Sudden PSA increase

[lokibear0803]

Hoping for some insights around what might be going on here. Thanks in advance for taking a moment with your thoughts.

I started ADT vacation after a 1-month lupron in February after 7 months of on-cycle. Since then my PSA has done this:

Feb 2022 = 0.17

March 2022 = 0.06

April 2022 = 0.04

May 2022 = 0.05

June 2022 = 1.23 (!!!)

Testosterone in May was 117, and in June it’s 418.

A PSMA scan in January showed very little — basically a single spot in right seminal vesicle, significantly smaller since starting the lupron in Aug 2021. All other spots from an August 2021 scan (maybe 2-4 of them) were “resolved”.

My PSA during off-cycle has never behaved like this — the DT has ranged between 3-6 months. This increase between May and June shows doubling almost 5 times in those 5 weeks. I expect a correlation to some degree between T increase during off-cycle and PSA, but this is a bit off the charts.

So given the radiographic insight + rate of T increase + my history, this is surprising. My knee-jerk is it’s surprising enough to be unlikely, i.e. more likely to be some kind of testing error, and I should just retest. Alternately, this is real and I should get another PSMA scan.

I welcome your thoughts on this.

[GP24]

Could be a lab error. Wait for the next PSA value in July.

[Tall_Allen]

It is a big jump for one month, but then again, your T level is up too. Retest next month.

The PSA may be benign - prostatitis or urinary retention.

Equivocal PSMA at seminal vesicle may be due to urinary excretion.

[lokibear0803 in reply to Tall_Allen]

Thanks TA.

Is it reasonable to think that multiple very long bike rides could cause prostatitis, or otw cause a PSA spike? My last bike ride was done 60 hours before my PSA was done, I would have thought that was long enough. But, these rides were about double my “usual” length, so perhaps I’d need a longer recovery time…?

FTM can I even get prostatitis, or even BPH, if I’ve had brachytherapy and EBRT done?

Many thanks in advance.

[Tall_Allen in reply to lokibear0803]

It doesn't cause prostatitis, but it does cause PSA to spike. Re-test if in doubt. Yes, you can still get prostatitis.

[SteveTheJ]

FWIW, my testosterone has been less than 20 for 2 years.

[Magnus1964]

Those "vacations" can be a problem.

[CAMPSOUPS]

Yep the T is up but and I don't mean to scare or be an alarmist but you have been having mets for about the last 7 or so years. I am actually very confused that you had a vacation.None the less probably some scans now would be good?

[lokibear0803 in reply to CAMPSOUPS]

Yeah agree, I’m thinking retest soon and schedule scan ASAP. Thanks Campsoups.

[Poppy1952]

What was starting PSA?

[lokibear0803 in reply to Poppy1952]

These are all the relevant PSA numbers for this most recent set of measurements — but let me know if I’m misunderstanding your question:

August 2021 = ~8 (started 6 months of ADT + Abi at this point)

Feb 2022 = 0.17 (at this point I received a final 1-month Lupron shot)

March 2022 = 0.06 (T measured as undetectable, and should start a slow recovery here)

April 2022 = 0.04

May 2022 = 0.05 (T is about 117 here)

June 2022 = 1.23 (wtf !!! — T is about 418 here)

Perhaps you’re asking about starting PSA before that on-cycle of ADT/Abi. It was around PSA = 8 in August 2021, with a DT of about 5.5 months.

Got PSA down to 0.06 in about 7 months (so by March 2022), and as you can see it continued down to a nadir of 0.04 even after the 1-month Lupron from February “wore off” and T started its recovery.

This behavior was really quite nice even after stopping the ADT, but then the June measurement was quite the anomaly. I’m trying not to get emotional here…

[j-o-h-n]

Get emotional!!! I would re-test.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 06/14/2022 6:55 PM DST