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G9 PSA rise but GP says no action needed?

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User
Posted 20 Dec 2020 at 06:21

Hi guys,


I have pondered this over the last day. Pete's a Gleason 9. Tc3 n1 mo. 5 yrs ago had surgery, radiotherapy and 3 years of prostap. Been off prostap for 2 years.


Recently his PSA went from undetectable to 0.2. this happened in Oct. Retest in December shows still at 0.2. Spoken to 2 gps now who both say as it has not changed in two months and still very low, no need to worry, no need for scans. The consultant hadn't set a point at which Pete needs to be reviewed, last he saw him was about 2-3 years ago .


My concern is that for a jump in PSA from undetectable to 0.2 with Pete's history and such a high gleason, are the gps 'right' in taking no action? They just want a retest of PSA in 3 months. I've heard some men with low PSA recurrence can nevertheless show to have mets. Am I over worrying?  Any advice greatly appreciated! 

'Sorrow looks back, worry looks around, but faith looks up'
User
Posted 20 Dec 2020 at 15:00

Don’t take any notice of what your GP(s) say. They maybe did a one-week module on PCa during their medical training.


As Matron says, wait for another quarterly PSA test, and if there is again an increase, ask to be referred straight back to oncology.


Best of luck.


Cheers, John.

Edited by member 21 Dec 2020 at 02:14  | Reason: Not specified

User
Posted 20 Dec 2020 at 12:40
I think waiting for another test to see what the trend is, is sensible - the fact that it has been 0.2 for two tests doesn't really give a picture of what is happening. But Ali, I think unless the PSA has gone back down at the next test you should ask to see the onco regardless. Peter shouldn't have been discharged from oncology even if monitoring was passed back to the GP so it isn't a case of needing the GP to re-refer.

Whether it was a G6 or a G9 doesn't make much difference right now - if it has recurred, it has recurred. If the PSA rises at next test, the interesting discussion with the onco will be about what scan tracers are available in your area and when is the best time to do the scan.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 Dec 2020 at 13:40

I have never been discharged from the oncology department. Our hospital has numerous nurse led clinic with rapid access to the consultant as required or on request.  I have regular PSA tests and telephone appointments with the oncology nurse.


Thanks Chris

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User
Posted 20 Dec 2020 at 10:55

As I replied in your other thread, the onco is unlikely to do anything yet so what's the point of bringing appointments forward. The point at which it is accepted that the cancer is back (0.2) is different to the point at which the onco might want to start him on long term HT and / or early chemo (which could be 5 or 10 or when the doubling time is less than 6 months). As the PSA is fairly stable at the moment, another test in 3 months seems sensible and then a call to onco secretary for an appointment. 

Edited by member 20 Dec 2020 at 11:01  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 Dec 2020 at 11:47

Thanks Lyn. I get what you're saying, and thankful for the reply.


My concern is with the high gleason whether action should be taken sooner. I would hate for us to 'sit on it' and then find it's getting out of hand. But I do appreciate this is most likely my worries rather than reality.


 

'Sorrow looks back, worry looks around, but faith looks up'
User
Posted 20 Dec 2020 at 11:48

P 


My position really reinforces Lyn's reply.  Not G9 but timings of treatments similar, I didn't have HT. My PSA hit .2 about 14 months ago the fell, rose and fell again. My plan is a bit confused my onco nurse and oncologist use different figures for a scan, nurse says 1 onco says 2,4 or even 8. I am on three to four month testing. My latest PSA results are in my profile, the extra tests were screening tests for a trial. Just make sure you get results from the GP and don't accept "it's okay or acceptable"


Thanks Chris


 


 


 


 


 

User
Posted 20 Dec 2020 at 12:03

Thanks Chris, sounds very similar situation. When did you get referred back to your onco?Pete's GPs are holding off any involvement with onco at moment, so we are only guided by them. 

'Sorrow looks back, worry looks around, but faith looks up'
User
Posted 20 Dec 2020 at 12:40
I think waiting for another test to see what the trend is, is sensible - the fact that it has been 0.2 for two tests doesn't really give a picture of what is happening. But Ali, I think unless the PSA has gone back down at the next test you should ask to see the onco regardless. Peter shouldn't have been discharged from oncology even if monitoring was passed back to the GP so it isn't a case of needing the GP to re-refer.

Whether it was a G6 or a G9 doesn't make much difference right now - if it has recurred, it has recurred. If the PSA rises at next test, the interesting discussion with the onco will be about what scan tracers are available in your area and when is the best time to do the scan.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 Dec 2020 at 13:40

I have never been discharged from the oncology department. Our hospital has numerous nurse led clinic with rapid access to the consultant as required or on request.  I have regular PSA tests and telephone appointments with the oncology nurse.


Thanks Chris

User
Posted 20 Dec 2020 at 15:00

Don’t take any notice of what your GP(s) say. They maybe did a one-week module on PCa during their medical training.


As Matron says, wait for another quarterly PSA test, and if there is again an increase, ask to be referred straight back to oncology.


Best of luck.


Cheers, John.

Edited by member 21 Dec 2020 at 02:14  | Reason: Not specified

 
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