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Slow but steady rise in psa

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User
Posted 29 Jul 2019 at 09:43

My partner had a radical prostatectomy about two years ago and since then his PS A has been steadily rising to where his new consultant  (the old one retired ) is now saying that although still on the low side he is now putting him I touch with an oncologist to plan future strategy . To me and my partner it seems obvious that the consultant  believes it is going to continue to rise as it seems to be more or less doubling each 3 months . My partner just wants to forget it all until it happens and I respect this but I want to be prepared for what is to come and have as much information on hand as possible so I can give him support when the time comes. He does know I message on this site . I have researched as much as I can but what I want to understand is if radiotherepy  on the prostate bed is carried out what are the chances cells will have already escaped into the general circulation .? In other words how likely is it that the radiotherapy will kill all the cancer cells . I know that the cancer originally had aGleason score of 9 when biopsied  which means it will be faster growing ! Or is it a case of how long is a piece of string !?

 

 

 

 

User
Posted 29 Jul 2019 at 16:30

I think you need to pull the trigger on salvage radio therapy sooner rather than later, you have clearly suffered a relapse.

User
Posted 29 Jul 2019 at 16:35
The nomograms located here will help with your decision making:

https://www.mskcc.org/nomograms/prostate

User
Posted 29 Jul 2019 at 19:04

I suspect you have made some errors in typing the PSA scores but it seems the first post-op PSA was 0.08 or 0.008 and it has been doubling since? This is classic pattern for stray cells left behind in the prostate bed, in which case salvage RT has a good chance of working and is certainly worth trying.

If the cancer had spread before the op, he would have been more likely to see PSA readings that were over 0.2 post-op and never dropped down lower.

Edited by member 29 Jul 2019 at 19:42  | Reason: Not specified

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

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User
Posted 29 Jul 2019 at 09:55
More details needed really. Did he have lymph nodes removed. What are his actual psa figures. If they are very low and gradually rising then it’s worth believing that they are just remaining cells in the prostate bed and that radiotherapy could be curative etc. However RT fails also in around 50% of cases but buys some time. If you read my profile you will see I’ve refused RT many times as my post op figures were dreadful and I had spread to nodes already. I didn’t want further damage and side-effects to my pelvis on a whim !!
User
Posted 29 Jul 2019 at 12:04

Neta,

Not enough info to comment in much detail (like Chris said, we need the PSA levels and dates).

Also, the histology performed on the prostate after removal, and likewise any lymph nodes removed.

There's a balance with the Salvage Radiotherapy (SRT). Ideally, you want to know where the remaining cancer is, but if the PSA is less than 2, PET scans may not find it. With a Gleason score of 9, they might not want to wait until the PSA is high enough for a PET scan to work, so they may have to work without scans. The histology might suggest the likelihood of location, and that it was non-nerve sparing would suggest the cancer was at least near the rear and/or lower surfaces of both sides of the prostate where the nerves run, so break-out there into the prostate bed might be a possibility. They might do a bone scan to look for any mets, and possibly a CT or MRI scan, because if it has spread significantly away from the prostate bed, the treatment path is likely to be different.

User
Posted 29 Jul 2019 at 15:56
Hi Thanks to all trying to help. Histology showed that the cancer did not appear to have breeched the outer capsule which surprises the latest team of the Consultant as the Gleason score was 9 After R P it has risen , doubling in amount though a tiny amount after 3 months 0.08 , then next time to 0.35next psa 0.065 then after another 3 months up to 0.1.06 Consultant has now referred him for a consultation with an oncologist with a view to discuss radiotherapy at a later date.
User
Posted 29 Jul 2019 at 16:02
Also histology did not show any spread to lymph nodes and Consultant at the time , now retired was old school I think and believed that it was better to take whole away without nerve sparing Bone scan pre op showed no signs of any spread
User
Posted 29 Jul 2019 at 16:30

I think you need to pull the trigger on salvage radio therapy sooner rather than later, you have clearly suffered a relapse.

User
Posted 29 Jul 2019 at 16:35
The nomograms located here will help with your decision making:

https://www.mskcc.org/nomograms/prostate

User
Posted 29 Jul 2019 at 19:04

I suspect you have made some errors in typing the PSA scores but it seems the first post-op PSA was 0.08 or 0.008 and it has been doubling since? This is classic pattern for stray cells left behind in the prostate bed, in which case salvage RT has a good chance of working and is certainly worth trying.

If the cancer had spread before the op, he would have been more likely to see PSA readings that were over 0.2 post-op and never dropped down lower.

Edited by member 29 Jul 2019 at 19:42  | Reason: Not specified

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

 
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