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PSA higher after hifu - is this OK?

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User
Posted 24 Jul 2023 at 17:27

Exactly 6 weeks after hifu (partial ablation of prostate) my PSA level is 9.3, an increase on 8.8 a few weeks before Hifu, and 7.3  a few months before that. 

The prostate nurse (at major London teaching hospital) tells me not to worry, as the first PSA readings after Hifu are often high due to inflammation.  This seems credible,  as my prostate was indeed inflamed for a few weeks, it caused acute urine retention for a while.  

However that's over now, I can pee normally, and urination no longer starts with a dash of diluted brown sauce. So shouldn't PSA have started to fall?

Also, within the 9.3 ng/ml, the proportion of free PSA to total PSA is reported as low, only 10.4%. I gather that low percentages of free PSA tend to be associated with prostate cancer whereas higher ones imply inflammation or benign enlargement.

It does seem strange that Hifu on the cancer-containing side lobe of my prostate should have no effect on the gradually rising trend of PSA level.  Unless the PSA is being generated somewhere else?  Despite no sign of it in last autumn's MRI, nor in the 30-core biopsy or the PSMA PET scan.  

Views and information welcome!

(Other details: age 73, T2a NoMo, Gleason 4+3, biopsy 4 out of 32 cores positive, max tumour length 2mm, total prostate size 50mm.)

 

User
Posted 24 Jul 2023 at 20:56

I don't know the answer. HIFU is such a rare treatment we just haven't had many posts about it.

With RP you can expect PSA to go close to zero within a few weeks. With HT you can expect it to drop to 1.0 or less within a couple of months. With RT you can expect it to rise a little as it is several years before the cancer cells die, and there will be inflammation from RT. Chemo also causes a rise in PSA I assume as the cells die, they exude PSA.

With HIFU, I believe the cells are killed immediately, unlike RT, so that would imply PSA would fall rapidly, but I guess as the remnants are still in your body they may leak PSA until they are eliminated.

I wouldn't worry too much about PSA being generated by metastasis, the probability of having mets with a starting PSA of less than 30 is quite low; if your starting PSA is above 100 the chances of mets is quite high.

I think you will just have to wait your next PSA test. Please post when you have it, it will help others.

 

Dave

User
Posted 25 Jul 2023 at 10:22

Thanks for your responses folks.     Paradoxically, I would be less concerned if my PSA had shot up really high for a while after Hifu, as that would clearly have been a hifu side effect which wouldn't have happened if my prostate cancer had been left entirely untreated, the very slow steady rise in my PSA level would have been expected to continue.  As arithmetically it so far has!

The inflammation effect was very obvious in other ways, notably the emergency re-catherisation I had to have at my local A&E for acute urine retention. 

I'm getting a further PSA test shortly via my GP. 

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User
Posted 24 Jul 2023 at 20:56

I don't know the answer. HIFU is such a rare treatment we just haven't had many posts about it.

With RP you can expect PSA to go close to zero within a few weeks. With HT you can expect it to drop to 1.0 or less within a couple of months. With RT you can expect it to rise a little as it is several years before the cancer cells die, and there will be inflammation from RT. Chemo also causes a rise in PSA I assume as the cells die, they exude PSA.

With HIFU, I believe the cells are killed immediately, unlike RT, so that would imply PSA would fall rapidly, but I guess as the remnants are still in your body they may leak PSA until they are eliminated.

I wouldn't worry too much about PSA being generated by metastasis, the probability of having mets with a starting PSA of less than 30 is quite low; if your starting PSA is above 100 the chances of mets is quite high.

I think you will just have to wait your next PSA test. Please post when you have it, it will help others.

 

Dave

User
Posted 25 Jul 2023 at 02:39
i am not aware to the extent that Inflammation may have played a part in connection with your HIFU treatment but after my first HIFU my PSA dropped slightly when first tested about the same interval as yours but thereafter began to rise very slowly but persistently. I subsequently has second HIFU that brought the level to 0.02 or 0.03 where it has remained - good enough for a man who still has a Prostate, albeit a previously radiated one. (HIFU was given as salvage treatment for failed RT in my case, although this is essentially the same procedure as where HIFU is as a primary treatment).

HIFU is a treatment that burns away cancer cells, so I would have have expected there would have been at least some PSA reduction at your first post treatment test if the HIFU hit your cancer which it should have done going on what previous scan/biopsy suggested.

In your situation and bearing in mind what specialist nurse said, I would seek to ascertain PSA level in 3 months time and if it has not fallen substantially by then, refer back to surgeon for what might be further PSA test and possibly further scan(s) as may be considered appropriate.

i

Barry
User
Posted 25 Jul 2023 at 10:22

Thanks for your responses folks.     Paradoxically, I would be less concerned if my PSA had shot up really high for a while after Hifu, as that would clearly have been a hifu side effect which wouldn't have happened if my prostate cancer had been left entirely untreated, the very slow steady rise in my PSA level would have been expected to continue.  As arithmetically it so far has!

The inflammation effect was very obvious in other ways, notably the emergency re-catherisation I had to have at my local A&E for acute urine retention. 

I'm getting a further PSA test shortly via my GP. 

 
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