Recurring PC with bouncing PSA

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User

Posted 29 Nov 2019 at 14:49

Hello, I was first diagnosed with prostate cancer in 2003 when my PSA was 15. (Gleeson 5. T2) grade 2+3).

I had 3D Conformal Radio Therapy May/June 2004 at PRESTON ROYAL PSA went down slowly to 0.72 in 2008. Stayed below 1.27 till 2015. Rose to 4.76 in Oct 2017. 7.28 in Oct 2018. (then dropped to 5.5 in Jan 2019?) 7.24 in Oct 2019. Tested every 3 months with readings up and down. Clear MRI scan this year.

I am 70 years of age and have never had any problems except loss of libido. The specialist wants me to start Hormone treatment if my PSA goes to 10. I am wondering as it is so slow moving if that will be necessary?

User

Posted 29 Nov 2019 at 20:06

The fact that the PSA test, is not very reliable, either - which is why it is not used in mass screenings.

Too much panic might be caused.

User

Posted 29 Nov 2019 at 21:09

My dad has had a recurrenceand his onco advised that rather than set a specific point of 10, 20 or similar, he would rather watch and wait - only intervening when the PSA doubling time gets to 6 months. He predicts (using well established nomograms) that in dad’s case, that will be about 20 years from now. Dad is quite a lot older than you, so 20 years would be a major achievement though 😂

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

User

Posted 30 Nov 2019 at 22:40

Hi Daveee, I was operated on at Preston and similarly live on the the Fylde Coast.

Your psa is varying quite a lot when viewed in the annual figures stated.

1.27 till 2015.
4.76 in Oct 2017
7.28 in Oct 2018
5.5 in Jan 2019
7.24 in Oct 2019

Waiting as long as possible before treatment seems a good strategy if you have the ability to put up with it as there are only so many treatments you can have.

The increases between 2015 and Oct 2018 must have been worrying but 12 months of down and up gives it a different context. If it was to double in 6 months it would be another surprise reaching up to 15. Waiting till it reaches a point where a more detailed scan type might find something could be a plan. It might be quite a long time if more recent trends persist. I wouldn't be so sure on just going on hormones with finding out all I could from scans, like perhaps a PET scan if possible. It could be that if something is seen it could be treated locally rather than systematically.

You presumably have a lot more readings so did it change gradually. Is there anything that might have affected your psa since Oct 18 it seems odd that it peaked there and then went down and back up. If it had carried on it would likely be around 12 or more now.

You must be one of the longest members of this forum. I've met 3 people from Thornton with the condition and have met very few in total. I don't know if that's coincidence, one was in the bed next to me after my op.

I'm not that knowledgeable about hormones but the above are my thoughts from what I've read.
Regards

User

Posted 30 Nov 2019 at 23:31

Peter has outlined the approach I would take in the same circumstances. It may be a PSMA scan and specifically targeted MRI might find a small tumour that could be individually treated. This could possibly obviate the need for HT or at least defer it. However. should the increased PSA trend reach a certain point (and 10 is a point used by many oncologists), there is a possibility that micromets may be thought responsible and HT should then be started.

Barry

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