PSA increase .08 to .15

[User14952]

Husband was diagnosed at age 50 (2.5 years ago) with a large primary prostate tumor, and 2 suspected Mets in the pelvic bone and 20+ pelvic lymph nodes. Gleason 8. PSA was 24. He did 8 weeks of full pelvic radiation , 2 years of Lupron, and 1 year of zytiga.

We see the oncologists at OHSU in Portland, and they are fantastic.

I have done 2.5 years of my own prostate cancer research, I know the studies, I understand the basics, I ask tons of questions of our medical providers, and have been lurking here consistently and reading everyone’s postings. I know that everyone’s cancer is different.

What I really want insight on is others experience. The oncologist suggested a lupron and zytiga break starting last December when his 6 month shot wore off. His T has been at less than zero since month 3 of lupron, and PSA was undetectable. It was decided that when/if his PSA started going up enough we would get a PSMA scan and get a better idea where the cancer is.

His PSA over the last 6 months has gone from undetectable to .08 to .15. I know that because he still has a prostate his PSA is going to go up more than if he had a RP. But we just got the T results back and his T is still undetectable (<3). I figured if his PSA was going up due to healthy tissue it would mean his T would go up as well? Is that an indication that the PSA rise is not related to healthy prostate tissue creating PSA but to the cancer?

We are getting the PSMA scan on the 20th, so we will have a baseline (of maybe nothing since the PSA is so low) in not too long. Our original scans were a mess of bad information, so this is the first time we may get a better idea of what’s going on with the pelvic mets.

Thank you in advance. I read these forums because my husband doesn’t, and the information here about everyone’s experiences are things I refer back to a lot for him. All of your postings are greatly appreciated.

[Tall_Allen]

PSA goes up just because he still has a functional prostate that puts out PSA, and 2 years post RT, not all of his "zombie" cancer cells have stopped putting out PSA.

I think you are getting the PSMA PET scan too soon (is insurance covering it?). There is no such thing as a "baseline." What will it mean if you find some sites that have PSMA uptake? It may just mean the zombie cells aren't quite dead yet. In any case, no action is warranted, and if it cannot possibly result in a change in therapy, the test should not be done.

[User14952 in reply to Tall_Allen]

I’m asking if his T hasn’t gone up why would PSA go up. He had undetectable PSA and T while on lupron, and with his PSA increasing but T still at 0, I am wondering if that is more likely to be new cancer cells.

If it was zombie cells or prostate activity it would have been present while even on lupron and zytiga I would think.

All due respect, I’m going with my supremely experienced oncologists opinion on the PSMA scan. We still don’t have a good idea where the cancer is in his pelvis. She believes there is value.

[Justfor_ in reply to User14952]

You are doing the best you can. Ignore naysayers.

[EdBar in reply to User14952]

Smart move, stick with the advice from your oncologist.

Ed

[Hidden]

Suggestion. Research micro-metastasis and discuss with your physician.

GD

[Hidden]

Generally speaking the chances of finding anything with psa of like 0.2 are really small. As long as you know that going in you will not have a huge disappointment later.

[Justfor_ in reply to Hidden]

This is what a silly doctor would have uttered. Her's is not in this league. You see, in the last 6 months her husband has gone from undetectable to 0.08 and 0.15. This boils down to a PSADT of 3 months at best. And a non-silly doc knows that PSADT is equally, if not more, important parameter in the PSMA pet positive detection efficiency. Finally, if they will get a negative scan this will be their best news since the start of their fight. It will be time for wild celebration, not huge disappointment.

[Hidden in reply to Justfor_]

Justfor,

At my last appointment I asked the MO about doubling time. My MO said that doubling times with numbers near 0.1 are not terribly reliable.

I would think that if the psma scan showed a hot node just outside of the previous radiation field, or even the tiniest spot possible on the elbow (or some other easily accessible out of the way place) would be considered *actionable* news. A blank scan puts you into the waiting game, on defense.

So for someone who might want to take active steps, a blank scan would be a disappointment. The implied assumption is the beast is back.

[tango65]

The detection rate of PSMA PET/CT with a PSA < 0.25 is around 45%.

urotoday.com/conference-hig...

[j-o-h-n]

When it comes to hospitals, doctors or meds...... most men are chicken...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/11/2022 8:13 PM DST

[ishitasen]

It's likely your PSMA scan will not show any active disease. Contrary to what is reported in literature, in a real life setting, the sensitivity of the PSMA scan in a PSA secreting tumour with a PSA level below 2 is rather poor. Nevertheless, the absence of any psma avid lesion means you continue your drug free period and follow up