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Falling PSA - Prostate cancer, diagnosis, active surveillance,treatment

Posted 19 Jun 2014 at 16:31


I was diagnosed in November 2013 with a Gleason score of 6 (3+3) when my PSA level was 5.6. Since then I have had 2 three monthly PSA tests which recorded falls to 2.3 and 1.94 (this week) respectively.

In the light of the PCa diagnosis can I safely rely on the PSA test and 12 monthly scans (under Active Surveillance) to be a good indicator of the advancement (or not) of my disease?

Any advice would be welcomed.



Posted 20 Jun 2014 at 09:29

Just looked at your profile to see what treatment you have had so far, what pills. DRE whatever and you don't say. So failing that I assume you have had a DRE and a biopsy (to give you the Gleason score), therefore, in my opinion, I would try to stay on a PSA test every 13 weeks and keep a note of all the results and if PSA goes up see your medical team for advice.


Posted 20 Jun 2014 at 09:55
Thanks Chris - I've actually had three biopsies in a three month period (one TR and two TP) taking 70 core samples in all. Apart from that, no other treatment or medication at all.

I suppose my "concern" is this. As I have had a definite cancer diagnosis, and subsequent to that diagnosis the PSA level has fallen substantially (indeed to what would otherwise be considered "normal"), how safe is it to rely on the PSA test almost solely (apart from possibly 12 monthly MRI scans) as a means of signalling any change in my condition? If the answer is that I can, and therefore have nothing to worry about, I can continue on Active Surveillance without fear of missing any current "window of opportunity" as it were.

On the other hand, if the PSA test is an unsafe indicator in my case (and therefore continuing "normal" level results should not be relied on) should I be doing anything other than simply waiting 12 months for the next MRI scan?

I apologise if this sounds like I am worrying unnecessarily, but I am worrying nevertheless - and all the medical people involved simply say "it's your decision, and yours alone, whether to have active treatment or not".


Posted 20 Jun 2014 at 11:22
Hello Johnday.

My husband John was on active surveillance for just over a year before he had treatment (seed brachytherapy) this month.

If you want more information go to the search feature (the one that says "show search" just above the conversation lists and on the right hand side)

There are a number of Active surveillance conversations on there that you could look at while you wait for more members to get back to you.

Difficult time, this waiting around. Indecision can be very draining, especially when you are expected to get on with it and make your own mind up.

Best Wishes


We can't control the winds - but we can adjust our sails
Posted 20 Jun 2014 at 16:06

have a look at your paperwork and check that you were diagnosed with adenocarcinoma. There are many types of prostate cancer but this one is the most common. There are a couple of very rare strains which are characterised by low PSA even though they are very aggressive and men with those rare types cannot rely on PSA as an indicator of progression. I am sure you do not fall into that category as the medics would be urging you straight into chemo rather than letting you opt for AS.

The other time that a minority of men cannot rely on their PSA is in the late stages of a very advanced cancer - in this circumstance, the cancer becomes so aggressive that it doesn't have the energy to produce PSA any more.

Having a more 'normal' kind of PCa, and having had 70 samples to reassure you and your medics that yours is a contained early stage low risk cancer, your PSA level should be a relatively reliable measure of what is going on in your body. I guess that you are one of those men who could in other circumstances have gone through the rest of your life oblivious that there was anything wrong!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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