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Another psa test, a slight trend up and scans make you worse

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User
Posted 10 Jun 2025 at 14:13

Three psa tests in a week reading 0.18, 0.15 from my GP.  Then 0.15 from the PCa team at a different hospital.

The NHS is really pulling out the stops.  I went to the GP with a sore back which came on during a coughing fit with Covid 8 weeks ago.  Also a sore area in the ribs I'd had for a while.  Thinking I'd be referred to a physio.  Perhaps it was an unfortunate request for them to preclude mets? 

Next thing I'm off for an X ray which finds 2 vertebrae with fractures and osteoporosis.  Then I'm off for a CT Scan which finds more unrelated problems.  An MRI of my spine is ordered plus a fracture clinic and a routine cardio clinic.  The more scans you have the worse you become.

Not only the above but the psa reading at 0.15 is +0.03 which is above trend and should be +0.02 at the most.   I'm not sweating yet, we'll see what the next reading brings as my psa has a habit of not increasing in summer.  If this is summer.

 

Edited by member 10 Jun 2025 at 21:58  | Reason: Not specified

User
Posted 11 Jun 2025 at 06:44

Hi Peter.

I was Gleason 9(4+5), PSA 7, T3a (extraprostatic extension) and had my RARP over two years ago. I was lucky and had negative margins. So far my PSA has remained undetectable at <0.02.

However, nomograms:

https://www.mskcc.org/nomograms/prostate

suggest that my chances of remaining BCR free after 5 years are 63%, after 7 years 49% and after 10 years only 37%. This mystifies me. Logically, I'd have thought the longer your PSA remains undetectable the less chance you'd have of BCR?

If we take 0.15 as your latest most accurate reading it appears that in your case, it has only risen 0.05 in two and a half years. 

I think if I were in your position I'd be asking whether, at this stage, any further treatment is really necessary?

I can also fully sympathise with your frustration of having other disorders to deal with. I have bone problems, and I don't mean just the inability of getting one.🙂

My pre op bone scan revealed several lytic areas around my pelvis area and both legs. Initially they thought it might be PCa linked but came to the conclusion it was some arthritic problem. I do get very frequent bone pain, especially when it's cold and damp. On top of that only a couple of months after my op I had a heart attack and ended up having a couple of arteries drilled out and stents fitted. So the old ticker is still being monitored.

I feel like I'm an old banger that's just  managed to pass its MOT but has got a ton of advisories. 

I hope that your PSA stabilises, mate.

Best of luck.👍

Edited by member 11 Jun 2025 at 07:05  | Reason: Typo

User
Posted 11 Jun 2025 at 07:59

Hi Adrian. The stats do seem to defy logic but if you look at it this way:

Take 100 men. 63 of them will be cancer free at 5 years. 43 will still be cancer free after 7 years and by 10 years only 37 men remain cancer free. So most of the BCR occurs in the first 5 years and gradually tapers off as time goes on. That said, with your T3a and Gleason 9 you are doing really well so keep drinking the beer, it's clearly good for you 😄

User
Posted 11 Jun 2025 at 10:19

Hi Adrian

You said that logically you would have thought that the chance of BCR would go down, the longer your PSA remains undetectable. There is a lot of research which shows that this is indeed true. Not only that, but a longer time to BCR also indicates a more favourable prognosis on average if BCR does eventually occur.

In terms of the Kattan nomogram, the way it works in relation to the figures that you quote is that if you are still undetectable at the time of your next PSA then the risks of BCR at 5/7/10 years (which are already lower than they were just after your operation) will all go down again. 

Best wishes

Kevin

 

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User
Posted 10 Jun 2025 at 21:26

Hi Peter. Sounds like you unexpectedly had a full MOT and discovered you are not as roadworthy as you thought you were. Just out of interest has the Oncology team said your detectable PSA is BCR or are they still keeping an open mind? My last two readings were very slightly detectable (0.02 and 0.01) so I might be following in your footsteps.

User
Posted 10 Jun 2025 at 22:45

Hi Chris,  You're right, the wheels are still on but at the moment I wouldn't take it on the motorway.

I once asked about formal BCR and the nurse said she'd find out.  I didn't pursue it.

They moved me unexpectedly from Urology to Oncology at 0.11 and offered RT to the prostate bed. I'd call that a BCR declaration.

Your psa at 0.02 and 0.01 is very low. Good luck, Peter

User
Posted 11 Jun 2025 at 06:22

It's good that you still have SRT to fall back on. Unfortunately I've already used that one up.

User
Posted 11 Jun 2025 at 06:44

Hi Peter.

I was Gleason 9(4+5), PSA 7, T3a (extraprostatic extension) and had my RARP over two years ago. I was lucky and had negative margins. So far my PSA has remained undetectable at <0.02.

However, nomograms:

https://www.mskcc.org/nomograms/prostate

suggest that my chances of remaining BCR free after 5 years are 63%, after 7 years 49% and after 10 years only 37%. This mystifies me. Logically, I'd have thought the longer your PSA remains undetectable the less chance you'd have of BCR?

If we take 0.15 as your latest most accurate reading it appears that in your case, it has only risen 0.05 in two and a half years. 

I think if I were in your position I'd be asking whether, at this stage, any further treatment is really necessary?

I can also fully sympathise with your frustration of having other disorders to deal with. I have bone problems, and I don't mean just the inability of getting one.🙂

My pre op bone scan revealed several lytic areas around my pelvis area and both legs. Initially they thought it might be PCa linked but came to the conclusion it was some arthritic problem. I do get very frequent bone pain, especially when it's cold and damp. On top of that only a couple of months after my op I had a heart attack and ended up having a couple of arteries drilled out and stents fitted. So the old ticker is still being monitored.

I feel like I'm an old banger that's just  managed to pass its MOT but has got a ton of advisories. 

I hope that your PSA stabilises, mate.

Best of luck.👍

Edited by member 11 Jun 2025 at 07:05  | Reason: Typo

User
Posted 11 Jun 2025 at 07:59

Hi Adrian. The stats do seem to defy logic but if you look at it this way:

Take 100 men. 63 of them will be cancer free at 5 years. 43 will still be cancer free after 7 years and by 10 years only 37 men remain cancer free. So most of the BCR occurs in the first 5 years and gradually tapers off as time goes on. That said, with your T3a and Gleason 9 you are doing really well so keep drinking the beer, it's clearly good for you 😄

User
Posted 11 Jun 2025 at 08:05

Thanks for that Chris. The way you've put it now makes sense to me. 👍

User
Posted 11 Jun 2025 at 10:19

Hi Adrian

You said that logically you would have thought that the chance of BCR would go down, the longer your PSA remains undetectable. There is a lot of research which shows that this is indeed true. Not only that, but a longer time to BCR also indicates a more favourable prognosis on average if BCR does eventually occur.

In terms of the Kattan nomogram, the way it works in relation to the figures that you quote is that if you are still undetectable at the time of your next PSA then the risks of BCR at 5/7/10 years (which are already lower than they were just after your operation) will all go down again. 

Best wishes

Kevin

 

User
Posted 11 Jun 2025 at 17:17

Hi Adrian,

You've done well to be less than 0.02 which is said to be a re-assuring score.  I never knew lower than 0.05 and the slowness it went up my psa might have been rising for years before I found out.

I agree that looking over 2.5 years it looks alright but 0.03 of that 0.05 increase came in the last 5 months.  I won't know until the next test if it's a new trend.

The Consultant, a year ago, offered me RT at 0.11 but said I could hang on until I'm in my 90s and then have hormones at the rate it's increasing.  I enjoyed those words, worthy of a beer in the evening.

Having had Prostate Cancer put me on a faster and more thorough pathway I think, I'd never have suspected any cardiac issues as I regularly exercise.   I hope there are no stents needed for me,  Good luck, Peter

 

 

User
Posted 11 Jun 2025 at 17:53
If you are a g9 you are much more likely to have a recurrence sooner rather than later. So if you make it past 5 years without one as a G9 that is probably really good news and you probably won't have one at all.

 
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