PSA Concerns

PSA Concerns

User

Posted 13 Jan 2015 at 01:43

Hi,

I almost feel guilty to ask for help again but there's been something that I have been wondering about for a while now.

It relates to PSA figures during and after treatment. I generally take great interest in the figures that people post after they've had their blood tests. Everyone who keeps us up to date with their progress through their treatment helps the rest of us following on. Good results are always worth celebrating and give all of us hope for the future.

I've noticed since joining this community, that some people on a similar treatment plan to mine (Hormone Treatment and Radiotherapy) seem to have very low PSA figures after their course of treatment even when they've had a high figure at the time of their diagnosis. These can be as low as 0.02 or similar. Following Radiotherapy I asked my oncologist what PSA figure she thought I might end up with after my two further years of Hormone Therapy. She said I should expect it to be around 2 to 2.5 and she said she would be happy with that. When I questioned that, she said that you would never get down to the lower figures unless the prostate had been removed. I think the results posted on this site prove that this is not always the case. I know that no two people are alike in the way their bodies react to this disease but you can probably understand why I would wonder about it.

My own PSA figures since diagnosis have been as follows:

2014:

Late May: 48.85 (results given at diagnosis, June 11th).

17 July: 18.24 (after 3 weeks HT).

14 Aug: 2.35

25 Sept: 4.14 (surprised at the rise, oncologist not concerned).

18 Nov: 1.63 (post radiotherapy, I was a little disappointed, expected it to be lower).

More info about my diagnosis is on my profile (click on NikonSteve or picture to access this).

I'd be really grateful if you could spare a moment to let me know what you think about this and if there's anyway you could give an indication how your PSA figures have gone throughout your own treatment. I think this would be educational for all of us to read.

Thanks for all your help.

Steve

User

Posted 13 Jan 2015 at 13:08

Hi Steve,

I'll start with a caution, what I am writing here is a well read layman's understanding of the science, I am not a medic, but I used to be a scientist.

I think your consultant is right, you still have a prostate so your current prostate level will depend on:

your own pre-cancer physiology,

how much of your healthy prostate was destroyed along with the mal-functioning cancer cells,

how much functioning normal prostate is left

how much cancer tissue is left (hopefully none).

the effects of ADT on healthy and unhealthy prostate cells

and more that I dont know about!

Radiotherapy takes advantage of the fact that the DNA of cancer cells is already damaged and damaging it further has a number of effects, it can kill them immediately, it can further damage the DNA so that the cell becomes non-viable on mitosis (cell division, sometimes several cycles explaining why RT caries on working for a couple of years). Cancer cells can also be less able to repair RT damage while normal cells are able to repair damage or if the damage is severe apoptosis will be triggered (the cell commit suicide - this is one of the things that commonly goes wrong with cancer cells)

If much of your normal prostate tissue has recovered from the RT then you will be producing PSA just like someone who has never had cancer and a level of 1 or 2 could be quite normal.

As I said this is only my understanding of a complex subject and I am happy to be corrected.

Best wishes

Andrew

User

Posted 13 Jan 2015 at 13:49

Hi Steve

Like you, Dad's PSA jumped up just prior to him starting RT after being on hormones for quite a few months. At diagnosis PSA was 19.7, it hovered around 1.8 and then jumped up to 2.8 in the space of about 3 weeks, I was concerned about this but the oncologist wasn't, saying it didn't matter as he would be starting RT imminently. A further rise followed after a week of RT to 3. One week after RT had finished he had a PSA test which came in at 2. Gradually after that it reduced to less than 0.1 but he still has a further year or so on hormones yet. All Dad's info is on my profile.

best wishes

Sarah

User

Posted 13 Jan 2015 at 18:27

i was diagnosed last feb psa65 started ht straight away for 6 months then r/t finished 29th sept 1st psa at follow up 0.1,if you are on ht prior to r/t your psa i think psa tends to drop quicker thats what i have been led to believe hope that helps.

User

Posted 13 Jan 2015 at 20:20

Steve,

From your Profile: 7th November, 2014: Radical Radiotherapy completed.

18th November, 2014: PSA Test: 1.63

That is no time for the R/T to show full effect. It could be a while before you reach your nadir. Look at my profile to see how long it can take to achieve the nadir on HT + R/T. Each case will vary. You are aiming for around 0.1 ideally.

The figure around 2 your Onco mentions would be when HT is over & effects dissipated . i.e. Post treatments

User

Posted 13 Jan 2015 at 21:40

Steve,

I'll echo what Rob has said.

I'm 500 down to 0.01 at the moment but I'm on HT, Abiraterone and am 7 months post RT.

So, the RT is still cooking and HT & abbey are keeping on top of anything that is thinking of getting back up.
Nice. :)

My abbey trial finishes in the summer, so if HT is still working well I'll still stay with low numbers.
If and when I get the chance to come off HT I'll fully expect the numbers to rise.
If RT has done the job the numbers should plateau at a suitable low'ish number.
If not, back on the HT once the numbers call for it.

The future is unknown but hey, let's be positive about things.

All the best

Kevin

User

Posted 13 Jan 2015 at 22:08

Steve

I agree with Rob (as usual http://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-smile.gif)

My own PSA is now 1001. Apart from a strange urge to shampoo the carpet I still feel the same as when it was 0.89 http://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-smile.gif

As an incurable PCa patient, I know we are not comparable but each type of PCa treatment has its own associated PSA profile. Trust in the medics http://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-smile.gif

Nil desperandum

Allister

User

Posted 13 Jan 2015 at 22:37

Steve,
It's not possible to forecast, there are so many possibilities as have already been mentioned. Also, some cancer cells can be more radio resistant, possibly through type or through mutation, so the RT is less effective. Also HT, usually lowers the PSA quite dramatically early on and for some works for years but sadly for others stops working within a year. My PSA was 0.06 2 years after RT and that was with no HT post RT. Even now some 6 1/2 years on it is still only 1.06. This might be put down to some PSA being generated in parts of the Prostate but having been scanned at my request, it has been found that I have grown a new tumour (which I am hoping to have treated by HIFU) so another unpredictable development going on quietly without raising PSA very much. We can't predict outcomes and even the oncos with all their experience and individuals case histories find it difficult and sometimes impossible to call. It's even more difficult for us to try to access our long term prospects by trying to compare our situation with others who can respond so differently to the disease and treatments.

Barry

User

Posted 14 Jan 2015 at 01:38

Thanks everyone,

As usual, really interesting replies with a lot of useful information. Thank you for taking the time to reply. That's the great thing about this site, there are always people ready to help out.

Allister, great to hear you feel well in spite of the higher PSA figure. I find the carpet fetish a little worrying though. http://community.prostatecanceruk.org/editors/tiny_mce/plugins/emoticons/img/smiley-smile.gif

Steve

User

Posted 14 Jan 2015 at 22:48

I don't really understand why your PSA isn't lower - did you have to miss a Zoladex injection due to the heart problems?

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

User

Posted 15 Jan 2015 at 10:43

Hi Lyn,

That's the reason why I finally decided to post my question. When I started to see many others posting far lower results you can see why it made me want to ask.

Hope to have a chance to meet you one day, maybe at a future event (yet to make it to one, so far, hope I can soon).

Thanks.

Best Wishes,

Steve

User

Posted 15 Jan 2015 at 12:19

Hi Steve

I found that my PSA would rise just before my HT injection was due (every three months) I assumed that the Hormones had lost its potency around two months after my injection, I asked if I could introduce Casodex into the mix but was refused, I believe on cost grounds but they wouldn't admit it. Were you at castrate level, which I believe is 0.63, if not it could be that the testosterone was rising at the time.

Good luck with the procedure

Roy

Edited by member 16 Jan 2015 at 00:53 | Reason: Not specified

User

Posted 15 Jan 2015 at 14:40

Hi Steve,

I was diagnosed with locally advanced PCa and the cancer had come outside of the prostate.I'm having 3 monthly Prostap injections since January 2013, I was told that this contained the cancer. For a brief period before the injections I had Tamsulosin. I had 37 sessions of radiotherapy from October 2013, my PSA readings are:

10/12/12. 408

30/01/13. 58

08/05/13. 13

31/07/13. 0.77

08/01/14. 0.19

09/07/14. 0.01

14/01/15. Less than 0.01

I was given a Macmillan booklet which said PSA for men aged 50-59 3 is considered normal, 60-69 4, 70 and over 5. I'm not sure if these figures are up to date.

Arthur

User

Posted 15 Jan 2015 at 22:38

Not disputing your figures Arthur but I think these must apply to men who have not had radical treatment or who are not currently on HT?

Barry

User

Posted 16 Jan 2015 at 09:45

Barry

I've had 37 sessions of "normal" radiotherapy but still continuing with the hormone treatment for another year

Arthur

User

Posted 16 Jan 2015 at 10:01

Hi Steve.
Been following you for a while now, hope your troubles are well behind you and 2015 will be kinder!
Just 'celebrated' my first year since diagnosis so 2014 wasn't good to me either. Had to do the HT/RT route. Here's my full psa & treatment diary.

24.02.06. 3.4
15.07.09. 6
06.11.09.    3.2
26.10.10.    2.3
10.05.11.    5.4
15.06.11. 5.0
19.01.12. 6.0
11.09.13. 6.71
November 13 12 needle biopsy
14.01.14 Diagnosis Carcinoma T2 M0 N0 Gleason 3+3 Volume 51 ml
21.01.14. MRI Scan Organ confined disease
31.01.14. Addenbrooks for Da Vinci assessment. Regarded to T3a Not suitable for Prostatectomy. Back it sign up to HT / RT
06.02.14 Start Bicaltamide
20.02.14 First Zoladex injection. No problems with injection & SE's yet to start
12.03.14. 2.3. After 1 month Zoladex
15.05.14. 1.22 After 3 months Zoladex
2.06.14. Gold seed implants - Fiducial markers
18.07.14. 0.94. After 6 months Zoladex
28.07.14. Start 37 x 2Gy
17.09.14. Finish RT
15.10.14. 0.13. 1 month after RT
Zoladex for another 2 years, making 3 years total
Next PSA scheduled April 2015
Not very high numbers but have the disease anyway. Hope you find this of interest.
Regards. Chris
BTW. Always thought the F3 was Nikon's finest

User

Posted 16 Jan 2015 at 14:47

Chris, did you go back and ask for an explanation of why you were not referred in 2009 at 6 or 2011 at 5.4? I find your PSA history shocking and not surprised it had gone as far as T3 in the intervening 5 years :-(

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

User

Posted 16 Jan 2015 at 20:31

Hi,

Thanks for all the info.

My GP is retiring next month. He's really been excellent throughout my illness, very supportive. I'm hoping he'll let me have a PSA test before he goes as it will be three months then since I last had one.

That one was done less than two weeks after my RT finished so I don't think it gave me a true picture of how well my treatment had worked compared to others who are reviewed usually after four to six weeks. It could go someway to reassure me that things were still working.

My next "official" PSA test is in May when I next see my oncologist, not sure if I can wait that long.

Steve

User

Posted 16 Jan 2015 at 21:00

Steve I was in a slightly different situation but they refused to test my PSA after adjuvant RT until 6 months had elapsed as there is a risk of a false reading.

In terms of waiting till May...They put me on a 6 monthly testing regime that did concern me. However, it did mean I had a good summer and xmas between tests....squeeky bum creeping in now though ;-)

Take care
Bri

User

Posted 16 Jan 2015 at 23:41

Hi Arthur,

I don't think I made myself clear. I was not referring to your individual PSA figures (I had read what you said about your treatment) but the Macmillan figures you alluded to. Trust this now makes sense.

Barry

User

Posted 17 Jan 2015 at 16:27

Hi Lyn.

Numbers didn't seem particularly high at the time, not far outside the 'norm' for my age, so no action taken. It's only when you get intimately involved with all of this that you realise what might have been! Bit late now, have to make the best of a bad job :-(

User

Posted 20 Jan 2015 at 12:51

I was wrong about who published the booklet I mention above it is:

Living with Hormone Therapy - a guide for men with prostate cancer, link below

http://prostatecanceruk.org/prostate-information/our-publications/publications/living-with-hormone-therapy

Arthur

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