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Advice needed psa rising

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User
Posted 18 Feb 2020 at 18:00

Briefly.. I had a RP in October 2014 aged 52 My psa was 0 for 33 months, then rose to 0.08 in August 2017. It then meandered up and down but eventually rose to 0.1 in March 2018. My consultant suggested SRT combined with HT but I opted just for the SRT in June 2018. My psa dropped to 0.00 August 2018. All was well until June 2019 but then my psa reappeared at 0.04 and this month (Feb 20) hit 0.1 once again.

My consultant has now said to wait another 6 months before testing again and has indicated that he won’t take any action until my psa hits 5! 
Please, anyone out there with a similar experience, does this seem a safe course of events? Thanks in advance.

original diagnosis.. psa 4.7  template biopsy said 3+3 Gleason 6 upgraded to 3+4=7 t2c no mo after lab report

Am I reading too much into a potentially short doubling time? Can you use doubling calculators with low numbers?

Thanks
Adrian

 

 

 

User
Posted 18 Feb 2020 at 20:14
ADJ, take a look at my profile where John's PA results are listed. Following RP 10 years ago and then salvage RT 8 years ago, his PSA crept up and has bobbed along at between 0.1 and 0.11 for the last 3 years. He continues to have 3 monthly tests and regular reviews with the urologist and / or oncologist but we have no intention of doing anything until there is evidence of a problem. The onco has said he will arrange scans if it rises significantly and targeted RT if there is a visible recurrence away from the prostate bed but since it has stabilised, it may just be that he produces a high level of 'healthy' PSA. We are not concerned and I don't think you should be yet, either.

The thing about waiting until it gets to 5 does make sense, believe it or not, although some oncos say that they would wait until 10 or even 20. There is a difference between the level at which it is accepted that there is a recurrence (0.2 or 3 successive rises above 0.1) and the optimum point at which to reintroduce treatment, particularly as the treatment will usually be long term HT and is not curative. HT has a limited lifetime of usefulness so the earlier you start taking it, the earlier it will stop working. Waiting until the PSA gets to 5 or whatever means that you have delayed the time when you run out of treatment options. I imagine that you could press for scans once it gets to 2.0 rather than wait until it gets to 5.

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

User
Posted 18 Feb 2020 at 22:47

Adj

Very similar to yourself, my PSA rose to 0.33 last week a couple of years post SRT without HT. My next step is to wait until PSA gets above 1 at which point I will be getting some sought of scan. I discussed the 5,10, or 20 intervention figures and our onco nurse says it all depends on rate of rise and individual circumstances.

Thanks Chris

User
Posted 18 Feb 2020 at 23:25

Someone on here wrote recently doubling shouldn't be used as a criteria below 0.1.

It seems odd that it was hit by the SRT but then came back.  Is it possible to have a psa bounce with SRT.  Lyn seems to imply it is.

When you say your psa was 0, did it not have a 'less than' figure?  It's unusual to be zero.  I assume you've always used the same hospital lab.

I can't add experience, but all the best. Peter

User
Posted 18 Feb 2020 at 23:53

I haven't suggested anything about PSA bounce after RT - if there was such a thing, it wouldn't be this late after treatment, I think, as 18 months post-RT the PSA should be hitting its nadir. 

Sadly, lots of men have a recurrence after salvage treatment; if you need salvage treatment your chance of ever achieving full remission is significantly depleted.

Edited by member 18 Feb 2020 at 23:56  | Reason: Not specified

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

User
Posted 19 Feb 2020 at 06:22

I would be pushing for a scan to find it, but you probably need to wait until PSA is a bit higher before the scan has a good chance of finding where it is. It probably isn't in the previous radiotherapy target area, and if it's far enough away and no more than a few hot spots, it might still be treatable with some focused radiotherapy such as cyberknife.

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User
Posted 18 Feb 2020 at 20:14
ADJ, take a look at my profile where John's PA results are listed. Following RP 10 years ago and then salvage RT 8 years ago, his PSA crept up and has bobbed along at between 0.1 and 0.11 for the last 3 years. He continues to have 3 monthly tests and regular reviews with the urologist and / or oncologist but we have no intention of doing anything until there is evidence of a problem. The onco has said he will arrange scans if it rises significantly and targeted RT if there is a visible recurrence away from the prostate bed but since it has stabilised, it may just be that he produces a high level of 'healthy' PSA. We are not concerned and I don't think you should be yet, either.

The thing about waiting until it gets to 5 does make sense, believe it or not, although some oncos say that they would wait until 10 or even 20. There is a difference between the level at which it is accepted that there is a recurrence (0.2 or 3 successive rises above 0.1) and the optimum point at which to reintroduce treatment, particularly as the treatment will usually be long term HT and is not curative. HT has a limited lifetime of usefulness so the earlier you start taking it, the earlier it will stop working. Waiting until the PSA gets to 5 or whatever means that you have delayed the time when you run out of treatment options. I imagine that you could press for scans once it gets to 2.0 rather than wait until it gets to 5.

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

User
Posted 18 Feb 2020 at 21:25

Thanks for this. It’s exactly why I posted, I’m looking for others with experience as every step along this path is new. 
Best wishes

Adrian

 

User
Posted 18 Feb 2020 at 22:47

Adj

Very similar to yourself, my PSA rose to 0.33 last week a couple of years post SRT without HT. My next step is to wait until PSA gets above 1 at which point I will be getting some sought of scan. I discussed the 5,10, or 20 intervention figures and our onco nurse says it all depends on rate of rise and individual circumstances.

Thanks Chris

User
Posted 18 Feb 2020 at 23:25

Someone on here wrote recently doubling shouldn't be used as a criteria below 0.1.

It seems odd that it was hit by the SRT but then came back.  Is it possible to have a psa bounce with SRT.  Lyn seems to imply it is.

When you say your psa was 0, did it not have a 'less than' figure?  It's unusual to be zero.  I assume you've always used the same hospital lab.

I can't add experience, but all the best. Peter

User
Posted 18 Feb 2020 at 23:53

I haven't suggested anything about PSA bounce after RT - if there was such a thing, it wouldn't be this late after treatment, I think, as 18 months post-RT the PSA should be hitting its nadir. 

Sadly, lots of men have a recurrence after salvage treatment; if you need salvage treatment your chance of ever achieving full remission is significantly depleted.

Edited by member 18 Feb 2020 at 23:56  | Reason: Not specified

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

User
Posted 19 Feb 2020 at 06:22

I would be pushing for a scan to find it, but you probably need to wait until PSA is a bit higher before the scan has a good chance of finding where it is. It probably isn't in the previous radiotherapy target area, and if it's far enough away and no more than a few hot spots, it might still be treatable with some focused radiotherapy such as cyberknife.

User
Posted 19 Feb 2020 at 07:23
I find it strange that after 10 months at 0.00 my psa returned. The drop from 0.1 after the salvage looked like successful targeting. Peter, yes sorry my bad my psa was recorded as <0.03 after my RP for 33 months, and then after RT the same lab used 0.00

LynEyre, I need to learn more about post RT nadir, I would be delighted if I had reached some sort of nadir!

I think the biggest hit about these little numbers is the psychological hit especially after good numbers after RP. I Am coming to terms with the next stage on this journey but the feeling of control being taken away is not good.

Thank you all for replying.

Adrian

 
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