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re-recurrence of rising psa

Posted 17 Oct 2022 at 17:42

Having had a RARP in 2015 and a recurrence of PSA of 0.07 in 2017, I underwent radio therapy together with hormone therapy for 2 years. Now my PSA has again started to rise from <0.03 to 0.07 to 0.26 in the space of 1 year. Anyone had the same or similar 'problem'? Consultant wanted to wait till it gets to 0.5 but I'm getting worried what another 6 months might do. I'm 77 but not ready to go yet!

Posted 17 Oct 2022 at 21:06

Hi,   There is another person called 'wellyeknaa' in a similar position, he last posted a couple of weeks ago if you look down 'recent conversations' you could comment to him.   His consultant is waiting till he reaches 0.4.   There's a better chance of finding something at that level.  As you say there is some risk in waiting.   

If you wait 6 more months yours is likely to be over 0.5 based on your rate of change if the last 2 were 6 monthly appointments. PSA sometimes increases at different rates.  Although you could be on 3 monthly appointments or blood tests.

After your appointment it also depends on how quickly they can scan you, get the results and then another appointment to talk about treatment.   

You could ask about these concerns, some people get more worried than others.   The above is only what I've read.  All the best, Peter

Posted 17 Oct 2022 at 21:14
wellyeknaahas not had salvage therapy yet so is not comparable.

Unfortunately it looks like your salvage RT has failed. Your best option for a long HT free remission now is a PSMA scan and hope it can be detected and it is in an area outside previous RT treatment.

So you need to ask what the plan is if it gets to 0.5..

Posted 17 Oct 2022 at 21:28
At 77 I don't think a PSMA scan is necessary or cost effective. Once your PSA reaches 0.5 there is a better chance of scans spotting something but that could just as well be a choline PET scan, Axumin or PSMA - they all have their strengths and limitations at such low readings. In reality, unless the scan happens to spot one or two lone mets outside the pelvic area, you are only going to have two treatment options - long term hormone therapy on its own or long term hormone therapy with chemo / additional tablets.

Long term HT has a limited life span so many oncos will prefer to wait until the PSA is higher before starting treatment - often PSA of 5 or 10. In other words, the point at which it is clear you have a recurrence (0.2) and the optimal point for restarting HT are completely different.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Posted 18 Oct 2022 at 09:58
Thanks all for comments. Have got a call-back from my GP on Friday so will see what she has to say, but will ask for another test sooner.
Posted 18 Oct 2022 at 11:29

Ian, I had surgery in 2014, my PSA rose to 0.27 in 2017 and I had salvage RT without HT.  After an initial drop in PSA it started to rise again, I went on a prostate cancer vaccine trial but the whole trial failed. Earlier this year at a PSA of 1.4 I had a PSMA scan an a tumor in a lymph node was picked up. In August this year I had 5 SABR sessions to the tumor. My too early PSA test did show the rise had halted, but it will be some time before I know how successful it has been. Now 71.

Thanks Chris 


Posted 18 Oct 2022 at 14:15

Hi Chris

That's good information, thank you. I will use that on Friday. I am in the Bournemouth/Christchurch Trust area, what area were you in for the PSMA?


Posted 18 Oct 2022 at 14:41

Ian, Nottingham area.

Thanks Chris 

Posted 23 Aug 2023 at 21:21
Just an update on the eventual outcome in case anyone is still watching this post. Had another PSA in January - 0.62, but still nothing from onco. Next PSA in July 1.6 and immediately put on Prostap, first Prostap 1 now on Prostap 3. Urologist wants to see me again in next month or so!! Looks like hormone treatment is the way to go!


Posted 23 Aug 2023 at 21:39

Ian , only seems like yesterday you were posting. If you are happy on Prostap and it doesn't ruin your quality of life that is good. My SABR last year wasn't the success I hoped for and I had another 5 sessions in June this year along with 6 months of bicalutamide, at least my PSA has dropped to 0.32.

Hope your treatment goes well.keep in touch.

Thanks Chris 


Edited by member 23 Aug 2023 at 21:40  | Reason: Clarity

Posted 24 Aug 2023 at 10:19
Many thanks Chris for reply. Sorry to hear that your SABR wasn't initially successful. Terrible worry for you and your family any time that treatment is not as successful as hoped. Since my first diagnosis in 2015 and subsequent RARP the thought never leaves you.

Lets hope that Bicalutamide works for you. I was on that for 2 years in 2917/18 and up to last year had negligible PSA.

Will keep looking at posts.

All the best for the future


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