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User
Posted 23 Jul 2023 at 10:02

Hi, I am now aged 62 and had a radical prostatectomy in 2019 and here is my PSA test results to date


21 Jul 2023     0.11


12 Jan 2022    0.08


18 Jul 2022     0.06


17 Jan 2022    0.05


08 Jul 2021     0.05


23 Jun 2020    0.03


08 Apr 2020    0.03 


23 Jan 2020    0.02


28 Oct 2019    0.02


30 Jul 2019     0.02


At a PSA of 0.11 am I  halfway to prostate cancer recurrence? 


Thank you,


Anthony.


 

User
Posted 23 Jul 2023 at 20:06

Tony, it is a slow but reasonably steady rise. I was told my PSA may level off at 0.1, unfortunately it didn't. At least with having the more sensitive test you can see a pattern. There is no point worrying about it, that would not alter the result. Plenty of options if you do need them and treatment options and detection have improved in the last few years. 


At 0.1 I was brought back under the umbrella of urology, all that meant was making sure my PSA testing was monitored by urology.


Thanks Chris 

User
Posted 23 Jul 2023 at 21:33
One of the advantages of RARP is is still leaves RT as an option down the road. What was your original Gleason and tumour diagnosis? If, like me, it was a T3 then reoccurrence is a possibility down the road, my surgeon said she wouldn't do anything until PSA>0.2 and then she would scan for possible RT treatment.

If it was me, I would push for 3 monthly tests now, even if I had to pay for it myself and just keep an eye on it.

As Chris says, no point in worrying about it, it's still perfectly treatable.
User
Posted 23 Jul 2023 at 23:38
Biochemical recurrence is a PSA of more than 0.2 or 3 successive rises over 0.1 so if your next test is 0.12 and the one after that is 0.13 there is no need for you to wait until it gets to 0.2 - you should be referred to oncology at the 3rd rise. Some urologists would refer you now that your PSA is above 0.1 although they are not obliged to.

I do think 3 monthly testing would be a good idea now but I don't agree with the advice to pay if you need to - the most important thing is to ensure that the next couple of tests are done at the same lab as the previous ones - changing to a new provider who tests at a different lab with different machines means that you lose your base line and the next test will be unreliable. You shouldn't need to fight for a 3 monthly test on the NHS as you are now over 0.1

As stated above, even if you do get further rises there is no need to panic. A low PSA post-op which starts to creep up over the next couple of years is typical of a few cells left behind in the prostate bed. Salvage RT is usually successful in these cases. My husband had a recurrence 2 years post-op (0.033, 0.08, 0.12, 0.16) and is now 12 years post-salvage RT.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 24 Jul 2023 at 07:48

I agree with Lyn that it is important to make sure that your PSA is measured at the same laboratory. My PSA had remained the same at LESS than 0.003 ('super sensitive' test at a private hospital) for 5 years but when we moved I had an NHS test which was 0.06. Obviously worried and I had it measured at the private hospital and it had remained at 0.003 which compares with 0.01 (NHS)  measured last week. I was told by my urologist that if and when my PSA hits the 0.2 mark I should monitor it every 6 months. There does no appear to be any specific figure for taking action. The most important aspect appears to be the rate of rise of your PSA backed up by scans if necessary - that is what my urologist suggested.

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate


 


 

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User
Posted 23 Jul 2023 at 20:06

Tony, it is a slow but reasonably steady rise. I was told my PSA may level off at 0.1, unfortunately it didn't. At least with having the more sensitive test you can see a pattern. There is no point worrying about it, that would not alter the result. Plenty of options if you do need them and treatment options and detection have improved in the last few years. 


At 0.1 I was brought back under the umbrella of urology, all that meant was making sure my PSA testing was monitored by urology.


Thanks Chris 

User
Posted 23 Jul 2023 at 21:33
One of the advantages of RARP is is still leaves RT as an option down the road. What was your original Gleason and tumour diagnosis? If, like me, it was a T3 then reoccurrence is a possibility down the road, my surgeon said she wouldn't do anything until PSA>0.2 and then she would scan for possible RT treatment.

If it was me, I would push for 3 monthly tests now, even if I had to pay for it myself and just keep an eye on it.

As Chris says, no point in worrying about it, it's still perfectly treatable.
User
Posted 23 Jul 2023 at 23:38
Biochemical recurrence is a PSA of more than 0.2 or 3 successive rises over 0.1 so if your next test is 0.12 and the one after that is 0.13 there is no need for you to wait until it gets to 0.2 - you should be referred to oncology at the 3rd rise. Some urologists would refer you now that your PSA is above 0.1 although they are not obliged to.

I do think 3 monthly testing would be a good idea now but I don't agree with the advice to pay if you need to - the most important thing is to ensure that the next couple of tests are done at the same lab as the previous ones - changing to a new provider who tests at a different lab with different machines means that you lose your base line and the next test will be unreliable. You shouldn't need to fight for a 3 monthly test on the NHS as you are now over 0.1

As stated above, even if you do get further rises there is no need to panic. A low PSA post-op which starts to creep up over the next couple of years is typical of a few cells left behind in the prostate bed. Salvage RT is usually successful in these cases. My husband had a recurrence 2 years post-op (0.033, 0.08, 0.12, 0.16) and is now 12 years post-salvage RT.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 24 Jul 2023 at 04:58
Thank you, Chris, Steve and Lyn for your replies, much appreciated.
User
Posted 24 Jul 2023 at 07:48

I agree with Lyn that it is important to make sure that your PSA is measured at the same laboratory. My PSA had remained the same at LESS than 0.003 ('super sensitive' test at a private hospital) for 5 years but when we moved I had an NHS test which was 0.06. Obviously worried and I had it measured at the private hospital and it had remained at 0.003 which compares with 0.01 (NHS)  measured last week. I was told by my urologist that if and when my PSA hits the 0.2 mark I should monitor it every 6 months. There does no appear to be any specific figure for taking action. The most important aspect appears to be the rate of rise of your PSA backed up by scans if necessary - that is what my urologist suggested.

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate


 


 

User
Posted 25 Jul 2023 at 07:45

Thank you for taking the time to reply.

User
Posted 26 Jul 2023 at 11:36

Hello Chris ..and others , my oncologist said also at 0.03 ( that was my psa in sept +dec 22) that we hope that the psa would level off as you said at some point ,then it was 0.05 march to may 2023 and  now i am at 0.07,


you mentioned 0.1  - is that a "magic" mark? or could the psa find a level even later at i dont know 0.3 or 0.6?


i guess the higher the psa is crawling the unlikelier it will be...? 


Raoul

Edited by member 26 Jul 2023 at 11:37  | Reason: Not specified

User
Posted 26 Jul 2023 at 12:51

Rauol, my reply is a personal experience at my hospital and it was a few years ago. My urology consultant would like to see his patients stay below 0.1,once above that figure he closely monitored patients rather than leaving it in the hands of a GP. When my PSA got close to 0.2 I saw the oncologist and plans were put in place to start salvage RT. Not all hospitals treat recurrence in the same way. 


I don't suppose there is much data to establish whether a stable PSA at 0.3 or 0.6 for men without a prostate is acceptable and not cancer. Most guys without a prostate will have had some intervention around those higher figures.


Thanks Chris 

User
Posted 26 Jul 2023 at 14:12
"you mentioned 0.1 - is that a "magic" mark? or could the psa find a level even later at i dont know 0.3 or 0.6?"

The magic mark is 0.2 although once you get to 0.1 and keep rising it is reasonable to assume that you are going to reach 0.2 sooner or later. The reason is that very small amounts of PSA are produced in other parts of the body (e.g prostate specific antigen is not prostate specific!) but only in amounts smaller than 0.1 Even women can produce PSA; it can be present in breast milk, for example.

The complex bit is that the magic mark means different things in different circumstances. For a man who has had his prostate removed, 0.2 (or 3 rises above 0.1) is the point at which he is said to have biochemical recurrence. The same would be said of a man who has had his prostate removed and then had salvage RT. However, in the second case, although BCR may be confirmed at 0.2 the onco may delay restarting treatment until the PSA is 5 or 10 or the doubling time reaches less than 6 months. For a man who has had RP and reaches BCR, many oncos want to start treatment as soon as it is confirmed.

For a man who still has his prostate and has had radiotherapy / brachytherapy, BCR would be 2.0 plus his lowest ever reading
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 27 Jul 2023 at 01:40

Raoul as Lyn says 0.2 is the magic mark, in the UK for men who no longer have a prostate. One can not use 0.0 as Lyn says other cells in the body produce a tiny amount of PSA.


With very small numbers there will be random errors in your PSA results, though I think it very unlikely your PSA has really been steady at 0.05 and the first few results were -0.02 in error the middle ones had 0.00 error and the latest has an error of +0.02. I think your PSA is probably genuinely rising.


So based on the evidence you have should you be worried? No.


The magic number 0.2 is fairly arbitrary, but medics who know more than we do had to draw a line somewhere. Maybe they have seen PSA level out below that number, maybe they see rises which will breach the number but it's not practical to attempt to treat prior to that number. So until a medic says you have biochemical recurrence, just get on with your life. As we say in England, "Don't cross the bridge until you come to it".

Dave

 
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