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Slow but definite PSA rise

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User
Posted 08 Dec 2021 at 15:27

PSA undetectable for 18 months after RP in February 2018, then O.O3 in July 2019, bobbled along at 0.05  from November 2020, now 0.06 in December 2021.


 


Nurse has me down for another blood test end of February, and if a rise, will qualify as a referral to onco.


 


To me it looks like an inevitable rise, and I just wanted to draw on some experience and advice as to what my treatment options might look like if indeed it does rise, as Nurse said, 0.07 or above? ( a third increase).


Based in London, I have no idea about time frames , or various treatment options.


Clearly anxious , just wondered what experiences you may have had with similar numbers


thanks in advance...


 

User
Posted 08 Dec 2021 at 20:22

We had this same discussion on a thread about a week ago. As you don't have a prostate ideally PSA would be very low and stay that way, and actually 0.06 is very low. Bobbling along at that sort of figure is not a problem. Other bits of your body can create a bit of PSA. In general if it is less than 0.1 ignore it, pretend all your results were reported as <0.1 and don't worry about ultra sensitive PSA results.


For me and Bob who have had RT we don't need to worry whilst it is less than 2.1 unless there is a sudden sharp rise.

Dave

User
Posted 08 Dec 2021 at 20:01
2 years after Radio therapy & Hormone, mine is 0.25, the Onco is not bothered at all about that.
I still have a Prostate, & they will create a bit of PSA
I would say, no worries - as the young ones would say & get on with life!
User
Posted 08 Dec 2021 at 20:37

Anthony,


It may mean you will need some more treatment, but that probably won't happen for a while. If PSA does indicate some cells remaining, they will typically wait until your PSA is 0.2 or 0.5, and a PSMA PET scan can find where they are. Below that level, the scan is unlikely to find them. This enables radiotherapy to be targeted at the cells.


The other option is that they assume the cells are in the prostate bed, which is most likely if your PSA was very low after the RP and then creeps up very slowly. In this case, they might do radiotherapy on the prostate bed earlier, before a scan would have worked.


Another factor will be considering the histology report, and if your treatment centre has a PSMA PET scanner available (they are more likely to do a scan if they have a scanner, rather than if they have to send you off somewhere else for the scan).


It's probably too soon to assume anything though.

User
Posted 08 Dec 2021 at 21:35

AntonyB 


After surgery I was discharged to my GP with a letter that said if my PSA breached 0.1 I would be referred back to urology. Once I hit 0.1 I was referred to urology and had more regular PSA tests than I would have had under the GP. When I hit 0.2 I was referred to oncology and at 0.27 started Salvage RT without HT. 


Covid seems to have changed that procedure slightly. I was refused a PSMA / PET scan and was given SRT to the prostate bed with the words it is " a very educated guess based on years of experience" .


 Although the PSA did drop it has since risen again.


Get the better scans if you can, but as mentioned previously at low levels of PSA they are not always successful.


I did see a post elsewhere the other day where a guy's post surgery PSA had risen to 0.1 and had been at that level for the last 3 years.


My numbers are listed near the start of my profile, my post op histology was not good with positive margins and extra prostatic extension. 


Hope you get sorted.


Thanks Chris


 

User
Posted 08 Dec 2021 at 22:29

Hi


Your doubling time is quite long so it is more likely they'll either watch it a bit longer or give you salvage RT.  A psma scan can identify small areas of concern that might be included in the RT.  Otherwise they'll fire blind at the prostate bed.


My PSA has just risen to 0.06 from undetectable <0.05.  I keep telling myself many top hospitals call undetectable <0.1 so there is time to spare.  There is a sweet spot with PSA between too early and not seeing it well on a scan, and too late when it gets away. I prefer a bit early especially when you can't trust timescales.


My blood test is April, you did quite well with Feb.  On the other hand you could have to wait till you get 3 successive rises and are over 0.1.  Your Gleason might also feature in doing it earlier if it's high.


All the best Peter


 

User
Posted 09 Dec 2021 at 08:45
Pretty much identical to my figures, the previous post is the best answer IMHO.
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User
Posted 08 Dec 2021 at 20:01
2 years after Radio therapy & Hormone, mine is 0.25, the Onco is not bothered at all about that.
I still have a Prostate, & they will create a bit of PSA
I would say, no worries - as the young ones would say & get on with life!
User
Posted 08 Dec 2021 at 20:22

We had this same discussion on a thread about a week ago. As you don't have a prostate ideally PSA would be very low and stay that way, and actually 0.06 is very low. Bobbling along at that sort of figure is not a problem. Other bits of your body can create a bit of PSA. In general if it is less than 0.1 ignore it, pretend all your results were reported as <0.1 and don't worry about ultra sensitive PSA results.


For me and Bob who have had RT we don't need to worry whilst it is less than 2.1 unless there is a sudden sharp rise.

Dave

User
Posted 08 Dec 2021 at 20:37

Anthony,


It may mean you will need some more treatment, but that probably won't happen for a while. If PSA does indicate some cells remaining, they will typically wait until your PSA is 0.2 or 0.5, and a PSMA PET scan can find where they are. Below that level, the scan is unlikely to find them. This enables radiotherapy to be targeted at the cells.


The other option is that they assume the cells are in the prostate bed, which is most likely if your PSA was very low after the RP and then creeps up very slowly. In this case, they might do radiotherapy on the prostate bed earlier, before a scan would have worked.


Another factor will be considering the histology report, and if your treatment centre has a PSMA PET scanner available (they are more likely to do a scan if they have a scanner, rather than if they have to send you off somewhere else for the scan).


It's probably too soon to assume anything though.

User
Posted 08 Dec 2021 at 21:35

AntonyB 


After surgery I was discharged to my GP with a letter that said if my PSA breached 0.1 I would be referred back to urology. Once I hit 0.1 I was referred to urology and had more regular PSA tests than I would have had under the GP. When I hit 0.2 I was referred to oncology and at 0.27 started Salvage RT without HT. 


Covid seems to have changed that procedure slightly. I was refused a PSMA / PET scan and was given SRT to the prostate bed with the words it is " a very educated guess based on years of experience" .


 Although the PSA did drop it has since risen again.


Get the better scans if you can, but as mentioned previously at low levels of PSA they are not always successful.


I did see a post elsewhere the other day where a guy's post surgery PSA had risen to 0.1 and had been at that level for the last 3 years.


My numbers are listed near the start of my profile, my post op histology was not good with positive margins and extra prostatic extension. 


Hope you get sorted.


Thanks Chris


 

User
Posted 08 Dec 2021 at 22:29

Hi


Your doubling time is quite long so it is more likely they'll either watch it a bit longer or give you salvage RT.  A psma scan can identify small areas of concern that might be included in the RT.  Otherwise they'll fire blind at the prostate bed.


My PSA has just risen to 0.06 from undetectable <0.05.  I keep telling myself many top hospitals call undetectable <0.1 so there is time to spare.  There is a sweet spot with PSA between too early and not seeing it well on a scan, and too late when it gets away. I prefer a bit early especially when you can't trust timescales.


My blood test is April, you did quite well with Feb.  On the other hand you could have to wait till you get 3 successive rises and are over 0.1.  Your Gleason might also feature in doing it earlier if it's high.


All the best Peter


 

User
Posted 09 Dec 2021 at 08:45
Pretty much identical to my figures, the previous post is the best answer IMHO.
User
Posted 15 Dec 2021 at 10:42

Originally Posted by: Online Community Member


We had this same discussion on a thread about a week ago. As you don't have a prostate ideally PSA would be very low and stay that way, and actually 0.06 is very low. Bobbling along at that sort of figure is not a problem. Other bits of your body can create a bit of PSA. In general if it is less than 0.1 ignore it, pretend all your results were reported as <0.1 and don't worry about ultra sensitive PSA results.


For me and Bob who have had RT we don't need to worry whilst it is less than 2.1 unless there is a sudden sharp rise.



Thanks Dave - Yes my Onco covering letter, following the 0.25 PSA result, was "No concern at this time" 
Have another one in 6 months! I did not know the actual levels of concern.
Obviously for those that have had the thing removed, there will be different results.


 

User
Posted 15 Dec 2021 at 13:38

Hi Bob,


The level of concern is the nadir + 2.0 . The nadir for me was 0.1 and for most people who have had HT that is the case. I don't know your nadir but it can't be higher than 0.25 (your current reading) so the level of concern for you may be 2.25, but whatever the precise level is for each person, you and I are currently well below it so no worries.

Dave

 
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