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Increasing PSA post Treatment

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User
Posted 29 Feb 2024 at 09:47

In late 2018 I was diagnosed with Prostate Cancer Gleeson 6 Stage T1c, the biopsy result was one 2mm focus of atypical fused gland plus 4 cores showing marked BPH from a total of 14 needle biopsies. Prostate size was estimated at 65cc.

In March 2019 I completed 39 sessions of External Beam radiation with no other treatment.

My PSA came down to 1.09 on the 4.12.20 from 14 prior to the start of treatment.

Since then my PSA results are:

15.6.21     1.25

7.12.21      1.47

8.6.22        1.45

10.1.23      1.72

12.7.23       1.69

23.2.24      1.97

There is an obvious upward trend but on two occasions the was no rise in 6 months, I understand there is neither 3 consecutive increases nor a rise of +2 ng/ml above nadir.

I think I also have unusually high testosterone for a 73 year old at 941 ng/dl or 32.66 nmol

Has anyone any knowledge or experience of similar increases and in particular does it look as though I am heading for biochemical failure.

 

Geoff 

User
Posted 29 Feb 2024 at 22:56

Well by the textbook you don't have recurrence. You also have a large prostate, BPH, high testosterone and you are 73. You have plenty of reasons to have a high PSA without it being cancer. 

The rise is in steps of 0.25 once per year. The growth is not accelerating. If it were established cancer I think you would have a clear doubling time rather than a haphazard slow rise.

I presume you have been discharged from the supervision of your oncologist, if that is the case, as soon as the PSA rises above 3.1 get referred back. It is possible that this is a brand new prostate cancer. On current form it will be another four years before you will reach this level.

If one can measure anxiety on a scale of 0 to 10, then I think your current statistics warrant a score of 1 or 2.

Keep monitoring things and keep posting to this thread with new results.

 

Dave

User
Posted 29 Feb 2024 at 21:57

BUMP!

Can any of you RT lad's or lasses help?

User
Posted 01 Mar 2024 at 08:05

Not in the same situation but my PSA sometimes went up and down without any treatment. Whenever I ask the medics for a reason the short answer is usually "we don't know, but it happens". All my tests are listed at the beginning of my profile,all done in the same lab.

Thanks Chris 

 

User
Posted 01 Mar 2024 at 11:07

Yes I did notice the rises alternate between 0.0 and 0.25 every six months. Us humans always look for patterns in data, that is what science is all about. We then come up with a theory to explain it. 

Any data also has errors or noise these are random but for short periods may cause a pattern which we spot. We then try and explain it with a theory, but sometimes there is no explanation.

I did think, is there some activity you do in the last half of the year that increases PSA? but some theories are a little too far fetched.

At the moment the best fit line for your PSAs is +0.25 ng/dL per year, with errors of ±0.125. Very importantly that line is straight it is not accelerating, cancer has an accelerating line. It may be after more results we will spot a pattern of acceleration, until then don't worry. Keep getting tested so you can spot a pattern early if one develops.

 

Dave

User
Posted 23 Jun 2024 at 10:14

I now have the latest results from 21.6.24 (I live in Cyprus had the bloods taken at 11.10 had the results online within 2 hours) that came in at 1.632 from 1.997 in February, very happy!

Testosterone still high at 33.72 nmol/L

6 weeks ago I started having a glass of Tomato juice with a dash of Extra Virgin Olive Oil every day to help reduce my  elevated cholesterol levels and subsequently found out it was also good for prostate health.

I Don't know if it was the reason for the PSA drop after it slowly increased for the last three years but I will continue with Daily TJ and EVOO until at least the next PSA result.

 

Geoff

 

Edited by member 23 Jun 2024 at 17:15  | Reason: Not specified

User
Posted 11 Jul 2024 at 14:04

Thanks Barry, I understand that HT reduces PSA, But I also believe there is a correlation between Testosterone and PSA levels, and as Mine is high for a 74 year old at 33.72 nmol/L I thought it could be influencing my PSA results. Oncologist has put me back to 6 Monthly PSA tests from 4 Monthly and will not Go to yearly until PSA settles down.

 

Geoff

User
Posted 11 Jul 2024 at 23:58

If you look at the research of Abraham Morgentaler, he challenges Higgins and Hodges and suggests that the response of prostate cancer to Testosterone is not a straight line where more Testosterone promotes prostate cancer, but is a hockey stick profile where the prostate is saturated with Testosterone at the bottom of the normal range, and further level increases have no further effect.

He even suggests that Testosterone levels below the normal range promote prostate cancer with a higher Gleason, except when you get down to hormone therapy levels, which do suppress it.

https://www.youtube.com/watch?v=wafNZV-Hkqk

I can't say if he's right, but it's an interesting view (and I have high Testosterone too).

Edited by member 12 Jul 2024 at 09:33  | Reason: Not specified

User
Posted 13 May 2025 at 01:40

That is a largish jump. Strictly speaking your nadir was 1.09 so biochemical recurrence would be triggered at 3.09 . You do have a prostate and it is a large prostate. Your PSA jumps around a bit but it does seem to have an upward trend, and this time it has accelerated a little. 

I can see why the oncologist would decide this needs investigating. I really don't know what they are likely to find. I would guess you have a 50% chance of finding it's cancer, but at the moment it doesn't look like it is particularly aggressive.

Dave

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User
Posted 29 Feb 2024 at 10:45

Hi Geoff.

I had surgery so I'm afraid I can't help. However I just wanted to welcome you to the forum. There are many here that will be able to help with your question.

User
Posted 29 Feb 2024 at 21:57

BUMP!

Can any of you RT lad's or lasses help?

User
Posted 29 Feb 2024 at 22:56

Well by the textbook you don't have recurrence. You also have a large prostate, BPH, high testosterone and you are 73. You have plenty of reasons to have a high PSA without it being cancer. 

The rise is in steps of 0.25 once per year. The growth is not accelerating. If it were established cancer I think you would have a clear doubling time rather than a haphazard slow rise.

I presume you have been discharged from the supervision of your oncologist, if that is the case, as soon as the PSA rises above 3.1 get referred back. It is possible that this is a brand new prostate cancer. On current form it will be another four years before you will reach this level.

If one can measure anxiety on a scale of 0 to 10, then I think your current statistics warrant a score of 1 or 2.

Keep monitoring things and keep posting to this thread with new results.

 

Dave

User
Posted 01 Mar 2024 at 07:16

Thanks Dave, I could not understand why the PSA results showed no increase after 6 months then go up again on the next test (twice), that was the main reason for the post to see if any one else had this type of experience. At first I was hoping it was a bounce but too long after treatment now.

 

Geoff 

User
Posted 01 Mar 2024 at 08:05

Not in the same situation but my PSA sometimes went up and down without any treatment. Whenever I ask the medics for a reason the short answer is usually "we don't know, but it happens". All my tests are listed at the beginning of my profile,all done in the same lab.

Thanks Chris 

 

User
Posted 01 Mar 2024 at 11:07

Yes I did notice the rises alternate between 0.0 and 0.25 every six months. Us humans always look for patterns in data, that is what science is all about. We then come up with a theory to explain it. 

Any data also has errors or noise these are random but for short periods may cause a pattern which we spot. We then try and explain it with a theory, but sometimes there is no explanation.

I did think, is there some activity you do in the last half of the year that increases PSA? but some theories are a little too far fetched.

At the moment the best fit line for your PSAs is +0.25 ng/dL per year, with errors of ±0.125. Very importantly that line is straight it is not accelerating, cancer has an accelerating line. It may be after more results we will spot a pattern of acceleration, until then don't worry. Keep getting tested so you can spot a pattern early if one develops.

 

Dave

User
Posted 23 Jun 2024 at 10:14

I now have the latest results from 21.6.24 (I live in Cyprus had the bloods taken at 11.10 had the results online within 2 hours) that came in at 1.632 from 1.997 in February, very happy!

Testosterone still high at 33.72 nmol/L

6 weeks ago I started having a glass of Tomato juice with a dash of Extra Virgin Olive Oil every day to help reduce my  elevated cholesterol levels and subsequently found out it was also good for prostate health.

I Don't know if it was the reason for the PSA drop after it slowly increased for the last three years but I will continue with Daily TJ and EVOO until at least the next PSA result.

 

Geoff

 

Edited by member 23 Jun 2024 at 17:15  | Reason: Not specified

User
Posted 24 Jun 2024 at 10:48
Geoff: Are you laying off ANY serious sexual activity for 7 days before a PSA test? I hope I don't have to spell that out !

It does effect your PSA level along with some other body infections you may have.

I had that advice at the same time as my HT & RT treatment 4 years ago.

My Latest reading was about 0.5 with no concerns.

Hope that helps.

User
Posted 24 Jun 2024 at 11:52

Thanks Bob, Yes I was aware of that and no heavy exercise etc, Oncologist reduced tests from 6 months to 4 months because of the steady increases, I will be seeing the Oncologist on wednesday. Will just have to see what the next few tests are

 

Geoff

User
Posted 27 Jun 2024 at 21:41

Originally Posted by: Online Community Member

Thanks Bob, Yes I was aware of that and no heavy exercise etc, Oncologist reduced tests from 6 months to 4 months because of the steady increases, I will be seeing the Oncologist on wednesday. Will just have to see what the next few tests are

 

Geoff


OK Good luck 

User
Posted 30 Jun 2024 at 14:48
It is the HT rather than RT that lowers Testosternone level and you arn't having HT so not surprising your T figure is so well up. PSA changes after RT do usually give an indication of whether there is some cancer, except in more rare types of PCa which put out very little PSA. It is only to be expected that there will be a minor increase in PSA after good cells recover from radiation, or where the radiation did not effectively kill or the cancer cells. Cancer cells can remain pretty inactive even for a long time and at some point wake up, so generally this shows up by PSA increasing at a greater rate. So this is sometime that needs to be observed. There can come a point too when small rises mount to a higher level than an indivual patient's circumstances suggest is acceptable and further scans are thought advisable. But you are not there, yet at least but certainly need careful monitoring.
Barry
User
Posted 11 Jul 2024 at 14:04

Thanks Barry, I understand that HT reduces PSA, But I also believe there is a correlation between Testosterone and PSA levels, and as Mine is high for a 74 year old at 33.72 nmol/L I thought it could be influencing my PSA results. Oncologist has put me back to 6 Monthly PSA tests from 4 Monthly and will not Go to yearly until PSA settles down.

 

Geoff

User
Posted 11 Jul 2024 at 23:58

If you look at the research of Abraham Morgentaler, he challenges Higgins and Hodges and suggests that the response of prostate cancer to Testosterone is not a straight line where more Testosterone promotes prostate cancer, but is a hockey stick profile where the prostate is saturated with Testosterone at the bottom of the normal range, and further level increases have no further effect.

He even suggests that Testosterone levels below the normal range promote prostate cancer with a higher Gleason, except when you get down to hormone therapy levels, which do suppress it.

https://www.youtube.com/watch?v=wafNZV-Hkqk

I can't say if he's right, but it's an interesting view (and I have high Testosterone too).

Edited by member 12 Jul 2024 at 09:33  | Reason: Not specified

User
Posted 12 May 2025 at 21:54

A bolt out of the blue today, more recent PSA results are

21.6.24.  1.63

3.1.25.    1.99

But on the 9.5.25.  it was   2.82. Meeting with oncologist today he said he would organise bone scan, pet scan and probably psma? scan.

 

I'm struggling to get my head round the fact that he considers it as biochemical failure.has anyone had a similar increase but scans were clear.

 

Geoff

 

 

Edited by member 12 May 2025 at 22:09  | Reason: Not specified

User
Posted 13 May 2025 at 01:40

That is a largish jump. Strictly speaking your nadir was 1.09 so biochemical recurrence would be triggered at 3.09 . You do have a prostate and it is a large prostate. Your PSA jumps around a bit but it does seem to have an upward trend, and this time it has accelerated a little. 

I can see why the oncologist would decide this needs investigating. I really don't know what they are likely to find. I would guess you have a 50% chance of finding it's cancer, but at the moment it doesn't look like it is particularly aggressive.

Dave

User
Posted 13 May 2025 at 05:00

Would it be normal to try and eradicate other reasons before the scans say a course of antibiotics aimed at water infection or prostatitis etc, or in fact repeat the PSA test?

 

Geoff

User
Posted 14 May 2025 at 04:00

Originally Posted by: Online Community Member
Would it be normal to try and eradicate other reasons before the scans say a course of antibiotics aimed at water infection or prostatitis

The test for prostatitis is based on a relatively simple urine sample and can give an instant result. Your GP could probably do one for you.

I know it's a bit of a worry if your oncologist is suggesting scans but it's probably a good thing to be sure and if a psma pet scan is on offer, you're lucky. They don't hand them out readily.

I'm in a waiting situation a bit behind where you are, age 78, RT and HT; psa in Jan. 24, 0.23 with testosterone @ 18.4nmol/L; psa in feb. '25, 0.63 with testosterone @ 27nmol/L. Next appt. with oncologist is in about a month so I'll have a few questions to ask him. I'm probably within the guidelines of a reasonable psa level given I still have a prostate but watching the level rising is unnerving.

Jules

User
Posted 14 May 2025 at 08:06

Thanks Jules, Yes psma is on offer if 1st 2 scans are clear, not sure if that's because the oncologist believes there is something to find!, or just belt and braces.

I've never been on HT and my Testosterone is  32.66 m/l on the last test (12 months)

Geoff

Edited by member 14 May 2025 at 08:20  | Reason: Not specified

User
Posted 15 May 2025 at 10:24

Paid for a PSA test yesterday, the result  was 2.181  from 2.816  five days earlier, delighted as you can imagine. Will be having an 'official' PSA test at the oncology centre next week. 

 

Geoff

User
Posted 15 May 2025 at 11:12

Originally Posted by: Online Community Member

Paid for a PSA test yesterday (clinical lab), the result  was 2.181  from 2.816  five days earlier, delighted as you can imagine. Will be having an 'official' PSA test at the oncology centre next week. 

 

Geoff

User
Posted 16 May 2025 at 04:21

Excellent news Geoff and maybe a plateau.

The PSMA test might be put on hold now, preferably forever but it's certainly looking good for now.

Jules

User
Posted 20 May 2025 at 15:40

PSA test today but not good at 2.878.

 

I know different lab results can vary but from 2.181 to 2.878 is a large difference.

 

The recent tests were:

 

6.5.25.    2.490.    Local lab

9.5.25.    2.816.    Oncology lab

14.5.25.  2.181.    Local lab

20.5.25.   2.878.   Oncology lab

 

In the past the results have been very close, in fact the oncology lab was usually lower.

 

Waiting for a call back from oncologist but does anyone have any ideas about the different results.

 

Geoff

User
Posted 21 May 2025 at 05:09

Different labs can give different results, so really you should only compare results from the same lab, which gives you a slight decrease in the local lab figures over about a week and a slight increase in the figures from the oncology lab but there's really not enough there to come to any conclusion from either set of results. Dave suggested earlier that your recurrence figure could be a bit over 3.0, so you're pretty close to that now.

Clearly this is causing you anxiety and that's very understandable with your psa at doubtful level. Your oncologist is going to be the one who decides if it's time to do some scans and if he's following up with the suggestion of bone scan with PSMA PET scan it should clarify where you stand and maybe that will give you some peace of mind?

Jules

User
Posted 23 May 2025 at 11:23

Talking to oncologist Monday, would the psma scan be better than having a bone scan followed by pet scan followed by the psma scan.  I may be able to pay for the psma scan for faster results

 

Geoff

Edited by member 23 May 2025 at 11:41  | Reason: Not specified

 
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