Fluctuating PSA on AS , usual?

User

Posted 07 Nov 2024 at 10:46

Hi, this is my first post and seeking any experiences of quite variable PSA. I'm 52 and was diagnosed in Mar 24 with PC gleeson 3+3 1/16 cores. I've beennhaving PSA tests for a few years as Dad was diagnosed at stage 4 about 5 years ago and passed away earlier this year (74 yrs old).

My readings have been yo-yo'ing but with definite upwards trend. Consultant says nothing to worry about and stick with AS, next PSA in Jan.

PSA results -

Feb 22 - 3.9

Jun 22 - 3.7

Dec 22 - 5.2

Mar 23 - 4.4

Aug 23 - 3.7

Feb 24 - 5.4

Jun 24 - 5.9

Aug 24 - 5.2

Oct 24 - 6.7

Should I worry that has gone from 4 to nearly 7 in less than 2 years? Is it normal for levels to go up and down so much?

Concerned biopsy might have missed something more significant particularly given my Dad's PC was quite advanced in his 60s.

Appreciate any thoughts. Thanks

User

Posted 07 Nov 2024 at 18:00

Hi Chris,

Welcome to the forum. There are many non cancerous reasons why your PSA can rise. However, a trend that shows a continuous rise should be further investigated.

Best of luck mate.

User

Posted 09 Nov 2024 at 17:45

Have you had a MpMRI? Was your first biopsy a random grid? If you did have an MRI, with the continuing PSA increase I would definitely push for another one in January and that way they also have your previous one for comparison. In addition if something is seen they can do a fusion guided MRI biopsy. AS certainly is extremely valuable for quality of live issues such as incontinence and ED. It was overwhelming shown prostate cancer patients were over-treated with surgery and radiation and incurred these side effects when they might have never needed surgery and hence AS. Unfortunately not everyone can remain on AS and that is the need for continued regular surveillance through PSA checks, MRI’s and additional biopsies. Also unfortunately no one knows exactly when that tipping point at what month or year the cancer needs treating. Many on AS are devastated to hear they now need treatment as it appears the cancer has left the capsule. That is the point, it is really difficult to know when that point is going to occur, but if caught early through active surveillance most treatment options including surgery are still available. I think many people on AS believe it will always be caught just before breaking out, but more likely it is caught after that, because the cancer for the patients who ultimately will have to leave AS, that cancer is growing. The belief in AS is that this gives patients possibly many years of quality of life with no incontinence and ED and also many times in those patients on AS that AS did not work maybe a year or two. That becomes the trade off if you are able to accept that if you on AS and it fails and although the cancer might have left the capsule you will get successfully treated as if you immediately were treated in the first place. The difference is for maybe two additional years you enjoyed the highest quality of life but with the trade off knowing that you have cancer inside of you that could be growing. Also new treatments and techniques are always in the pipeline that if able to hold off on treatment it might be something that becomes available to you. AS is a difficult decision but its a trade off.

User

Posted 11 Nov 2024 at 08:59

Thanks Ned. Had MRI in March this year. Assume was mpMRI not sure how you know? I also had MRI in 2022. The one in 2022 was pirads 2/3 (47cc prostate) the one this year was pirads 3/5 (52cc prostate) and noted indeterminate 6.5mm area in right mid gland towards apex. I had been quite comfortable with AS as MRI result didn't seem too concerning, PSA was relatively low at 5.4 ( psa density 0.1) and only one core of 16 in biopsy finding 3+3. But the PSa rise to 6.7 has spooked me a bit. Definitely going to push for another MRI in Jan. But how reliable are they? Is PSA better indicator of progression?

User

Posted 11 Nov 2024 at 09:24

Hello friend, from my own experience the PSA is quite nonspecific.
It is a specific marking for the prostate but not for cancer in untreated men,
however it is very specific for cancer in already treated men.

B.R.

User

Posted 11 Nov 2024 at 18:14

An MpMRI is a different type of scan using other software for more detailed images. I have no idea if it is difficult or easy or how quickly to change a regular MRI machine to read MpMRI or certain machines are left in one mode or the other. Your Doctor would definitely know which one, but it seems more common an MRI scan of the prostate is standard as done as an MpMRI because the request is for a prostate and just referred to as a MRI, but not always. The accuracy of the MpMRI I believe is something like 90%+ accuracy for detecting the cancer but cannot determine the level of aggressiveness or grade which comes from the biopsy and usually then the biopsy is a MRI fusion directed of the lesion or area of abnormality. Your doctor would know if you had a fusion biopsy or not. It can show if it appears contained. A typical random grid is 12 cores, so 16 might indicate the additional core areas were taken in the specific area of concern. Your increasing PSA is definitely of concern and needs to be addressed through another MpMRI. Having the ability to compare two MRI’s for differences is significant.

Your biopsy may still have been a random grid which can miss the cancer which would be the concern with your rising PSA. Only 1 core out of 16 and finding just one core of 3+3 is understandable with your AS position, however the increasing PSA is concerning and does need further investigating. I think being under AS with these PSA number increases, another biopsy would be warranted.

Here we have Decipher testing and Prolaris to determine how aggressive the cancer is from a biopsy usually ordered for cancer above 3+3.

User

Posted 11 Nov 2024 at 20:50

Thanks Ned. Coincidentally I received the MRI and Biopsy reports today. It was an MPMRI.it noted chronic inflammation in peripheral and transition zones consistent with prostatic hyperplasia and small 6.5mm focus of mild restricted diffusion in the right midgland towards apex posterior peripheral zone (3/5). The Biopsy seems to have covered to midzone (left & right lateral and medial) and base (left and right lateral posterior and medial posterior). 2 cores in ea h of theb8 locations. All benign apart from one core in midzone right medial - gleeson 6, 5mm. That seems to tie in with the area from the mri if I've got my zone correct! I think that's a little more reassuring as both mri and Biopsy seems to be indicating same location and enlarged prostate may be contributing to psa levels. Anyone know if 52cc prostate is unusual at 52 years. Thanks

User

Posted 11 Nov 2024 at 21:00

Hello mate, those results sound reassuring.
I hope that mine are also good in the mpMRI that I have scheduled for December 17th
since I have had a rise in PSA from 5.85 to 35.80 ng in 3.5 months
and now within 1 month I have a PSA of 11.70 after of a 14-day
treatment with ciprofloxacin and permixon.
I hope these fluctuations have nothing to do with the tumor :(

Tremendous anxiety that I am suffering. B.R.

User

Posted 11 Nov 2024 at 21:27

Hi Krispy,

In answer to your query about the size of your prostate gland, my gland was 28cc at age 66.

Best wishes,

JedSee.

User

Posted 11 Nov 2024 at 21:29

Definitely reassuring for BPH which also increases PSA

User

Posted 11 Nov 2024 at 21:35

Hopefully your rise is just down to infection. Treatment seems to be bringing it down. Good luck.

User

Posted 12 Nov 2024 at 21:51

Hi Chris,

I just posted some of my thoughts which crossover with your situation on another thread but I suppose my only question on AS at your very young age (not as young as me though! 🤪) is what is continued AS going to achieve? It's not going to make it go away, it can only get more significant if left to it's own devices and you will surely require treatment at some stage.

My PSA readings also fluctuated and I had multiple contrast mpMRI's after my first biopsy came back negative and none of them could identify the cancer that the 2nd biopsy eventually picked up. MRI's are good but saturation TP biopsies are the gold standard and even they can never be completely accurate.

The fact that your biopsy came back so favourably in terms of only one positive core at a low grade is fantastic news (as much as being told you have cancer is 'fantastic'!)

At the moment, you can and should be in control of your own destiny. It would be a completely different story if you were 70 or 80 but I would be cautious about giving this disease the time to get the upper hand given your age.

All the best, Paul

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