PSA no longer undetectable. Now what?

[Istomin]

I had a prostatectomy in 2017, radiation, and nearly 3 years of Lupron, with the last injection on 5/10/20. Other details are in my profile. PSA was undetectable for 2.5 years. Yesterday's draw shows that it's 0.032. I gather that I should wait for 3 consecutive monthly rises before moving to more/other treatments? Grateful for any thoughts.

[6357axbz]

If I read correctly you’ve gone about 6 month since your 6 month Lupron injection expired. Makes sense that your PSA is up.

[Istomin in reply to 6357axbz]

Hi, 6357axbz--actually, it's been approx. a 15 month "vacation."

[Tall_Allen]

I don't know why you are using a sensitive PSA test and think that 3 consecutive monthly rises has any value for you. You may be less anxious if you switch to a regular quarterly PSA test (lowest value 0.1). There is nothing you would do until your PSA reaches 1 or 2.

[Istomin in reply to Tall_Allen]

Thanks, TA--noted. It's what Smilow's lab uses and I haven't asked to change.

[Magnus1964]

You PSA is still great. Wait for the three rises. Then you should consider ADT drugs, casodex, xtandi, zytiga.

[Istomin in reply to Magnus1964]

Thanks, Magnus1964.

[Hidden]

Sometimes the best thing to do is nothing.

[Istomin in reply to Hidden]

Thanks for replying, Nameless999

[timotur]

Also track your T to see if it correlates to a rise in PSA.

[Hidden in reply to timotur]

When you say “correlate” do you mean the T rises by 50% then the PSA rises by 50%, and that shows what, exactly? Is there a standard increase that is acceptable?

[timotur in reply to Hidden]

As T rises to a baseline level, the PSA would rise with T and level off if there were benign prostate tissue remaining. On the other hand, if PCa remained, PSA would continue to rise after T leveled off, the rate, depending on the Gleason level— then consecutive rises and DT would be notable. This assumes hormone sensitive and not CR.

[Istomin in reply to timotur]

Thanks, timotur.

[EdBar]

I’ve had the same thing happen recently, my PSA was undetectable for over 6 years but has become detectable again. And yes I use an US test too and have been for about 7 years, it was recommended by Snuffy Myers when I was a patient of his. I’m currently a patient of Dr. Sartor and he recommends the continued use of a US test as well.My PSA went from .019 to .068 in about a year, the increase qualified me for Provenge treatment which I had back in August/September. Since Provenge the rate of PSA increase has slowed substantially. It appears that some men see a PSA benefit from Provenge - per Sartor.

Next step will be a PSMA test once I reach a certain level which will likely be at a lower level than what is typical. Sartor says that since I’ve been on ADT for so long - 8 years, PSA could be suppressed but a PSMA scan could still be valuable at lower levels.

I find using an US test extremely valuable, otherwise I’d still be thinking my cancer was dormant (undetectable) but with an US test I’ve already gotten treatment and have mapped out the way forward with my oncologist.

Ed

[Istomin in reply to EdBar]

Thanks, EdBar.

[Cooolone]

The ultra-sensitive PSA tests are nothing more than noise makers and anxiety creators! Not sure why labs are even allowed to test to those levels as there is neither diagnostic or treatment benefit to having it! The FDA should do something useful for a change and disallow such testing IMO. Just my humble opinion!

With such low readings you should be celebrating rather than worrying about what's next!

I asked my RO the same question when I was just about done with my 40 treatments of IMRT... What's next "IF"...

She had the correct and perfect response! Let's worry about that when we need to! I did need to as the RP & RT failed to control my PCa, but that's my story, not yours! Your PSA can remain undetectable, which is the level you're at, for a long, very long time... Nobody knows if or when, so why worry? Again... Enjoy Life, Enjoy the test results while they show what they show. Stay current but in the NOW, not what if, might, maybe, possibly, could happen...

Best Regards

[Istomin in reply to Cooolone]

Thanks Cooolone!

[cancerfox in reply to Cooolone]

My urologist must anticipate this problem, because he doesn't even tell me the exact PSA value, he just tells me that it's "zero." I went behind his back and got it from his nurse, though. 😆 I couldn't resist knowing the exact value (.02 most recently).

[MateoBeach]

It is impossible not to feel trepidation when becoming “detectable” rather than undetectable, regardless the test. You have time with no panic to follow the trend and consider plans. Question: when you had RT after prostatectomy what was that for? And did it include radiation to the entire pelvic LN fields as well as the prostate bed? If not you should be thinking about that and discuss with your RO. A PSMA PET scan will not be sensitive enough until PSA reaches or exceeds PSA >0.20 or 0.25, and still may fail to detect the smaller sites.In the meantime, your PC is still HS and not technically, demonstrably metastatic, even if presumptively micro metastatic. And tumor burden very low. So where to focus? In my opinion it is to reduce the Progression towards more advanced states. This means attending to the two drivers of progression. Which are inflammation and accumulating genetic mutations. Protect your genes and reduce sources of inflammation. Search for “Hallmarks of Cancer” or read my prior post on this topic.

Yes, it would be great if you could get Provenge. But it is not covered until one is metastatic (on scans) and castrate resistant. Catch 22. Unless there is a Provenge clinical trial you might fit in. I understand there is or was one for very early disease.

I was BCR in 2009, after RARP, docetaxel chemo and SRT to prostate bed, all in 2007. PLNs only in pelvis in 2019 on PSMA scan and had pelvic LN RT. Still HS. Still not metastatic and PSA ~0.10 today. Warrior mentality for the long run, no panic. Best regards, Paul

[Istomin in reply to MateoBeach]

Thanks, MateoBeach, for your advice--as I recall the radiation was everywhere it should've been to hit the PC hard, including one metastasis in the sacrum (no LN involved, however).

[SteveTheJ]

I don't think anything below about .2 is anything to worry about.

[Istomin in reply to SteveTheJ]

Thanks, dr_gonzo

[j-o-h-n]

Sometimes the best thing to do is something......................and that something is nothing......

(that sounds familiar)...

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 03/02/2022 9:49 PM EST

[Istomin in reply to j-o-h-n]

Thanks, j-o-h-n