Keep them comfortable till
death”?

A WHAT IS PSA?; AN ANTIGEN (PROTEIN) PRODUCED IN THE PROSTATE GLAND.
PSA test values are concentration values from chemical analysis of blood.
B THE CONTROVERSY; IS A TEST FOR PSA CONCENTRATION USEFUL OR EVEN RELEVANT?
C OBSERVATIONS by A H Krugler, a professional chemical engineer.
(seek-ask-knock.com)
D CAN TUMORS BE DETECTED?? ARE NEEDLE BIOPSIES NECESSARY?
E CAN TUMORS BE RATED FOR AGGRESSIVENESS??

Just my observations, no more, no less; not a doctor, surgeon, urologist, or radiologist.
An engineers observations over 20 years studying my high and variable PSA test results.

A Prostate Specific Antigen ( PSA ) : a protein produced mainly by the prostate
gland. The PSA Test: A very accurate bio-chemical test for very small
concentrations of the antigen which has migrated into the blood.
The test was released in 1986. See Wikipedia, “PSA” for more complete
definitions.

B There has been much controversy over attempts to relate the concentration to
cancer or to justify biopsy procedures. This is unfortunate, and in my opinion,
unnecessary.

First: The prostate gland produces the antigen ( protein ) continuously and some enters the blood stream where the concentration can be determined by the PSA test. Tests for production rates in the prostate (mg PSA/gm /day) are essential but not available.
Second: The antigen must also be removed from blood continuously to prevent the concentration from going sky high. (As high as a recorded instance of 2,571 with no reported cancer problems.) Urologists know very little about the removal process.
( The Where, How, and Why of Removal and Removal Rates)
Third: The many factors that affect antigen production, transfer rates from gland to blood, and its removal rate make any conclusion depending on PSA concentration alone to be unreliable.
Fourth: Adding the DRE (Digital Rectal Exam ( a Urologist feeling for lumps or hardness in the gland ) does little to help when the prostate gland is enlarged.
Fifth: Adding other blood tests have thus far not led to clear answers. It is difficult to sense small but aggressive tumors inside the soft prostate gland.
Sixth: Biopsy needles do not sample the entire gland leaving areas for tumors to hide.

C Observations by A H Krugler, a Chemical Engineer, during 20 years of monitoring
PSA, DRE’s, a biopsy, and several ultrasound examinations.
1 Total amount of antigen in the blood is very small. An average 160 lb man may have
6 liters of blood; a concentration of 4 mg/liter means a total of .024 grams of the
antigen.
This would amount to 1/2 of a drop of liquid if the protein were a liquid.
2 Small increases in transfer rates affect test results quickly, easily doubling
blood concentration. PSA results come down much more slowly.
3 Size matters, a larger factory produces more protein and elevates PSA
concentration.

Prostate size varies from a small walnut to a large grapefruit.
Urologists have a term, “density”; equal to PSA reading divided by size in cubic
centimeters. A result less than .17 has been suggested as “not indicating
cancer”.
Size can be determined by a minor frontal ultrasound examination.
4 Urinary infections: An infection can easily double the concentration in the blood
but it is not known if infection increases the production rate or if the transfer
rate alone is increased. More on cause of infections later.
Antibiotics and sulfa drugs are often prescribed. Stopping the infection does not
result in a rapid drop in PSA concentration. A month or more is required to reach
equilibrium.
5 Mechanical pressure;
– A urologist pressing the prostate with a forefinger in search of hard nodules or
tumor growths (DRE) will cause the antigen to be sent into the blood stream.
– Prostate glands compete for space in the lower pelvis region. A large stool
squeezes the gland as it passes through the pelvic region forcing protein into
the blood stream.
– Riding a bicycle can increase concentration.
– Researchers state that ejaculation also forces the antigen into the blood stream.
6 Factors that affect removal of the protein from the blood.
– Please note that removal rates determine PSA levels to a greater extent than
production, but there are no tests to determine this factor. In fact, I have yet
to find a clear answer on how the antigen is removed or used. Studies have
demonstrated that after complete surgical removal of the prostate gland,
approximately one month ( 700 + hours ) is required to reduce the PSA levels to
near zero. During the month the ‘average’ heart will pump 55,000 gallons of blood
equal to 450,000 lbs to remove 0.002 lbs of PSA. ( 4 mg/liter)
This might indicate the protein is not removed in either kidneys or liver but
rather metabolized with other proteins?
– Blood leaving the kidneys cannot be free of PSA. My computer simulation
indicates that levels of PSA would be very very low no matter the amount of PSA
generated.
If kidneys do remove PSA, their efficiency would be somewhere near .005% per pass.
– If the body does process this protein with other proteins, removal would depend
on protein content in the diet and protein needs of the body.
7 Age seems to matter. With age, more men develop enlargement of the prostate and
higher test results.
8 Urologists watch these increases in PSA results. The rate of change is called
“Velocity”.
An increasing number, whether high or low, is cause for concern.

D Reliably detecting tumors in the Prostate Gland with sensitive Ultrasound scanning.
1 The gold standard for detection of cancerous tumors is the needle biopsy.
– Needle biopsies are a very unreliable indicator of the presence of tumors,
especially in enlarged glands. In an enlarged prostate, tumors as large as 30 mm
can be missed in 12 locations by a 7 needle biopsy; the 9 needle biopsy is only
slightly better.
2 Surgeons have stated that all aggressive tumors are ‘bloody messes’ and have
determined that an active tumor sends a signal which the body acknowledges and
creates extra blood arteries and veins to supply the requested blood directly to
the tumor.
3 Ultrasonic instruments have increased their precision and are now able to detect,
not individual capillaries but the aggregate of increased blood levels in a tumor.
Ultrasound photos can be color coded to show the size and location of this
increased blood supply.
4 Tumors can no longer hide nor mask their aggressiveness.
5 More research is required to determine how and how quickly cancers ‘jump’ from the
prostate to other organs or the skeleton where death actually begins.

E Aggressiveness, and Treatment options
1 Urologists use a Gleason Score obtained from biopsies to rate aggressiveness in
recommending a treatment.
2 The author is convinced that color enhanced ultrasound examination is more
reliable, less costly, less danger of infections, no antibiotics, no recovery time,
no damage to the prostate gland. It is time for the medical profession to consider
this option.
3 There are many approaches to cancer treatment; drugs, radiation, surgery, hormones
etc.
4 This author has not needed to study treatments nor had the opportunity to observe
results.
5 The authors’ hope is that with a clearer understanding of the prostate condition,
detection might be reliable and treatment selection, when indicated, might be
easier.