I'm in a pickle and would like to ask for your suggestions. The following is my PSA history. As you can see it is rising. The quandary is that those of us who have had radiation as our primary treatment still have a prostate in some form. My RO and urologist both said don't worry yet. We do get bounces.
Biopsy PSA dx 13.8
Gleason 3+4 (40% 4)
seeds 10/23/06
external beam 10/06-01/07
3.2 (1/23/07)
2.2 (4/23/07) start
2.5 (10/23/07)
3.2 (1/23/08)
3.5 (4/23/08)
5.6 (6/26/08)
7.5 (10/23/08) bounce
6.0 (11/23/08)
3.7 (3/15/09)
3.4 (7/23/09)
2.3 (11/6/09)
2.7 (3/23/10)
3.7 (7/25/10) bounce
2.4 (10/16/10)
0.8 (2/22/11)
0.5 (10/17/11)
0.2 (5/3/12)
0.2 (10/24/12)
<0.1 (5/3/13)
0.1 (9/15/14)
0.1 (11/27/15)
0.19 (11/17/16)
0.4 (06/09/17)
0.4 (10/23/17)
0.71 (07/20/18)
1.1 (02/28/19)
My last blood test also tested:
Total T 825 ng/dL
Free T 6.9 ug/dL
DHEA 166.1 ug/dL
Estradiol 34.5 pg/mL
When you do a blood test through Life Extension, they give you an 800 number so you can talk to a doctor about your results. The doc told me, since my T is so high, I should also test for DHT. He said high T can drive the DHT up which can drive the PSA up so it may not be cancer.
As an aside, in the last few months I have added more supplements like BIRM, 4MU and metformin to my normal vitamins and minerals.
My plan now is to have a blood test in three months and test PSA, T, and DHT. Also, from what I understand, I may qualify now for an Axumin scan.
What do you guys think?
Written by
LeeLiam
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Your hormone levels are not at issue. The only issue of importance to you whether you are having a recurrence or not. I note that you have a history of bounces, which probably reflects underlying prostatitis.
You also have no idea how the supplements you are taking affect PSA. They may be masking it, thus destroying the best monitoring tool you have.
I don't think you can qualify for an Axumin scan until your PSA reached 2.0 (nadir+2). When and if it reaches 2.0, a PET scan will tell you if you are having a recurrence.
Assuming that you have not had any treatments since your external beam radiation in October 2007, your PSA history is pretty remarkable. You had PSA bounces that got up fairly high (though significantly higher have been recorded) and yet your nadir was exceptionally low and was reached seven years after your last treatment.
Surprisingly, according to what I have read (unfortunately I don't keep track of what I've read and can't give you citations), PSA nadir below 0.2, bouncing PSA, a long delay before reaching nadir, and no recurrence of the cancer for 8 or more years, are all actually very positive signs. Men with any of those signs have a higher than average likelihood of no recurrence of the cancer. You've got all four of those signs, so I'm thinking that there is significant reason to think you're okay.
I think Tall_Allen's suggestion that you have a history of prostatitis is logical. If you feel any pain in the prostate, that's another indication that you may have prostatitis. The fact that your previous bounces went so high indicates to me that your current rise in PSA is still well inside the potentially safe zone. If you had surgery instead of radiation, or if you had radiation but reached nadir very early and stayed there for a long time, then your current PSA rise would be much more suspicious.
My recommendation is to accept your doctor's advice and wait. Keep tracking the PSA as you planned. I don't think you want to initiate some treatment, whether ADT or more radiation at this time. There is an excellent chance you'd be getting harm from the treatments without any real benefit. I think it's fine to continue your supplements, they might make tracking the PSA harder, but I don't think there's any big decision you need to make based on a point or so in PSA.
The big task for you at this time, and it can be a difficult one, is to relax, stay calm, and enjoy your life. If you have a recurrence of the cancer, there are drugs to deal with it, and they're getting better every year. You can get a scan when your PSA gets high enough but, unless it shows a lesion in only one or two spots that can be hit with radiation or surgery, your recommended treatment will likely be ADT and it probably won't matter whether you get that treatment when your PSA reaches 2.0 or when it reaches 10.
So be cool. Don't let fear rule your life. We're all going to die of something and the key thing is not to destroy what's left of our lives with anxiety and depression.
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