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PSA Rising on ADT

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User
Posted 05 Jan 2023 at 12:56

Hi all,


Telephone consultation today following blood test in December.

PSA has risen from 0.10 to 0.22 since my last blood test in April of last year despite still being on Prostap injections.

That looks like really bad news to me, though the nurse insisted that because the reading was still relatively low, it was nothing to worry about yet.

I've found no evidence of anyone on the forum experiencing rising PSA whilst still receiving ADT. Have I just not searched thoroughly enough?


Has anyone any other thoughts on this?

Many Thanks,

User
Posted 05 Jan 2023 at 16:40
It's fine - the ADT starves the cancer cells but does not prevent the healthy cells of your prostate regenerating. As your prostate recovers from the RT, small rises in PSA are to be expected.

I am more surprised that your blood tests are so infrequent!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 05 Jan 2023 at 18:45
I think quite a lot of men have in-between PSA tests via their GP, not just a PSA test before seeing their oncologist / urologist. A minimum of 6 monthly would be wise or, from May 2023 onwards, 3 monthly tests (but then you have to weigh up whether 3 monthly testing is going to give you reassurance or just cause additional anxiety).

If my husband or brother was finishing HT in May, I would certainly be making sure the PSA was monitored at least 6 monthly. From May onwards, you will most likely see the PSA rising - as long as it stays below about 2.1, all is well.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 12 Jul 2023 at 14:30

I would be asking for a PSMA PET scan.


Castrate resistant cancer cells can be more sensitive on PSMA scans, so a better chance of showing up.


They might want to do a nuclear bone scan first as it's cheaper and not such a long waiting list.


I suspect you had some cancer somewhere other than the prostate which thus didn't get treated with the radiotherapy. However, having found this only after your primary treatment, they may be prepared to treat this with curative intent too, depending how many spots of it there are. If this had been found before your primary treatment, they might have classed you as metastatic at that point and not offered any curative treatments. However, I'm guessing at what's happened here, and I could be wrong.

Edited by member 12 Jul 2023 at 15:50  | Reason: Not specified

Show Most Thanked Posts
User
Posted 05 Jan 2023 at 15:07

Hi DaveHz,


any rise in PSA is always a worry. I read your profile and you seem to have had radiotherapy in December 2020. When is your last hormone therapy injection scheduled?


best wishes,


Ian 

Ido4

User
Posted 05 Jan 2023 at 16:10

Hi Ian,


My final injection is scheduled for May this year,


Dave

User
Posted 05 Jan 2023 at 16:40
It's fine - the ADT starves the cancer cells but does not prevent the healthy cells of your prostate regenerating. As your prostate recovers from the RT, small rises in PSA are to be expected.

I am more surprised that your blood tests are so infrequent!
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 05 Jan 2023 at 17:01

Hi Lyn,


Many thanks for injecting a bit of hope in to my situation. 


I've found the tests/calls situation a bit odd also. My previous call from the consultant was in November 2021, 14 months ago. During that call, I was told the next call would be in May last year, so I got my bloods done in early April because I was heading off to the sun for three weeks. When I returned early May I realised I'd had no appointment letter through for a call, so I chased them up for when it might happen. I was told over the phone my PSA was 0.10 ng/ml and they were happy with that, and an appointment letter would come out shortly afterwards, 


A few days later I got the appointment through for 8 months later. I found that surprising too.


Dave

User
Posted 05 Jan 2023 at 18:45
I think quite a lot of men have in-between PSA tests via their GP, not just a PSA test before seeing their oncologist / urologist. A minimum of 6 monthly would be wise or, from May 2023 onwards, 3 monthly tests (but then you have to weigh up whether 3 monthly testing is going to give you reassurance or just cause additional anxiety).

If my husband or brother was finishing HT in May, I would certainly be making sure the PSA was monitored at least 6 monthly. From May onwards, you will most likely see the PSA rising - as long as it stays below about 2.1, all is well.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 05 Jan 2023 at 19:56

Did you have COVID or a COVID vaccination within the month before your PSA test? This can cause a rise in PSA.


If this happened to me (and it wasn't due to COVID), I would ask for it to be referred back to the consultant, and I would also ask for a Testosterone test to make sure the hormone therapy injection worked, and I'd want another PSA test in 3 months or sooner.

User
Posted 05 Jan 2023 at 21:46

Hi Andy, 


I had a Covid booster 42 days before the bloods were taken for the PSA test. 


I had Covid symptoms around the time of the blood test, but the better half had similar symptoms and tested a couple of times, both were negative, and I assumed we both had the same non-Covid virus. (A bit embarrassing given how I bang on to colleagues about assuming nothing in the office).


I think I'll try and get a follow up PSA + testosterone test in the near future.

User
Posted 12 Jul 2023 at 14:08

So 6 months on, and it feels like the wheels have come off rather majorly, with my PSA shooting up to 3.61 ng/ml from 0.22 ng/ml in December. This all despite my having had Prostap injections which should still be active at this point (last one was a three month injection in May, which should be working through to end of August). It seems Prostap for me stopped working after around 2 and a half years as opposed to the three year average I believe I've seen quoted at a few places on the internet.

I was wondering if any one has been on a similar journey to mine and what happened next, or whether anyone could offer any observations on my situation?


 


 

User
Posted 12 Jul 2023 at 14:30

I would be asking for a PSMA PET scan.


Castrate resistant cancer cells can be more sensitive on PSMA scans, so a better chance of showing up.


They might want to do a nuclear bone scan first as it's cheaper and not such a long waiting list.


I suspect you had some cancer somewhere other than the prostate which thus didn't get treated with the radiotherapy. However, having found this only after your primary treatment, they may be prepared to treat this with curative intent too, depending how many spots of it there are. If this had been found before your primary treatment, they might have classed you as metastatic at that point and not offered any curative treatments. However, I'm guessing at what's happened here, and I could be wrong.

Edited by member 12 Jul 2023 at 15:50  | Reason: Not specified

 
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