I started ADT(trestar+Casodex)in august after 2bone spots found onPSMAPETCT PSA=0.7
First PSA..< 0.003 In 2 october
SecondPSA..0.003 In 29 november without <sign.Confused.
Is my PSA rising slowly only after less than 3months!what is your ideas guys?
Wish you all the best.
Hello Alinur,
We have seen these kinds of reports many times. I think your actual PSA is unchanged. I think the only difference is that someone left off the "<" less than sign.
As you probably know, when a PSA test report shows <.003, it means that .003 is the lowest possible value that this test is capable of measuring, in other words, the test equipment came back with no detected PSA. The machine and/or the lab technician might report that as the lowest detectable value (.003) or might report it as <.003. When you get two different reports of that kind, it almost always turns out that it's just an artifact of the report not a change in the PSA.
Congratulations on the excellent response you're getting to your treatment.
Alan
Alan thank you!
I repeated the the next day.same lab.the result is 0.008!! Incredible!! Less than 24 hours. Is that reliable after only 3 months of ADT!!
If by "reliable", you mean does it indicate that the amount of cancer has increased by 2-2/3 times in 24 hours, the short answer is certainly No. Here are some possibilities:
1. The numbers are due to random testing factors and are meaningless.
After all, we're talking about truly submicroscopic amounts of PSA. .008 ng/dl (nanograms per deciliter) works out to 8 trillionths of a gram of PSA in 100 grams of blood. That might happen if the testers didn't perfectly clean out their machine and a spec of blood from the last person tested was still there, or if the machine calibration were very, very slightly off. Maybe there happened to be a few live circulating tumor cells in the blood sample you gave and they put out a few hundred molecules of PSA that were trapped in the sample.
2. The numbers mean something, but don't mean anything about cancer.
It could conceivably happen if something happened to you before the test that stimulated your prostate tumor cells to produce a bit more PSA - maybe something you ate or some exercise that you did. PSA output varies in most people from day to day and hour to hour and when measuring such tiny amounts, we don't know what caused it.
3. The numbers mean something and it is related to cancer growth.
This is the one we should be concerned about. I'm pretty sure that the 8:3 ratio of PSA in the two tests doesn't mean you have a cancer cell doubling time of 10 hours or so. I've never heard of anything even remotely close to that. However it could conceivably mean that the cancer is growing.
What I would recommend is that you and your oncologist come up with a thought out plan, so that you both know what you'll do if the cancer is in fact growing. Panic is, of course, not a plan. Let's not think about it, just wait and see what happens (easy for a doctor to say, not so easy for a patient) isn't much of a plan either. I personally would like a plan that says something like the following:
- We'll do a PSA test every 2 months (or 1 month or 3 months or whatever - I'm no expert on what is best.)
- If and when the PSA gets beyond 2.0 (or 0.5, or 10.0 or whatever - again I'm no expert on what is best) we'll add Zytiga (or chemotherapy, or Casodex (if you're not still on it), or Firmagon, or whatever) to your treatment.
A plan like that is a kind of wait and see, but it's not a dumb wait and see. You'll have a plan for how long you'll wait between tests, a plan for what you do or don't want to see (i.e., a particular PSA level), and a plan for what you'll do if you see it.
I don't think you need to rush to the doctor's office this week to work out a plan. Even if you have incredibly aggressive cancer that has become completely resistant to your current treatment, it will probably take months to reach any reasonable growth threshold a doctor would recommend for changing treatments.
The plan doesn't have to be rigid. You and the doc may change your minds. There may be new findings about prostate cancer or new drugs or whatever that would cause you and the doctor to think differently. But having a plan means that you're still in control and know the path forward. It removes some of the critical uncertainties.
In the meantime, I think there's still a decent chance that the .008 reading was a fluke and that your next reading will be lower again. But even if it's not, I think there's really nothing to do until after your PSA has been clearly established as going up. You can ask your doc about it, but I suspect that almost all doctors would say it's a mistake to change treatments because of a change in PSA of 0.005 ng/dl.
Also in the meantime, don't forget to live your life. After all, living our lives is not all about being frightened of dying. We all knew we would die someday long before we were ten years old. It was scary, and it's still scary, especially when can see the end more clearly than we could then. But I really hate the idea of giving up my life now because I know I'll have to give it up later. What can be more self-defeating than that?
Best of luck.
Alan
Pertinent advice,Alan.
I don't do regular exercises but I walk almost everyday about 10km.I had 15km jogging 2 consecutive days for the first time just a long distance. Since I have osteoarthritis all over my bones which sometimes messes with my PC imaging, I was having pain everywhere aftermath.Then the next day I had my blood drawn.
What I knew is that exercise doesn't affect PSA if you have no prostate! But...
Yes,my cancer is considered aggressive because at a PSA of 0.7 (g7) they found 2 bone mets on PSMA PET but after less than 4 weeks of ADT my PSA was <0.003.then after another 5 weeks 0.008 rising!?
I would like to know if anyone in this forum had such short time effective ADT.
I never let my PSA go beyond 1ng/ml since my surgery 7 yes ago.
Best to you!
I'm not sure about the idea that no prostate means no effect of exercise. You've still got prostate cells even if they are tumor cells and even if they're scattered around and outside the prostate bed and in distant metastases.
It's believed that inflammation is a significant factor in prostate cancer and we know it causes a rise in PSA among prostatitis (inflammation of the prostate) patients who don't have cancer. We also know that inflammation is accompanied by an increase in inflammatory chemicals (e.g., prostaglandin) in the blood. We also know that arthritis causes chronic inflammation that presumably gets worse after exercise puts a strain on it, and we even know that you have bone mets which might even be near targets (arthritic bones) that are attracting inflammatory chemicals. So (and I admit that I'm speculating based on something not too far from total ignorance here) it seems at least plausible to me that your exercise caused your PSA to rise by 5 or 6 trillionths of a nanogram per 100 grams of blood.
Looking at your last sentence of the above reply, I see that you do have a plan for handling the disease and that it's been working for you.
Good luck.
Alan
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