3rd (now 4th) PSA increase

Hi Ray,

I guess you are in the same boat as me, still a fairly low PSA but one which is consistently rising.

My own thoughts, and that is all they are, the uniformed thoughts of a layman, are as follows.

Those of us who have had RT as opposed to RP are still left with a residual 'healthy' prostate gland, which might be expected to make some PSA?

Over the years following RT, the healthy cells of our prostate gland should recover and grow, so some sort of increase in PSA is only to be expected?

Even if cancer has returned, either in the prostate or at some secondary location, the tumour can't be very big if it is only churning out such a low level of PSA.  So presumably no point having scans etc as there is nothing big enough to see?

Choice is therefore whether to go back on HT or not?

Last time I did that, on the recommendation of my consultant's houseman, was when my PSA had gone from 2 to 4 to 6 in as many months.  At my next consultation, the Consultant browsed my notes and said he might have not have put me on HT so soon, he may have been tempted to see how fast the PSA would rise.

As and when the time comes to go back on HT, I am inclined to opt for intermittent HT, and if that was the case the question is how high would we let PSA rise to during the intermittent periods off HT?  There seems little point starting HT until PSA has reached that threshold?

I don't know if any of these thoughts help you, I am merely trying to rationalise my own dilemma.

All the best.

:)

Dave 

Hi Ray,

The 3 consecutive increases do not necessaryily mean that in every case PSA will continue to be upwards and lead to further treatment being offered. Looking at your PSA history I see your PSA in April 2012 was 1.22 and in January 2015 was 1.5, both above your latest figure, so over a long time your PSA has fluctuated but hitherto has fallen from it's peak. Certainly, PSA is not an infalable indicator of where you stand and you were diagnosed with an agressive cancer. It may be that your GP feels it is a point in time where you could be referred back to an oncologist for his/her opinion on whether anything else needs to be considered.

Naturally it is of concern but too early to be alarmed.

i

Hi Ray,

I am not entirely sure that the Gleason grade at initial diagnosis is quite so relevant in the long term.

My initial 2007 G9 cancer had only a 40% chance of surviving the HT and RT I had in 2007-2010, and by 2012 it seemed to have been beaten.

When it 'came back' in 2013 I went through all the tests again, and then some, MRI scans, CT Scans, bone scans etc, template biopsy, and I asked the consultant what my Gleason grade was, he told me that they don't use Gleason grading for previously radiated prostates.

I also asked whether my 2013 cancer was the same 2007 G9 variant that had survived the RT and HT, or whether I had developed a whole new cancer in what had previously been healthy prostate tissue unaffected by the original cancer?  I was told that there is absolutely no way of knowing that, in fact I think the answer was 'your guess is as good as mine'.

Let us assume that my 2007 cancer had been killed off by the initial treatment.  By 2012 I was a man with some healthy prostate tissue within me.  All of the risk factors remained, I still had two grandfathers who had died of PCa, I still had a cousin with PCa, all of the environmental and lifestyle factors that had contributed to me getting cancer in the first place remained.  I was basically still in the high risk camp over 60 etc.  So what came along in 2013 could well have been a brand new cancer?

Let us assume that you hadn't developed PCa initially and not had any of the treatment, you would still at your age be a prime candidate for a new PCa and it could be any Gleason grade, take your pick, 6, 7, 8 ,9, 10?

:)

Dave

I think you are correct Dave that tumours can start afresh within a previously radiated prostate or be due to a few cancerous cells, possibly due to some of these not having been reached by RT or being radio resistant, beginning to become more active at some stage, although it has not yet been established that Ray is in this situation.

In my case after failed RT, the template biopsy given prior to my having HIFU in 2015 was given the same Gleason grade of 3+4=7 as was assessed at my original pre RT biopsy in 2007.

B****r - and we so wanted it to be just the GP being over-cautious. Really sorry to see this update Ray but your gut instincts have not failed you in the past - what is your inclination right now? Referral back to oncology is a given, I imagine, but a game plan is needed.

Hi Ray,

PSA could still be part of a fluctuating cycle but certainly sensible discussing with your consultants. If considered appropriate, HT may bring the PSA level down but can mask what is the true situation. For some, (which included me), high quality scans can show tumour growth with a quite low PSA, whilst scans of others with rather higher PSA levels show nothing, maybe due to less concentration of the cancer cells. As the scans in my case showed a suspected Prostate tumour with the PSA of 1.44. I had a 50 needle template biopsy with only a single core revealing cancer. It rose to 1.99 immediately before HIFU which has subsequently knocked it back to between 0.39 and 0.76 (0.66 at most recent PSA test). I decided not to have the offered HT until PSA goes beyond 2. Our respective situations may be different but you could ask about a high quality scan at some stage if your PSA continues it's overall upward trend and maybe HIFU if this and a biopsy identifies a tumour in Prostate. Like me, perhaps you would wish to defer HT if appropriate, by having salvage treatment first? But let's see what your consultant's have to say.

Edited by member 20 Apr 2017 at 22:59  | Reason: Not specified

Hi Ray
About 6 months after starting Cialis I had swallowing issues. I've always had acid reflux and used gaviscon. But the swallowing was different. Was put on Lanzoprazole which worked but it trashed my guts. Now on Pantoprazole and zero issues.