PSA <0.04 to exactly 0.05

[brzandme]

My husband was diagnosed with stage 4 PC in November 2019.(Gleason 9) He had 2 mets on his lower spine only. (thus the stage 4 diagnosis) He has been on Zytiga and Lupron since that time. He had radiation to the primary tumor and both mets in the summer of 2020. His PSA has been <0.04 since that time. However, last week his PSA came back at 0.05. We met with my husband's oncologist's PA (physician assistant) on Friday. She expressed concern and immediately scheduled additional bloodwork in 3 weeks. She's already setting up a PSMA scan and planning his next treatment. (I don't believe insurance will pay for the scan since is PSA is technically still less than the 0.2 threshold) With this just being the first change in PSA in nearly 2 years (although I appreciate her proactive approach) it seems she's made up her mind that his current treatment of Zytiga has failed. Is it just me or shouldn't we wait for the next 1 or 2 blood tests to make sure it's not a hiccup or lab issue? His Oncologist is out of town and I wonder if he shares her concern yet. It really made me nervous to hear her speak like that. She said "he has many more treatments to fail" She could have worded that a little more optimistically. Any thoughts on the matter? Is it possible at all this could be just a slight bounce? Thank you in advance for your input.

[tango65]

I do not think anybody will do anything with just one PSA value from <0.04 to 0.05. The first thing will be to repeat the test in a couple of weeks. A PSMA PET/CT most probable will not detect anything with a PSA of 0.05.

Treatments are usually change or modified when there is evidence of radiographic progression of the cancer. Most MO do not treat the PSA.

[Tall_Allen]

"Is it just me or shouldn't we wait for the next 1 or 2 blood tests to make sure it's not a hiccup or lab issue?" I agree with you completely! There is nothing you should do or change until PSA reaches 2.0. There is no reason to pay for a PSMA PET scan now. It won't show anything new anyway, and even if it did, there would be nothing to be done about it.

[brzandme in reply to Tall_Allen]

As it turns out she did jump the gun. they tested him again yesterday and it came back at <0.04 again. Whew!

[cesces]

1. The PSA tests aren't that accurate to start with.

2. Start doing monthly tests. Pay attention to trajectory not absolute values. When you get 3 increases in a row, then maybe start to pay attention.

3. The scans are most accurate at PSA of 2.0 or greater. If you take it before then, you are risking a false negative. Deciding to accept the risk of a false negative is a patient decision, not a Doc decision.

4. Any time you do a psma scan you also want to pair it with an FDG scan. Or again, you expose yourself to the risk of a false negative.

5. Measure 3x and cut once. Set up some out of town second opinion doctor relationships. Ahead of time.

[TJGuy in reply to cesces]

What is the cost of a FDG scan?

[cesces in reply to TJGuy]

I don't know. Ask Tall_Allen

[EdBar]

After being undetectable for several years my PSA showed up again last year, it recently hit 0.17 and my MO, Dr. Sartor has ordered a PSMA scan. He is concerned that my PSA continues to rise, and yes it means that Xtandi is failing in my case. We will take action based on what the scan shows.

Interestingly he mentioned that after long term ADT he has seen PSMA scans with low PSA like mine come back showing nothing, a small amount of cancer as well as widespread cancer. So I wouldn’t wait much longer, I think your MO is wise in taking a more urgent approach, that’s been my strategy for almost 9 years now, to be aggressive and proactive. You can always get another PSA done to double check your current results in the meantime. I disagree with anyone telling you to wait until it reaches 2.0, especially with G9 disease. BTW, I also have G9 PCa.

Ed

[Wife32]

Every cancer is different. Please do NOT wait until his psa reaches 2.0 to scan if your oncologist is recommending earlier. Specialists from cancer centers know your husband’s situation better than any insurance company or person on this forum.

While your husband’s increase is small, it is still an increase. Having a chat with the MO about waiting until the next draw to decide on the scan could give you more understanding of the rational, and maybe all could agree to wait.

Please do not believe the 2.0 psa scan info, but talk to your docs. My husband has had 6 scans over the past 5 years that showed Mets with well under a 2.0 psa. Of course these are the psma, choline, and axumin pet scans, not a bone scan or mri. His cancer is NOT neuroendocrine, it is the most common adenocarcinoma (Gleason 9). He has docs at CLeveland Clinic, Mayo Clinic, and MD Anderson - all agree that the 2.0 scan threshold is more of an insurance decision. They all scan with any increase to baseline.

Again, every cancer is different. It’s scary to find things on scans, but more scary to not know what you’re dealing with. My husband is also oligometastatic and has had spot treatment when things come up. He still works full time and feels great. He was on ADT for 18 months total over the past 5 years, but hasn’t been on any systemic treatment since 6/2021. We’ve had wars with the insurance company and it takes at least 3 tries to get any pet scan covered, but the docs help by sending the latest nccn guidelines.

This forum is amazing for info and support. We found 2 of our specialists out of state through here. We’ve also gained valuable info on different treatments so that we can ask informed questions to our care team. We’ve followed wise advise to get 2nd and 3rd opinions. It’s been extremely helpful. I’d just caution you to go back to your doc with questions before making decisions, get second opinions, and remain hopeful!

Best of luck. This is hard on the guys but also on us wives. Take care

[brzandme in reply to Wife32]

thank you so much!

[Wife32 in reply to brzandme]

Feel free to message me anytime.

[Granica4818]

Hi My husband's PSA is 0.3 and a recent bone scan found met at T9 and the 9th rib. so I'm assuming since this showed on the bone scan it will also show on the PSMA pet scan on Dec 5. The main thing I have learned from reading about everyone's stories is that no one story is the same. And I guess you find the team of doctorers you trust and keep researching and learning what you can. And do what your gut tells you to do. You know your body and if something doesn't feel right Then have it checked. Never hurts to have a test and find out it's normal rather than not having the test at all. I'm thankful for all of you and all the knowledge everyone has shared. Thank You.

[Velohomme]

.05 is very low. PSA values can fluctuate at low numbers. I was undetectable for 18 months, then my PSA shot up, but then returned to undetectable a few weeks later. I would be surprised to hear an MO wanted to take action without validating the trend.

[JHT969]

Psa numbers are not an EXACT science so I think the doctor is over reacting. So many things can influence PSA numbers so you should start reading up on recent articles for peace of mind. I had surgery March 2020 with a PSA of 36 but my Gleason score was a 3+4. Now after radiation last year at 68 yo my PSA IS 0.2 which Me,my Cancer team and family are elated with. I did a very "deep dive" into PSA,you should too...

[Sanctus]

Hello :

I was diagnosed with Stage 4 in May 2022 with PSA of 23.7. I started with Lupron in July 2022 after which a blood work-up repeated in August showed my PSA had gone down to 4.0. With Lupron, my urinary frequency decreased precipitously and my getting up to urinate at night decreased as well from 4 times to 3x and sometimes 2x. I started on Zytiga on October1 st with a lower dose of 500 mg/day and one tablet of prednisone. My PSA, which was measured last week, is 0.7.

I am not an oncologist, but statistically speaking, PSA of 0.04 is not different from PSA of 0.05, your husbands present PSA status. It is within a technician's and the measuring instrument's statistical error. The PA who carelessly told your husband that the treatment has failed should not, without a doubt, be in the medical profession. The PA's statement is baffling to me.

The whole idea in this business is supportive and encouragement of patients with obvious medical honesty. I believe that your husband's treatment has not failed. There is just a statistical glitch, which I believe will be self correcting in due course. Furthermore, a PSA of less than 4.0 is normal, unless there is a met.

Good luck to your husband and best wishes to you.

[brzandme in reply to Sanctus]

thank you. Good luck to you as well!