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PSA has risen {slightly} but still worried

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User

Posted 15 Apr 2025 at 10:06

Hi guys

First i must thank you for your replies to my original post.

My first PSA test after my op was 0.044 in December

My second PSA test was 0.055 in April (last week)

It has risen only slightly so really i should "man up" and not worry, but my question is--- Can the cancer spread and the PSA level stay low?

My doctor did say that my cancer was "not just confind to the prostate gland, however, a number of nodes were removed which showed no signs of cancer"

On a different subject urinary continence is almost back to normal. Erections!!! zero out of ten, dont really have any sexual urges never mind erections, its 7 months since my op, your helpfull comments please

thanks

ARTHUR

User

Posted 15 Apr 2025 at 11:31

I really would not worry about that tiny increase, it's gone up by just 0.011 which (I would think) is well within the normal range of day-to-day fluctuations.

User

Posted 16 Apr 2025 at 07:12

Hi Arthur,

Please don’t beat yourself up about feeling this way, and if anyone tells you to “man-up”, tell them to 🤬🤬🤬 off!

All of us on this journey know about PSA anxiety, some can handle it better than others, and I’m not one of them so I know how you’re feeling.😩

If you’re in doubt contact your CNS or one of the Specialist nurses on here for reassurance.

All the best,

Derek

User

Posted 16 Apr 2025 at 16:58

Hi Arthur. As Craig380 says you are talking about tiny amounts here and it's too early to draw any conclusions. Did your histology indicate any positive margins on the prostate? It's possible there might be a tiny bit of healthy prostate left in there which is doing what prostates do - producing PSA. Two readings are not enough to determine a trend, so here's hoping it just stays stable. Chris

User

Posted 16 Apr 2025 at 21:37

Arthur, you are hopefully a long way off any further intervention, but make sure you get your blood tests done. You could be another couple of years before any further action is considered. It took a while but I stopped worrying about PSA results. Worrying won't change the results. If my PSA went down great, if it went up I asked what's next.

Thanks Chris

User

Posted 17 Apr 2025 at 08:27

Hi again Arthur.

Your post op cancer staging was Gleason 4+5, T3a N0 MxR1. I'm not medically trained but believe the MxR1 is basically the same as saying you had a positive margin.

This means a microscopic amount of the disease had been left behind which could account for this very small PSA rise.

My post op cancer staging was identical to yours except I had no R1, meaning I was lucky to have negative margins.

Very recent research indicates that the R1 doesn't significantly increase the risk of recurrence.

https://pubmed.ncbi.nlm.nih.gov/35387469/

Unfortunately, our high Gleason score does increase the risk of recurrence. I've been lucky, and two years later all my PSA checks have remained undetectable at <0.02. However, nonograms still indicate that I have 50% chance of recurrence within 5 years.

As far as I'm aware, further treatment may be considered if your PSA rises three consecutive times or reaches 0.02.

Hopefully your PSA will stabilise and remain at such a low level that no further treatment is needed.

Best of luck mate. 👍

Edited by member 17 Apr 2025 at 09:23 | Reason: Typo

User

Posted 17 Apr 2025 at 10:26

Adrian

My interpretation of that research was slightly different. I thought that they were saying that, although recurrence is somewhat more likely with positive margins, a lot of men with positive margins nevertheless do not end up with recurrence and that positive margins alone should not necessarily lead to adjuvant radiotherapy.

My impression is that most research does show that positive margins increase the risk of recurrence. Here is a recent study which looks at the results from a large number of research projects and summarises how the increased risk may depend on the location of the margin.

https://pmc.ncbi.nlm.nih.gov/articles/PMC11846713/

Incidentally did you mean 0.2 rather than 0.02 ?

Kevin

User

Posted 17 Apr 2025 at 10:28

Hi Adrian

I am not sure that is what this research paper is saying. I think it is saying a positive margin is not a reason to offer adjuvant therapy ie before evidence of BCR. It is saying that in their research there is a stronger correlation between BCR and higher Gleason score but if I am reading it right 50% of men with positive margins experienced relatively early BCR.

User

Posted 17 Apr 2025 at 14:45

Hi IDK2 and KS25.

As far as I understand things that increase the risk of BCR are extra prostatic extension, Gleason score and positive margins. This new research seems to indicate that R1, positive margins are less significant than once thought, and less significant than the other risk factors?

Kevin, you're right, mate, in saying that most hospitals still use 0.2 as a possible trigger to salvage treatment and not as I stated 0.02.

I can only put that mistake down to a typo. I'm sorry if I caused any confusion 😕

Your link to very recent research on PSM and BCR is interesting. Thanks for posting it

Edited by member 17 Apr 2025 at 16:59 | Reason: Typo

User

Posted 17 Apr 2025 at 15:52

Yes - and other factors are sometimes included (eg pre-op PSA, cribriform pattern, tumour volume).

I suppose that from Arthur's perspective, the post-op pathology would seem to indicate an above-average statistical risk of recurrence, which is bound to be worrying.

The initial PSA test results may be an early sign of recurrence but, as others have said, it is too early to say and more results will be needed to see if there is a real upward trend. That is a bridge to cross when it comes and Arthur's medical team will no doubt be monitoring the results carefully to assess whether any further treatment will prove to be necessary.

It is, however, important to keep in mind that, although potential recurrence is always a worry, with prostate cancer it is very far from implying the gloomy prognosis that it has with other cancers.

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