Is a new PSA level of 2 significant?

User

Posted 25 Apr 2018 at 15:32

My husband was diagnosed in December last year and began hormone treatment. On diagnosis, his Gleeson Score was 9 and his PSA level was 139. His MRI showed no spread of the cancer, but were were told that, with his PSA level being so high, it was highly likely that cancer cells had spread elsewhere. His bone scan was also clear.,

After starting the treatment, his PSA results dropped to 0.89, then 0.68. However, the PSA test he had last week now shows 2.

The oncologist didn't seem fazed by this and said they wouldn't suggest anything until it reached 50, by which time it would be obvious that the cancer had become active again. However, obviously, I am a little worried.

I'd be very grateful if someone could tell me if it is it common for PSA levels to fluctuate like this, especially in the early months of treatment. I expected his levels to stay below 1, as they were earlier in the year. My husband doesn't see his oncologist again for another 6 months, when he will have another PSA blood test.

Thanks in advance for any advice.

Edited by member 25 Apr 2018 at 16:48 | Reason: Not specified

User

Posted 25 Apr 2018 at 17:14

Genevieve, I am a bit surprised by the oncologist being prepared to wait until the PSA hits 50 before considering treatment options. As regards fluctuations, PSA bounce is not uncommon. I can recall experiencing this myself ten years ago. My numbers were not unlike your husbands. I think I would have expected the next test to be three months hence. Your husband might raise this with the Oncology Nurse and also discuss other treatment options like radiotherapy (not much use if the PCa has escaped the capsule) and chemotherapy which may be available. To be forewarned is to be forearmed!

Good Luck

User

Posted 25 Apr 2018 at 21:03

Thank you AC. I've spoken to my husband and he's going to do as you suggest and speak to his Specialist Nurse about having another PSA test in three months. The oncologist did say if the cancer had 'found a gap in the market' (his words), then other options would include chemotherapy. I was surprised myself that he was prepared to wait until the PSA level is 50, but I'm sure we can discuss that more fully if the level continues to rise. I will definitely be asking for further treatment to begin earlier.
Thanks again for your time.

User

Posted 26 Apr 2018 at 19:00

Genevieve, does he have his testosterone (T) measured at the same time as his PSA? Like AC, I think you should consider having the next test in 3 months and ask for the T to be tested at the same time. A level of 2 at this point could just be bounce but it could also be that the last injection was flawed in some way (not stored correctly, part of a bad batch, not injected correctly) in which case the next result will drop back down.

Testosterone is significant because it tells you whether the HT is doing its job. While on HT, he should be at castrate level (0.69 or less) - if his T is higher then the HT isn't working properly. If he is at castrate level and the pSA continues to rise, it means that the cancer has learnt to survive on its own in which case a new treatment is needed.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 13 May 2018 at 14:00

Apologies, Lyn, I've only just seen your reply. Thank you for this. He is hoping to get hold of his specialist nurse next week, so will mention getting his T checked to him. As far as I know, his T isn't normally checked. Interestingly, his first two injections - with the very low PSA results - were given at the hospital, while the last injection was given at the GP's surgery. Definitely something to discuss, I think. Thanks again.

User

Posted 13 May 2018 at 17:12

I agree on suggestion for another PSA check plus testosterone level but am surprised that nothing will be done until PSA rises to 50. If rise in 3 months is significantly high but nothing else is proposed, your husband could consider getting a second opinion on the next step and it's timing.

Barry

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