I’ve had 3 readings of psa since my rp.
6 weeks <.01
5 months <.01
9 months <.01
My question is at what psa would I be considered to have had a bcr?
Is .2 still an applicable cut point? Or some value less than that?
Waiting for the seemingly inevitable rise.
I reached undetectable after a little more than a year.. then the rise... It sat in the 0.12/0.13 area for another year or two . Then up it went.... several other treatments and now climbing very quickly, but I have made it 5 1/2 years so far as stage 4 and that's not bad. Last PSA 80.9 after 21.4 a month earlier... Two month ago 11.9. Next month ???? I guess that could be called a rising PSA. Best of luck to you. Don't worry much about PSA at .2, but also keep your eye on the Alk/Phos. Mine always went up before PSA started to rise.
Thanks for the reply.
Hey Black holes , they do exist but don’t go down the pc rabbit hole . Keep the faith ..and please don’t predict it on yourself . Tell yourself you be clear many years ..I’ve been 7 yrs clear .I just stopped ADt five months ago . I chopped the boys to shut down the t in 2017 ..No T is a bitch ..pc gone wild is worse .. . This thing of ours always comes back . A long no signs remission is the best that one can hope for with a #4 dx . Diet ,exercise all matter . Some men have run under the radar for 12 yrs or more . You can be one of those . My docs said Id be dead 4 yrs back if i made it at all . He gave me a 50/50 shot! Live healthy and take time each day to not dwell on pc . It can obsess you . Picture a glass 1/10 full with pc . Imagine every day it’s getting less . Self image it . Don’t feed into anyone negative . You can do better than anyone says . I have .That is my hope for you and all newbies .. Keep you head up and keep rolling . 💪🍀
Shooter I am sorry to hear about your PSA. My husbands went up a few points this last time and it’s like a punch in the gut. I felt that same feeling reading your post. What is the most important thing you do to keep your self going. If I am crossing a line, my apologies, shooter🙏
No line uncrossable here on this site... I just keep busy doing what I can and enjoy doing... My apples are starting to fall and need processing into apple sauce and freezing for pies this winter... I like baking, gardening, hiking ( though not as strenuously as I used to), and shooting. I shot competitively with ML rifles for years but am now limited in what I can do. I also love to read and can usually do that when I am to tired to work in the garden or the snow starts to blow. I have a wonderful fireplace to sit by when the snow flies and about 4 cords of wood split and stacked for the next couple of years. Life Is Good, just count all the blessings you have had in this life and be grateful for what you can still do.
> but also keep your eye on the Alk/Phos. Mine always went up before PSA started to rise.
this is really interesting. Where can l learn more about this connection.
Seeing PSA climb is the worst feeling. My fathers PSA went up from .8 to 1.5 in 2 months. PSA rise didn't bother me as much as it representing castrate resistance.
There is a number of "magic" values that indicate an impending BCR. Lowest is 0.03 with give or take 50-50% for leading to a traditional BCR, aka 0.2. Next comes 0.06 with 60-80% (don't recall the probability derived from a wide relevent study). Going further up, 0.1 is currently considered by some as BCR has already occurred and salvage treatment is due. Old school and clinical trials still keep 0.2 probably for compatibility with previous data. BUT, all these values bare a secondary importance. Of primary importance is the PSA rate of rise and how much it correlates to an exponential rise. This can't be judged by same cut-off value. A substantial time series is required.
I would be interested in seeing any research papers or nomograms relevant to predicting which patients post RP who “lose their < sign” will go on to have true BCR, as well as which will go on to have an aggressive recurrence. I lost my < sign last week, 27 months after RP, and feel like I am starting over. I am guessing that with my metrics I have a good shot at avoiding an aggressive recurrence, but I am not sure what the chances of avoiding radiation are.
As I wrote above only a meticulously calculated PSADT (i.e. long PSA time series) offers some prognostic value. You write that you lost your < sign. This doesn't say anything in terms of PSADT. Also, the value behind the < sign is important. 27 months to breach 0.01 is quite different to 27 months to breach 0.1.
Yes, of course. I know 27 months to 0.01 is not a terrible place to be, and I feel humble in this crowd. Maybe the worse number I have is that I am 57, not that old. I am trying to be patient. It will be some time (a long time, I hope) before I can get a PSADT. Thanks for the reply.
Congratulations! 0.2 ng/ml is still widely considered to be biochemically recurrent.
TA, is that the number just for those who have had their prostate removed or does it include those of us that are doing RT & ADT instead? What was Nadir + 2 a indicator of?
By convention, confirmed 0.2 is post-prostatectomy and nadir+2.0 is post RT.
Thank you.
This is a good vote for rt.
I like the ultra sensitve tests, they allowed me to track small increases that lead to "recurrence" and i was prepared better for it. I had a PSMA Pet scan at PSA 0.12 that showed intense uptake in surgical bed. Good luck
I would start talking to docs once you lose the < sign. That means it is starting to rise.
"According to the American Urological Association, Serum PSA should
decrease and remain at undetectable levels after radical
prostatectomy. The AUA defines biochemical recurrence as an initial
PSA value 0.2 ng/mL or greater followed by a subsequent confirmatory
PSA value 0.2 ng/mL or greater."
So even if you should rise to .2 it should not be the cutoff unless it is confirmed by another .2.
do you know if these same values apply to those of us still with a prostate?
I suppose it depends on the number of prostate cells in your body. PSA blood test indicates indirectly the number of prostate cancer cells in the body.
No it doesn't. Sometimes us guys with full metastatic disease get fortunate and our treatment brings our PSA close to those low levels even with a prostate but not often. Prostate even when healthy will put out or show in blood test PSA.
In that case, what PSA values indicate BCR in a man with metastatic disease who still has a prostate? I'm having a difficult time finding this information. My MO just says that they look for trends (dblng) but does an increase albeit in a normal range indicate BCR?
Sounds like you must have had radiation treatment of prostate.
I see a lot of info. here but I skim over it a bit because I was fully metastatic at diagnosis so no prostate surgery, no prostate radiation. Immediately to lupron and chemo at diagnosis.
Anyway I would think that if you looked at the NCCN website you could find some answers or Tall-Allens blog site too.
You could alway create a new post with the question you just asked as well.
No radiation, no IV chemo. Great suggestion. Ty
Just looked at your bio and it looks like you too went straight to systemic treatment. No surgery, no radiation.
In that case the term/concept of BCR doesn't apply. BCR term is used for those who had surgery or radiation.
You might be like me. We just treat it systemically trying to keep the brakes on it so it doesn't progress further.
A trend of rising PSA and or a doubling time of 1 month would indicate current treatment is not working and time to move onto another treatment.
Blackholes, Your <.01 reading is typically referred to as "undetectable." That is the lowest reading you can get. Yes. Many of us do have a recurrence -- probably about 40% of us +/-. So, you don't need to consider a recurrence inevitable. You may never have one. The best thing you can do at this point, I think, is maintain a healthy diet, eliminate stress from your life, and exercise regularly, start to attack your "bucket list", and enjoy life. My PSA was undetectable for 39 months after my RP. Seven years after it reached the level of being detectable (0.2) my PSA is 1.76, but the most sensitive radio tracer PET/CT scans still can't find anything to treat, although I am probably at the point where I will need to consider treatment. I could have had "salvage radiation" to the prostate bed, and maybe got a cure, and almost certainly got unpleasant (at best) long-lasting side effects of the radiation. But, I have had 10 years of no symptoms of the disease and very tolerable, minor side effects of the surgery. You don't mention your age, but I'm 80, enjoying life, and will probably die of something else.
I believe <.1 indicates "undetectable". So <.01 is far less.
No. It ain't NecessarilySo.
👏👏👏🍀
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