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Active surveillance rise in psa

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User
Posted 18 May 2022 at 13:55

Well an update since March - my husband was diagnosed with localised prostate cancer. We saw the surgeon and oncologist and agreed a plan of active surveillance. Surgery probably not an option because of previous bowel cancer but bracytherapy may be.


Husband just had first post diagnosis PSA and it has gone from 7 to 8.9. Worried by this as it seems a big jump. Got an appointment with urology in a couple of weeks but has anyone had similar jumps without it being a cause for panic

User
Posted 18 May 2022 at 16:30

I have a friend who is on active surveillance. He tells me his tends to Bob around between 8 and 12. It surprises me that it goes up and down, but I am inclined to say don't worry about a moderate jump but if it seems to stay high and be on an upward slope then investigate further.

Edited by member 26 May 2022 at 12:54  | Reason: Not specified

Dave

User
Posted 18 May 2022 at 17:40
As Dave says, it's not so much the figure that matters as the trend. I would hazard a guess that when you see the consultant your husband will probably be put on 3-monthly PSA tests. If three consecutive tests show a steady rise in PSA then they'll recommend radical treatment.

Best wishes,

Chris
User
Posted 25 May 2022 at 12:51

Personally, I wouldn't worry too much about that jump. I've had similar rises and drops too and am also doing active surveillance. I was Gleason 3+4 in June 2016 psa at 5.4. Since then it's anywhere between 3.8 up to 8.65 and in Feb this year dropped to 6.41.


I've had biopsies, flow tests, MRI's, turp, dilatation. But between my two MRI's in Dec 2018 and Feb 2021, I started to drink fresh coffee illy decaf and whatever showed as suspect on my prostate has now disappeared and I have been downgraded from PIRADS 4 to PIRADS 2. I'll never know if it was the coffee.


But when I saw a consultant about a prostatectomy with a Da Vinci machine, he actually said to me "If you were my brother I would recommend we have it out." Thank God I didn't listen to him.


Good luck with your psa old chap.

Edited by member 25 May 2022 at 12:52  | Reason: Not specified

User
Posted 26 May 2022 at 18:00
Hold your nerve Kryten; 3+4 is indeed moderate risk and your most reliable recent result was a G3+3 with a reduction in PIRADS score so no indicators to describe your cancer as aggressive.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 26 May 2022 at 19:06
I'm confused there. If your last two tests show 3+3 then how are you 3+4?

Lyn - many of us here were diagnosed with 3+4 and told we needed radical treatment. I wasn't given an active surveillance option and I don't think many others were either. Some have been found to be worse after surgery. Can you explain what is different here?
User
Posted 26 May 2022 at 19:07
I had Gleason 3+3 with a PSA that had risen during watch and wait to over 10. My urologist advised treatment as he said " pussy cat cancers can turn into tigers" I opted for Brachytherapy and all is now well.
Brachytherapy was good for me, but we all vary, the hardest bit was making the choice re: treatment.

Welcome to the club (not) :-) John

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8 Feb '19 PSA 1.2


Jan '20 PSA 0.3 July '20 0.1 Jan. 21 < 0.1 Dec 21 <0.01 June '22 <0.01 April '23  <0.01

User
Posted 26 May 2022 at 19:19

Originally Posted by: Online Community Member
I'm confused there. If your last two tests show 3+3 then how are you 3+4?

Lyn - many of us here were diagnosed with 3+4 and told we needed radical treatment. I wasn't given an active surveillance option and I don't think many others were either. Some have been found to be worse after surgery. Can you explain what is different here?


 


You are confusing intermediate risk with aggressiveness - you said that G3+4 is aggressive and that is not correct. It may be that in your case the biopsies showed a reasonably high volume of cancer per core, or the cores showed that the cancer was close to the inner or outer edges, or the MRI scan showed that it was close to breaking out, or you had quite a high proportion of 4s in among your 3s. 


In OP's case, there is a lot of reliable data, most significant being his TURP. He may only have had very low % of 4s and it was almost all 3s, he may have had less than 5% positive in only one core, his cancer may be tiny and safely tucked into the peripheral zone with absolutely nothing showing in the central or transitional zones, or it might just be (as I suspect) that they removed almost all of it during his TURP. 

Edited by member 26 May 2022 at 19:20  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 26 May 2022 at 19:21
Thanks Kryten but I am teetotal. I smoke if you want to send me some fags ....
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Posted 18 May 2022 at 16:30

I have a friend who is on active surveillance. He tells me his tends to Bob around between 8 and 12. It surprises me that it goes up and down, but I am inclined to say don't worry about a moderate jump but if it seems to stay high and be on an upward slope then investigate further.

Edited by member 26 May 2022 at 12:54  | Reason: Not specified

Dave

User
Posted 18 May 2022 at 17:40
As Dave says, it's not so much the figure that matters as the trend. I would hazard a guess that when you see the consultant your husband will probably be put on 3-monthly PSA tests. If three consecutive tests show a steady rise in PSA then they'll recommend radical treatment.

Best wishes,

Chris
User
Posted 25 May 2022 at 12:51

Personally, I wouldn't worry too much about that jump. I've had similar rises and drops too and am also doing active surveillance. I was Gleason 3+4 in June 2016 psa at 5.4. Since then it's anywhere between 3.8 up to 8.65 and in Feb this year dropped to 6.41.


I've had biopsies, flow tests, MRI's, turp, dilatation. But between my two MRI's in Dec 2018 and Feb 2021, I started to drink fresh coffee illy decaf and whatever showed as suspect on my prostate has now disappeared and I have been downgraded from PIRADS 4 to PIRADS 2. I'll never know if it was the coffee.


But when I saw a consultant about a prostatectomy with a Da Vinci machine, he actually said to me "If you were my brother I would recommend we have it out." Thank God I didn't listen to him.


Good luck with your psa old chap.

Edited by member 25 May 2022 at 12:52  | Reason: Not specified

User
Posted 26 May 2022 at 12:22

I'm somewhat surprised at your situation, Kryten. Gleason 3+4 suggests that you have an aggressive cancer and surely it's only a question of time until it escapes the prostate. It's not a fast growing cancer, but neither is it slow. I do hope you won't be saying, "I wish I'd listened to the consultant" in the future.


To the OP: I had a high PSA for years and it jumped around somewhat - allegedly your recent sexual activity has an effect, for example. I wasn't, although I probably should have been, on active surveillance, and didn't have a test for a few years. Then when I did it had jumped to 9 and the biopsy showed cancer. Presumably your husband had a biopsy - what did that show? It is rather unlikely to have developed much from that in such a short time.

User
Posted 26 May 2022 at 12:55

I wish I hadn't read that Peter....I was under the impression that Gleason 3+4 was moderate risk, whereas 4+3 was aggressive. My TURP in 2017 came up 3+3, TP biopsy (32 cores) 2019 showed 3+3, MRI Feb 2021 PIRADS 2 (clinically significant cancer is unlikely to be present).

User
Posted 26 May 2022 at 18:00
Hold your nerve Kryten; 3+4 is indeed moderate risk and your most reliable recent result was a G3+3 with a reduction in PIRADS score so no indicators to describe your cancer as aggressive.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 26 May 2022 at 18:05

Thank you Lyn. If I knew where you lived, a bottle of champers would be heading your way.

User
Posted 26 May 2022 at 19:06
I'm confused there. If your last two tests show 3+3 then how are you 3+4?

Lyn - many of us here were diagnosed with 3+4 and told we needed radical treatment. I wasn't given an active surveillance option and I don't think many others were either. Some have been found to be worse after surgery. Can you explain what is different here?
User
Posted 26 May 2022 at 19:07
I had Gleason 3+3 with a PSA that had risen during watch and wait to over 10. My urologist advised treatment as he said " pussy cat cancers can turn into tigers" I opted for Brachytherapy and all is now well.
Brachytherapy was good for me, but we all vary, the hardest bit was making the choice re: treatment.

Welcome to the club (not) :-) John

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8 Feb '19 PSA 1.2


Jan '20 PSA 0.3 July '20 0.1 Jan. 21 < 0.1 Dec 21 <0.01 June '22 <0.01 April '23  <0.01

User
Posted 26 May 2022 at 19:19

Originally Posted by: Online Community Member
I'm confused there. If your last two tests show 3+3 then how are you 3+4?

Lyn - many of us here were diagnosed with 3+4 and told we needed radical treatment. I wasn't given an active surveillance option and I don't think many others were either. Some have been found to be worse after surgery. Can you explain what is different here?


 


You are confusing intermediate risk with aggressiveness - you said that G3+4 is aggressive and that is not correct. It may be that in your case the biopsies showed a reasonably high volume of cancer per core, or the cores showed that the cancer was close to the inner or outer edges, or the MRI scan showed that it was close to breaking out, or you had quite a high proportion of 4s in among your 3s. 


In OP's case, there is a lot of reliable data, most significant being his TURP. He may only have had very low % of 4s and it was almost all 3s, he may have had less than 5% positive in only one core, his cancer may be tiny and safely tucked into the peripheral zone with absolutely nothing showing in the central or transitional zones, or it might just be (as I suspect) that they removed almost all of it during his TURP. 

Edited by member 26 May 2022 at 19:20  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 26 May 2022 at 19:21
Thanks Kryten but I am teetotal. I smoke if you want to send me some fags ....
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 26 May 2022 at 23:32

Jim - do you have any more data on your present state? An RP is pretty drastic. In fact when a consultant advised me to have an RP four years ago, I kind of worry what his motive was. The NHS does have boxes to tick. In some areas of the UK has been shown here for equivalent readings, some are not offered an active surveillance program. For instance I was not offered HIFU where is some areas it was.

 
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