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PSA on the up when should I be concerned.

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User
Posted 17 Sep 2022 at 16:44

Back in 2006 I was diagnosed with Prostate cancer with a PSA of 17, treatment was 20 sessions of radiotherapy followed by Zoladex implant every 3 months for 3 years, my PSA then dropped to 0.10. There it remained until 2011 when it went up to 0.40.


From then until 2018 it varied between 0.40 and 0.71, but since then every test has shown a slight increase:


15th June 2018 PSA@0.59
24th Dec 2018 PSA@0.81
11th July 2019 PSA@0.71
3rd Dec 2019 PSA@0.71
8th Sept 2020 PSA@0.75
12th March 2021 PSA@0.84
16th Sept 2021 PSA@0.94 
15th March 2022 PSA@1.15
8th Sept 2022 PSA@1.47


Should I be concerned, the letter from the hospital with this latest result just suggests a retest in 6 month's time!

User
Posted 17 Sep 2022 at 20:08
The usual guideline for RT is that recurrence is signalled by your PSA rising to your nadir (minimum) + 2, so that would be 2.1 in your case.

Yes, I think there is cause for concern in that you're seeing a steady rise, and that's never good news.

Chris
User
Posted 17 Sep 2022 at 22:41

I'm going to say no you shouldn't be worried, but that is because I like things clear in black and white. I would argue if the definition of recurrence is 2.1 then anything under 2.1 is good.


I can see there is an argument that it is increasing, but for all we know it will level off and possibly fall again like it has already done at least once.


I am now a couple of years post treatment and things are going fine. My threshold for recurrence is 2.1 but I am told if it got there no treatment would be contemplated until it got to 10. you are 80 at the moment, you have already survived 16 years, and I would cautiously say that even if the cancer returned, it could be kept under control for another decade.


One thing I would say is that your GP and no one else is going to be paying much attention to your PSA and they will be using guidelines which say anything below 4.0 is fine. The fact you are keeping track of your PSA over many years is good; because if it goes over 2.1 you want to be referred straight back to oncology, and not be involved in an argument about whether it has to get to 4.0. The threshold for you is 2.1 anything less is good: anything more needs a referral.

Dave

User
Posted 19 Sep 2022 at 19:17
Your doubling time is just a little less than 4 years - possibly a very small active cluster in what's left of the prostate. The PSA may get to 2 and stabilise but if / when the PSA reaches 2.1 you should be referred back to oncology. As the next step would most likely be life-long HT, the onco may advise you to wait till the PSA reaches 5, 10 or even 20 before restarting treatment ... at this rate, that will be in about 12 years!

My dad officially reached biochemical recurrence in 2013 but his PSA rise is so slow he still hasn't had any salvage treatment; just gets his PSA test every 6 months and then goes off on another cruise!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 19 Sep 2022 at 20:52
Yes, dad is 85 and fancies his chances of avoiding any further treatment - the urologist predicted in 2013 that it might be 25 years before the cancer killed him and dad thought that was a challenge worth accepting!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 Sep 2022 at 12:14
I doubt at those levels you would have any symptoms for many years.

Re pain you should look for significant changes in pain level and get those looked at if they don't resolve.
User
Posted 27 Mar 2023 at 19:46
Given that your nadir was 0.1, with a PSA of 2.1 you now officially in "recurrence" but, as mentioned earlier in the thread, they'll probably want to wait until it gets significantly higher before taking any action, at the rate your PSA is increasing, that's likely to take a number of years, so regular testing and monitoring is the sensible course of action.

Best wishes,

Chris
User
Posted 29 Mar 2023 at 13:28

Frankly , I would not be too worried about such a low PSA at your age . If there is any cancer it’s almost certainly slow growing and you will almost certainly die of something else.   I am a little younger than you with a PSA of 7 but you will see in my profile it used to be 14 .  Always seek an alternative opinion if not satisfied with the initial one.  Cheers Keith 

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User
Posted 17 Sep 2022 at 20:08
The usual guideline for RT is that recurrence is signalled by your PSA rising to your nadir (minimum) + 2, so that would be 2.1 in your case.

Yes, I think there is cause for concern in that you're seeing a steady rise, and that's never good news.

Chris
User
Posted 17 Sep 2022 at 22:41

I'm going to say no you shouldn't be worried, but that is because I like things clear in black and white. I would argue if the definition of recurrence is 2.1 then anything under 2.1 is good.


I can see there is an argument that it is increasing, but for all we know it will level off and possibly fall again like it has already done at least once.


I am now a couple of years post treatment and things are going fine. My threshold for recurrence is 2.1 but I am told if it got there no treatment would be contemplated until it got to 10. you are 80 at the moment, you have already survived 16 years, and I would cautiously say that even if the cancer returned, it could be kept under control for another decade.


One thing I would say is that your GP and no one else is going to be paying much attention to your PSA and they will be using guidelines which say anything below 4.0 is fine. The fact you are keeping track of your PSA over many years is good; because if it goes over 2.1 you want to be referred straight back to oncology, and not be involved in an argument about whether it has to get to 4.0. The threshold for you is 2.1 anything less is good: anything more needs a referral.

Dave

User
Posted 19 Sep 2022 at 18:57
Thanks for your replies.
I am due to see my GP in a week's time about something else and will ask him about my concerns, will let you know what he advises.
User
Posted 19 Sep 2022 at 19:17
Your doubling time is just a little less than 4 years - possibly a very small active cluster in what's left of the prostate. The PSA may get to 2 and stabilise but if / when the PSA reaches 2.1 you should be referred back to oncology. As the next step would most likely be life-long HT, the onco may advise you to wait till the PSA reaches 5, 10 or even 20 before restarting treatment ... at this rate, that will be in about 12 years!

My dad officially reached biochemical recurrence in 2013 but his PSA rise is so slow he still hasn't had any salvage treatment; just gets his PSA test every 6 months and then goes off on another cruise!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 19 Sep 2022 at 19:23
Thanks, Lyn, for your positive reply, I am coming up to 82 so at that rate I should be OK until I am 94.
User
Posted 19 Sep 2022 at 20:52
Yes, dad is 85 and fancies his chances of avoiding any further treatment - the urologist predicted in 2013 that it might be 25 years before the cancer killed him and dad thought that was a challenge worth accepting!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 Sep 2022 at 10:25
I suppose biggest concern is the fact that I suffer with back pain in my lower back caused by Scoliosis and a trapped nerve that cause pain and a numbness in my right foot.
Pain is partly helped by pain killer medication.
In the letter that I get with my results it advises that if I have aches or pains in the bones lasting more than a week to report back to the hospital, how am I going to know if any pain is caused by my cancer?
User
Posted 20 Sep 2022 at 12:14
I doubt at those levels you would have any symptoms for many years.

Re pain you should look for significant changes in pain level and get those looked at if they don't resolve.
User
Posted 26 Oct 2022 at 15:33

Update on the above.


My GP has had a chat with the oncology department at my local hospital, they advise that they will not be concerned about my PSA until it reaches 6/7, also because I had a CT scan in May relating to a suspected stomach problem this showed no problem with the possibility of the cancer increasing my back pain problems.


Therefore, I will keep taking the pain killers, not worry, and get on with life.


Thanks all for all your replies to my original post.

User
Posted 24 Mar 2023 at 16:36

Latest reading a week ago PSA still on the up and has just reached 2.17 and in the letter from the PSA tracker Nurse I am to retest in 3months time now instead of in 6 months, so I assume that they are a little concerned!


 

Edited by member 26 Mar 2023 at 16:31  | Reason: Not specified

User
Posted 27 Mar 2023 at 19:46
Given that your nadir was 0.1, with a PSA of 2.1 you now officially in "recurrence" but, as mentioned earlier in the thread, they'll probably want to wait until it gets significantly higher before taking any action, at the rate your PSA is increasing, that's likely to take a number of years, so regular testing and monitoring is the sensible course of action.

Best wishes,

Chris
User
Posted 29 Mar 2023 at 13:28

Frankly , I would not be too worried about such a low PSA at your age . If there is any cancer it’s almost certainly slow growing and you will almost certainly die of something else.   I am a little younger than you with a PSA of 7 but you will see in my profile it used to be 14 .  Always seek an alternative opinion if not satisfied with the initial one.  Cheers Keith 

 
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