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Rise in PSA after surgery

User
Posted 24 Apr 2019 at 09:43

My knowledge is pretty good on prostate cancer, but last week online someone asked me a question that I didn't know the answer to. Q. If your PSA shows a slow but steady rise many years after surgery, is it assumed that this PSA is from cancer cells active on the old surgery area, or could they be elsewhere in the body? If so, how can those cells be detected and how can they be targeted for radiation treatment? I used to know most people on here but if there's anyone I know still, hello! :-)

User
Posted 24 Apr 2019 at 09:43

My knowledge is pretty good on prostate cancer, but last week online someone asked me a question that I didn't know the answer to. Q. If your PSA shows a slow but steady rise many years after surgery, is it assumed that this PSA is from cancer cells active on the old surgery area, or could they be elsewhere in the body? If so, how can those cells be detected and how can they be targeted for radiation treatment? I used to know most people on here but if there's anyone I know still, hello! :-)

User
Posted 24 Apr 2019 at 15:06

Hi Dan

I seem to be a bit of an exception on here.  After my RP, my PSA rose from 0.014 to 0.023 over the space of the first year.  I had a PSMA scan done privately and it picked up low amounts of cancer in lymph nodes in the prostate bed area.  I therefore had SRT.  Many, including my oncologist, weren't sure if with such low PSA there would be any uptake.  To answer your question though, it looks like a scan is the answer.

Ulsterman

User
Posted 24 Apr 2019 at 11:22

The most advanced way to locate PCa metastases is via a PET scan. A Choline PET-CT scan may be available on the NHS, but the scanners are not common, and there have been reports of shortages of the Choline tracing agent (probably down to Project FearπŸ˜‰).

A more accurate scan is the PET-PSMA scan using the radioactive isotope Gallium 68 as a tracer. £2600 at the last count.

I think we have a correspondent here who has had both, but despite nothing specific being found with either of them, his PSA continues to rise!

Cheers, John.

Edited by member 24 Apr 2019 at 13:23  | Reason: Not specified

User
Posted 24 Apr 2019 at 11:57

I think statistically if your PSA rises slowly more than three years post surgery it is most likely a local recurrence. The usual answer to that is external beam radiotherapy to the whole prostate bed plus a bit.

Statistically if your PSA rises rapidly within three years it is most likely due to microscopic metastasis.

I fell into the latter category but chose to have a radiotherapy attempt to cure what was found on scans. Recurrence was observed on the prostate bed plus a remnant seminal vesicle.

As ever there will be exceptions to these statistics.

The problem is finding areas of cancer when they are very very small.

The PSMA pet scan seems to be one of the best just now to detect areas of recurrence.

There are papers in the European Urology association website on this.

 

Ido4

User
Posted 24 Apr 2019 at 14:09

Hey at least someone remembers me :-) Hope all is well with you Devonmaid? 

User
Posted 24 Apr 2019 at 14:36

Barry! Hello! Yes I’m grand thanks, good to hear from you. 

User
Posted 24 Apr 2019 at 18:21
Hi Dan, good to see you posting.

A slow and steady rise years after radical treatment is classic pattern for recurrence in the prostate bed. A sudden sharp rise indicates mets.

My dad has had a recurrence 13 years pist-op but his doubling time is still only 21 months so no action being taken at present. The urologist said he could have a full scan but that these are unreliable at low levels for PCa recurrence (Ulsterman being the exception) and the cells have probably been there for the entire 20 years since the op.

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

User
Posted 24 Apr 2019 at 20:38

Hi Dan

 

still here. Just completed final sixth chemo. Lots to tell but let me know contact details

bazza Barry

Ten. YES BLOODY 10 years since DX!!

I am Spartacus - with the strength of iron, a will of steel and the fight to give this disease a real run for its money!! 

User
Posted 25 Apr 2019 at 07:28

Hi Daniel - still here!

User
Posted 19 May 2019 at 10:11

hi Daniel 

I don't think I've seen your profile before. have a peruse of mine.

I'm actually having quarterly psa tests.  I don't say anything  as was on 6 monthly.

incidentally my father had his op at addenbrookes in 1976.  I still remember the glass bell jar and orange rubber tubing..

anyway.  about yourself. have you put another dec place.  ? it doesn't match with your profile.

do you mean  0.11  ??

is this same assay ?  could be an error in sample. 

obviously you know a great deal.  get another reading .

This is actually the positivness of 2 or 3 dec places in my opinion.

all the very best.  another reading or 2 in the next 3 months .  I assume you can request ? and pay for those.

all the best.

Gordon.   

 

 

User
Posted 19 May 2019 at 10:14

Dan. Can you confirm the decimal points 0.011 or 0.11 or 0.1 

baz 

Ten. YES BLOODY 10 years since DX!!

I am Spartacus - with the strength of iron, a will of steel and the fight to give this disease a real run for its money!! 

User
Posted 19 May 2019 at 10:50
You are over-reacting Dan. It could be a change of machine, a different time of day, some extra adrenaline. The ultra-sensitive test has now been more or less discredited and is not offered by many labs in the UK now, for exactly this reason. Research at St James in Leeds showed the average woman has a PSA of 0.06.

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

User
Posted 20 May 2019 at 09:05

Don't  feel embarrased - it was probably all down to the wank!

However, on a more serious note, particularly for a newcommer, one can easily get the impression no one is ever cured when reading this forum (at least, for some value of cured, even be it life long remission). But it's easy to overlook that most people in that situation will probably drift away from the group over time, and that it's self-selecting for mainly those on treatment, so it's not representative of overall outcomes. Just something to bear in mind for those pre radical treatment certainly.

So congratulations on your continued excellent results, which are good to hear about.

User
Posted 20 May 2019 at 09:12
I think you have misread. Andy. Dan has been a member since 2010!

There is no such thing as s cure for cancer, the best anyone can hope for is long if not full remission. But you are correct that many join and then drift away after the initial stages.

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

User
Posted 20 May 2019 at 10:55

After 10 years of >0.003 why the hell are you still having tests every three months especially USPSA you must be bonkers!! Putting yourself through that.

Would you really have blind SRT for a 0.011 reading 10 years after your op??

I would suggest you swap to standard sensetivity tests now and get a life without PSA anxiety!!

Edited by member 20 May 2019 at 11:00  | Reason: Not specified

User
Posted 20 May 2019 at 15:16

Originally Posted by: Online Community Member
I am cured......πŸ˜‰

Cheers, John

 

You will always be an exception to any rule πŸ™„

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

Show Most Thanked Posts
User
Posted 24 Apr 2019 at 11:22

The most advanced way to locate PCa metastases is via a PET scan. A Choline PET-CT scan may be available on the NHS, but the scanners are not common, and there have been reports of shortages of the Choline tracing agent (probably down to Project FearπŸ˜‰).

A more accurate scan is the PET-PSMA scan using the radioactive isotope Gallium 68 as a tracer. £2600 at the last count.

I think we have a correspondent here who has had both, but despite nothing specific being found with either of them, his PSA continues to rise!

Cheers, John.

Edited by member 24 Apr 2019 at 13:23  | Reason: Not specified

User
Posted 24 Apr 2019 at 11:57

I think statistically if your PSA rises slowly more than three years post surgery it is most likely a local recurrence. The usual answer to that is external beam radiotherapy to the whole prostate bed plus a bit.

Statistically if your PSA rises rapidly within three years it is most likely due to microscopic metastasis.

I fell into the latter category but chose to have a radiotherapy attempt to cure what was found on scans. Recurrence was observed on the prostate bed plus a remnant seminal vesicle.

As ever there will be exceptions to these statistics.

The problem is finding areas of cancer when they are very very small.

The PSMA pet scan seems to be one of the best just now to detect areas of recurrence.

There are papers in the European Urology association website on this.

 

Ido4

User
Posted 24 Apr 2019 at 12:42

Hi Dan

long time no see!

love Devonmaid

User
Posted 24 Apr 2019 at 14:09

Hey at least someone remembers me :-) Hope all is well with you Devonmaid? 

User
Posted 24 Apr 2019 at 14:17

Hello Dan , Hope you are still well 
Barry

User
Posted 24 Apr 2019 at 14:36

Barry! Hello! Yes I’m grand thanks, good to hear from you. 

User
Posted 24 Apr 2019 at 15:06

Hi Dan

I seem to be a bit of an exception on here.  After my RP, my PSA rose from 0.014 to 0.023 over the space of the first year.  I had a PSMA scan done privately and it picked up low amounts of cancer in lymph nodes in the prostate bed area.  I therefore had SRT.  Many, including my oncologist, weren't sure if with such low PSA there would be any uptake.  To answer your question though, it looks like a scan is the answer.

Ulsterman

User
Posted 24 Apr 2019 at 18:07
Ian

All well and good but they treat you the same regardless of whether you recur early and fast or not and don’t give you any prognosis clues, at least in my case. It’s just a conveyor belt, most likely in my case leading to pushing up daises well early.

User
Posted 24 Apr 2019 at 18:21
Hi Dan, good to see you posting.

A slow and steady rise years after radical treatment is classic pattern for recurrence in the prostate bed. A sudden sharp rise indicates mets.

My dad has had a recurrence 13 years pist-op but his doubling time is still only 21 months so no action being taken at present. The urologist said he could have a full scan but that these are unreliable at low levels for PCa recurrence (Ulsterman being the exception) and the cells have probably been there for the entire 20 years since the op.

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

User
Posted 24 Apr 2019 at 20:38

Hi Dan

 

still here. Just completed final sixth chemo. Lots to tell but let me know contact details

bazza Barry

Ten. YES BLOODY 10 years since DX!!

I am Spartacus - with the strength of iron, a will of steel and the fight to give this disease a real run for its money!! 

User
Posted 25 Apr 2019 at 07:28

Hi Daniel - still here!

User
Posted 19 May 2019 at 09:01

Well, I suppose I expected it one day, 9 years after surgery and with <0.003 every 6 months, I decided not to have a PSA and left it a whole year. So, today, waiting for the results, I was as anxious as ever, but hopefully another <0.003 was around the corner. WRONG! The nurse handed me the paper and I stared at the result for longer than normal...0.011 (is that bad?) 

So, though I'm much of an expert in what happens pre a PSA rise, I'm not sure, though I have some ideas, of what to do next. All advice welcomed.

Regards

Daniel

 

User
Posted 19 May 2019 at 10:11

hi Daniel 

I don't think I've seen your profile before. have a peruse of mine.

I'm actually having quarterly psa tests.  I don't say anything  as was on 6 monthly.

incidentally my father had his op at addenbrookes in 1976.  I still remember the glass bell jar and orange rubber tubing..

anyway.  about yourself. have you put another dec place.  ? it doesn't match with your profile.

do you mean  0.11  ??

is this same assay ?  could be an error in sample. 

obviously you know a great deal.  get another reading .

This is actually the positivness of 2 or 3 dec places in my opinion.

all the very best.  another reading or 2 in the next 3 months .  I assume you can request ? and pay for those.

all the best.

Gordon.   

 

 

User
Posted 19 May 2019 at 10:14

Dan. Can you confirm the decimal points 0.011 or 0.11 or 0.1 

baz 

Ten. YES BLOODY 10 years since DX!!

I am Spartacus - with the strength of iron, a will of steel and the fight to give this disease a real run for its money!! 

User
Posted 19 May 2019 at 10:24

Hi Gordon, 1976? Blimey, another lifetime!

Yes, I'll go to another hospital and have it checked again tomorrow. I'm in Thailand and you can walk into any hospital here, pay £20 to have an immediate blood test, then wait 40 minutes for the result.

<0.003 is the supersensitive test which is the result I've had the past 9 years. The 0.011 was a surprise because that means a fairly quick doubling rate, not so good!

Will update tomorrow,

Best wishes

Daniel

User
Posted 19 May 2019 at 10:27

hi Daniel 

I see bazza has posted query. since I was typing on my mobile.

incidentally.    mine has gone down and up from 0.01 and 0.02

However despite non nerve sparing . I no longer have ED.

Took 3 years..  no longer on any meds..  

I have noticed . clear 'semen' very minute drop.   so   I assume. ..

Cowper's glands are involved in the immune defence of the genitourinary tract and secrete many glycoproteins, including PSA (Pedron et al., 1997).

so PSA does get produced and I assume leaks into blood stream  .   I'm no expert.

all the best..

 

User
Posted 19 May 2019 at 10:28

Christ Bazza,

Didn't expect to hear that! Sorry, my friend, I hope Spartacus steps on it!

Yes, 0.011 is the score, from <0.003 last year.

I'll go for another test tomorrow to confirm, then again in 6 weeks to see what the jump is. 

I'm back in the UK for 10 weeks starting 7th June so plenty of time to get to Addenbrookes for some therapy.

Did you have radiotherapy early days?

Best wishes

Daniel

 

User
Posted 19 May 2019 at 10:34

hi Daniel.

I see you are online.

ok.  keep us updated.

these are super sensitive.   few blokes have those.  it's all very much post code lottery here.  

get data progression  at £20. eh ?    you can't  extrapolate  from  this .

regards..  

Gordon 

User
Posted 19 May 2019 at 10:50
You are over-reacting Dan. It could be a change of machine, a different time of day, some extra adrenaline. The ultra-sensitive test has now been more or less discredited and is not offered by many labs in the UK now, for exactly this reason. Research at St James in Leeds showed the average woman has a PSA of 0.06.

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

User
Posted 19 May 2019 at 10:59

As a guy said on one of the other forums, "Did you have a wank yesterday? That would have done it."πŸ˜‚ I laughed because, yes, I had! 

User
Posted 19 May 2019 at 15:10

18 months after RALP, my PSA started rising so I had salvage straight away. That got it undetectable for another 14  months before Casodex and the slow journey to here started. 

Ten. YES BLOODY 10 years since DX!!

I am Spartacus - with the strength of iron, a will of steel and the fight to give this disease a real run for its money!! 

User
Posted 20 May 2019 at 08:18

Embarrassed but Grateful

I had a PSA test at Phyathai 3 Hospital yesterday. After 9 years cancer free, it showed I now faced a serious problem going forward. I phoned to ask if they would recheck the result, perhaps even a clerical error had occurred. They said they would do and rang me to back to assure me the result was accurate.

Feeling devastated, I went to BNH Hospital today to have a retest, just to confirm the result from Phayathai. Would you believe the result came back completely clear!!! >0.003 I could have cried with relief! I'd heard of rogue results, but didn't really believe in them until now! I'd like to thank everyone for their support on here yesterday, I feel embarrassed but truly thankful. I feel like I went through being diagnosed again yesterday, then the all clear within 24 hours, I'm still in shock!

User
Posted 20 May 2019 at 09:05

Don't  feel embarrased - it was probably all down to the wank!

However, on a more serious note, particularly for a newcommer, one can easily get the impression no one is ever cured when reading this forum (at least, for some value of cured, even be it life long remission). But it's easy to overlook that most people in that situation will probably drift away from the group over time, and that it's self-selecting for mainly those on treatment, so it's not representative of overall outcomes. Just something to bear in mind for those pre radical treatment certainly.

So congratulations on your continued excellent results, which are good to hear about.

User
Posted 20 May 2019 at 09:12
I think you have misread. Andy. Dan has been a member since 2010!

There is no such thing as s cure for cancer, the best anyone can hope for is long if not full remission. But you are correct that many join and then drift away after the initial stages.

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

User
Posted 20 May 2019 at 09:23

Originally Posted by: Online Community Member
I think you have misread. Andy. Dan has been a member since 2010!

"Newcomer" wasn't referring to Dan, but rather more people like me (still less than a year since diagnosis).

User
Posted 20 May 2019 at 10:55

After 10 years of >0.003 why the hell are you still having tests every three months especially USPSA you must be bonkers!! Putting yourself through that.

Would you really have blind SRT for a 0.011 reading 10 years after your op??

I would suggest you swap to standard sensetivity tests now and get a life without PSA anxiety!!

Edited by member 20 May 2019 at 11:00  | Reason: Not specified

User
Posted 20 May 2019 at 11:03

Of course not! 6 monthly PSA the way to go. Thank you for your animated advice, I needed to smile after today πŸ˜‚

User
Posted 20 May 2019 at 12:49

Hi Dan

Excellent news.      IMHO you might as well know 3 monthly , 6 monthly.   and supersensitive  eh ?   

At least you get more lead time to make informed decisions.     

I noticed in your profile you have   < 0.03 PSA Nov 2014  and other entries.     Have these been taken at differing labs? (or typos ?) .    

Gordon

 

 

 

 

 

 

User
Posted 20 May 2019 at 14:33

.<003 in many places Gordon and long may it continue πŸ˜‚πŸ˜‚πŸ˜‚

User
Posted 20 May 2019 at 14:48
I am cured......πŸ˜‰

Cheers, John

User
Posted 20 May 2019 at 15:15

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member
I think you have misread. Andy. Dan has been a member since 2010!

"Newcomer" wasn't referring to Dan, but rather more people like me (still less than a year since diagnosis).

 

Sorry Andy, I misunderstood. 

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

User
Posted 20 May 2019 at 15:16

Originally Posted by: Online Community Member
I am cured......πŸ˜‰

Cheers, John

 

You will always be an exception to any rule πŸ™„

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

 
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