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PSA slowly rising

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User
Posted 21 Sep 2020 at 10:03

Hi everyone,

After RP I can say my PSA has been at 0.03 for 2 years. After this períod PSA showed 0.05 for 3 months, Then 0.06 and now 0.08.

I had a doctor appointment this last Tursday. I mentioned my worries about the increase. His advise is to wait till 3 more months (however he even suggested me doing a following test 6 months later), given following reasons: still low and still zero for him till 0.1; at this level no exams will show anything, my post-op results were good despite the 1mm positive margin, which he neglected the importance as it was too small.

Well, if I haven’t followed this group as well as read a lot about the topic, I would be relieved by his words... but I am not.

What is your view?

Thanks in advance, Paulo

User
Posted 21 Sep 2020 at 11:44

Paulo

My post op letter says if I broke a threshold of 0.1 I would be referred back to the consultant. This did not mean I had any treatment, it just put me back under the consultants current patients. My tests reverted to 3 month testing and as I crept towards 0.2 I was referred to the oncologist.  Once l went above 0.2 the preparation for SRT began.

As you rightly say tracer type scans are not always success at 0.1.

You may be lucky and settle at 0.1, but looks like you are being proactive with your own care.

 

Thanks Chris

 

User
Posted 21 Sep 2020 at 11:47

Hi Paulo,

I think the combination of rising PSA and positive margins mean you probably will need some more treatment, I'm sorry to say.

Your doctor is right in that your level is still too low to have much chance of showing up on even a PSMA PET scan.

This means, you could go into blind prostate bed radiotherapy soon, or you could wait until the level is high enough to have a chance of showing on a scan (but still no guarantee), just in case that shows something else that needs including, such as pelvic lymph nodes. Given you had a positive margin, prostate bed is very likely the location, but doesn't rule out it also being somewhere else.

Your Gleason was 4+4 which is the high end of intermediate aggressiveness, so you might want to bear that risk in mind too, in that the chance of spread increases if you wait a long time. The decision is a gamble.

Sorry you find yourself in this position of having to make yet more decisions about the disease, and wishing you all the best.

User
Posted 21 Sep 2020 at 13:11
I think your doctor is spot on, Paulo. You haven't hit the threshold for biochemical recurrence yet (PSA greater than 0.2 or three successive rises above 0.1) and although the chances are that it will continue to rise, it isn't a certainty - you may settle at or around 0.1 as a result of benign prostatic tissue or high natural PSA production in other organs. As I have posted to you before, John's PSA has bobbed around the 0.1 mark for nearly 8 years now - sometimes just above but more often than not, just below.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 25 Sep 2020 at 15:08

Hi 

I had a Prostatectomy two years ago after being diagnosed with prostate cancer Gleason score 3+4 and localised non aggressive cancer,for the first year after the op my PSI was undetectable less than 0.1 on 4 seperate 3 monthly tests,a year later my PSA reading is 0.11 and I have just had another test with the reading due soon,what will this 0.11 PSA reading mean as I realise it is not an undetectable reading.

 

  Thanks for any help

User
Posted 25 Sep 2020 at 16:55
Hi Mutley, it depends on your next couple of tests, probably - if it rises again (even if just from 0.1 - 0.3and then 0.3 - 0.4 or something) I would expect your urologist to refer you to an oncologist for a conversation and possible scans although the onco may suggest waiting to see if it does actually reach 0.2 before taking any action.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 25 Sep 2020 at 18:36
I am in the happy position of being in the care of a billion pound super-hospital, whose super-expensive lab tests to only 0.1. Thus my successive post prostatectomy results have been all <0.1, “undetectable”.

I might be in the same boat as you, but ignorance is bliss!

But with consecutive PSA increases in your case, however small, something is going on. You need a PET-PSMA scan, which may or not show any metastases.

Best of luck.

Cheers, John.

User
Posted 25 Sep 2020 at 19:52

Motley

Under my consultant breaking a threshold of 0.1 just means they keeps a closer eye on you for a while. Frequency of tests may increase.

Thanks Chris

 

User
Posted 25 Sep 2020 at 22:50
I have taken the Bollinge approach stick to the 0.1 test.

Recent research has demonstrated no benefit to early SRT, just keep an eye on your PSA and try and stop thinking about it until (if) you breach the 0.1 threshold.

User
Posted 27 Sep 2020 at 23:06
Sorry to hear that paolo, probably time to think about next steps..
User
Posted 10 Oct 2020 at 15:06

 Got the test results back from my recent blood test last week and the reading is now less than 0.1> undetectable,so I guess that's good news for now.   

User
Posted 17 Mar 2021 at 15:15

Paulo, how are you getting on now? I face similar issues and am trying to build my understanding, thx

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User
Posted 21 Sep 2020 at 11:44

Paulo

My post op letter says if I broke a threshold of 0.1 I would be referred back to the consultant. This did not mean I had any treatment, it just put me back under the consultants current patients. My tests reverted to 3 month testing and as I crept towards 0.2 I was referred to the oncologist.  Once l went above 0.2 the preparation for SRT began.

As you rightly say tracer type scans are not always success at 0.1.

You may be lucky and settle at 0.1, but looks like you are being proactive with your own care.

 

Thanks Chris

 

User
Posted 21 Sep 2020 at 11:47

Hi Paulo,

I think the combination of rising PSA and positive margins mean you probably will need some more treatment, I'm sorry to say.

Your doctor is right in that your level is still too low to have much chance of showing up on even a PSMA PET scan.

This means, you could go into blind prostate bed radiotherapy soon, or you could wait until the level is high enough to have a chance of showing on a scan (but still no guarantee), just in case that shows something else that needs including, such as pelvic lymph nodes. Given you had a positive margin, prostate bed is very likely the location, but doesn't rule out it also being somewhere else.

Your Gleason was 4+4 which is the high end of intermediate aggressiveness, so you might want to bear that risk in mind too, in that the chance of spread increases if you wait a long time. The decision is a gamble.

Sorry you find yourself in this position of having to make yet more decisions about the disease, and wishing you all the best.

User
Posted 21 Sep 2020 at 13:11
I think your doctor is spot on, Paulo. You haven't hit the threshold for biochemical recurrence yet (PSA greater than 0.2 or three successive rises above 0.1) and although the chances are that it will continue to rise, it isn't a certainty - you may settle at or around 0.1 as a result of benign prostatic tissue or high natural PSA production in other organs. As I have posted to you before, John's PSA has bobbed around the 0.1 mark for nearly 8 years now - sometimes just above but more often than not, just below.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 21 Sep 2020 at 14:36

Thanks for your replies :-)

I remember seeing and reading 0.1 mark (particularly with your husband case, Lyn) is a reference and I haven't gotten there yet... Maybe I read too much about studies and I keep thinking I shouldn't start getting ready for what comes next. Hopefully "next" could be waiting and watching.

I have a few things that makes me always consider as negative: a gleason 8 and a positive margin even if small. This is aggressive and if I can still have curative treatment why wait too long before it can spread ... I also read that the odds of getting a success on salvage radiation is by doing it earlier than later and particularly not till it reaches 0.2 in situations as mine (potential increase). 

I like my doctor generally, as he is firm and convincing, he is young and stubburn in his advise, but I probably miss a doctor type too that could explain more about the reasoning for waiting. True I am getting mostly of this from you here and I appreciate. It is conforting to understand this.

Well, difficult :-)

 

 

 

User
Posted 25 Sep 2020 at 15:08

Hi 

I had a Prostatectomy two years ago after being diagnosed with prostate cancer Gleason score 3+4 and localised non aggressive cancer,for the first year after the op my PSI was undetectable less than 0.1 on 4 seperate 3 monthly tests,a year later my PSA reading is 0.11 and I have just had another test with the reading due soon,what will this 0.11 PSA reading mean as I realise it is not an undetectable reading.

 

  Thanks for any help

User
Posted 25 Sep 2020 at 16:55
Hi Mutley, it depends on your next couple of tests, probably - if it rises again (even if just from 0.1 - 0.3and then 0.3 - 0.4 or something) I would expect your urologist to refer you to an oncologist for a conversation and possible scans although the onco may suggest waiting to see if it does actually reach 0.2 before taking any action.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 25 Sep 2020 at 18:36
I am in the happy position of being in the care of a billion pound super-hospital, whose super-expensive lab tests to only 0.1. Thus my successive post prostatectomy results have been all <0.1, “undetectable”.

I might be in the same boat as you, but ignorance is bliss!

But with consecutive PSA increases in your case, however small, something is going on. You need a PET-PSMA scan, which may or not show any metastases.

Best of luck.

Cheers, John.

User
Posted 25 Sep 2020 at 19:52

Motley

Under my consultant breaking a threshold of 0.1 just means they keeps a closer eye on you for a while. Frequency of tests may increase.

Thanks Chris

 

User
Posted 25 Sep 2020 at 22:50
I have taken the Bollinge approach stick to the 0.1 test.

Recent research has demonstrated no benefit to early SRT, just keep an eye on your PSA and try and stop thinking about it until (if) you breach the 0.1 threshold.

User
Posted 25 Sep 2020 at 23:08

Hi Franci yes I have breached the 0.1 marker at 0.11.

User
Posted 27 Sep 2020 at 23:06
Sorry to hear that paolo, probably time to think about next steps..
User
Posted 10 Oct 2020 at 15:06

 Got the test results back from my recent blood test last week and the reading is now less than 0.1> undetectable,so I guess that's good news for now.   

User
Posted 12 Oct 2020 at 13:10

Very good Mutley and thank you for your feedback. That is a good sign and there is hope :-)

User
Posted 17 Mar 2021 at 15:15

Paulo, how are you getting on now? I face similar issues and am trying to build my understanding, thx

User
Posted 18 Mar 2021 at 13:28

Hi Christopher,
I am doing good, but experiencing a steady rise of the PSA. A couple weeks ago I had the PSA at 0.16 and 3 months before it was 0.13. 6 months ao it was 0.08.
3 months ago my urologist continued insisting I should wait, but guided me to an oncologist after my enquiries for a more specialized knowledge of the "thing". I did have an appointment with an oncologist and I have done a PET scan and a MRI by now. She confirmed that my PSA is increasing slowly and it appears as the cancer is of indolent type but it is probably still there and that I might be targeted for radiotherapy.
The PET scan (Galio 68) came out clean all over the body, but with a doubtful enlighted very small area at the base of the penis and the doctor asked for a RMI to rule out suspicions. The RMI did not confirm cancer in that area as well as it showed no sign of cancer in the whole pelvic area, including lymph nodes. So, now my doctor is having a meeting with a multi-disciplinary team to understand what to suggest, but now she says I might stay in watching mode for a while still, as I haven’t touched the recurrence mark. The meeting is to be held next Wednesday, so I am waiting for her feedback.
Let me know how you stand with the "thing".

 
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