Can increase in PSA in my case due to prostatitis?

[dac500]

After my brachytherapy in 2011, my PSA dropped to 0.1. Then between 2015 and 2016 it rose to 1.8. Second biopsy in 2016 found cancer in extraprostatic mass. ADT and cybeknife brought the PSA down to undetectable, which stayed there until April 2018. Then it started rising very sharply: April 6: 0.2 , July 13: 0.9, Aug 28:1.3. My question is can this increase be due to prostatitis. Only symptom I have is slight occasional burning during urination, which may due to radiation treatment. My prostate size has remained small after brachytherapy.

[arete1105]

My guess is the burning is due to inflammation. I would suggest Modified Citrus Pectin or Tumeric for that. If you had cyberknife after 2nd biopsy, in 2016, I would guess you should have been past radiation effects in terms of burning during urination.

As far as the increase in PSA, you said cancer showed up outside the prostate. That would explain the PSA pop. The increase could be due to either cancer outside of prostate or inflammation. Take care of the burning and then see what happens to the PSA.

[Tall_Allen]

When your PSA reaches 2.0, you can get an Axumin scan.

[cesanon in reply to Tall_Allen]

Allen, do you know what the minimum PSA is before Medicare will pay for an Auxumin scan?

Do you know if they have any other criteria for an axumin scan?

[mcp1941 in reply to cesanon]

I think all you need is a rising PSA after initial treatment. My MO said that I need to have a CT and BS scans that are both neg for mets before an Axumin scan is approved. Both my CT and BS were neg and I had the Axumin about a month later. Never had any problems with Medicare. All bills were paid.

[Tall_Allen in reply to cesanon]

Axumin is only approved for RECURRENT PC after primary radical therapy - either surgery or radiation. After surgery, recurrence is defined as a confirmed PSA≥ 0.2. After primary radiation, recurrence is defined as nadir + 2.0.

[dac500 in reply to Tall_Allen]

In my case, primary radiation ( brachytherapy in 2011) was followed a secondary radiation ( cyberknife in 2017 for extra capsular extension). Does the same criteria apply in my case?

[Tall_Allen in reply to dac500]

Yes - nadir + 2

[Hidden in reply to Tall_Allen]

How is recurrence defined after HIFU? Would it be analogous to radiation, since the prostate is still there?

[Tall_Allen in reply to Hidden]

That's one of the problems with focal ablation - no one knows how to define biochemical recurrence or even if a single definition is possible. The Stuttgart definition (nadir + 1.2) has been used but is wrong about clinical recurrence about half the time. It is most likely different for each individual depending on the extent of ablation and how much of the cancer was represented by the index lesion.

[Hidden in reply to Tall_Allen]

Thanks for that info. My HIFU ablation was 'whole gland' as opposed to targeting only the half of the prostate that had tumor evidence. Yeah, not many practitioners have experience with HIFU patients.

[charlesmeyers1964 in reply to Tall_Allen]

whats a axumin as far as i know i don't see medicare paying for anything unless its proven u have cancer. the aver psa on normal men is 0-4.0 if your is 2.0 i don't see ss paying for any treatment because you fall in the normal area. charlie

[Tall_Allen in reply to charlesmeyers1964]

It’s different when you have recurrent prostate cancer

[Hidden in reply to charlesmeyers1964]

My PSA was 2.7 -- in the 'normal area'. DRE turned up an abnormality and follow up biopsy indicated Gleason 8 in 5 of 12 cores. PSA alone is therefore not a reliable indicator of disease. Actually Gleason 8 in one, 6 in another, and 7 in the other 3 positive cores.

[charlesmeyers1964]

in my case with radiation a cell or two got outside and now 10 yrs fighting the cancer. if thats the case your fine move on with treatment and u most likely got more then 10 yrs or longer depending on your age

[charlesmeyers1964]

first of all why are u worrying about a psa not even 2.0. do u know the average of men know matter there age is 0.0-4.0 your not even above the normal range so back to sleep just have a psa every year then worry if its really high dude

[dac500 in reply to charlesmeyers1964]

What you are talking about may apply to men with no prostate cancer. I was diagnosed initially with a PSA of 3.4. After my brachytherapy in 2011, I has recurrence in 2016 with a PSA of 1.5. After my cyberknife and ADT in 2017, myPSA remained undetectable for a year. Then it has started rising rapidly with a PSADT of about 2 months.