rising psa but scans are clear

[planetman]

I had brachytherapy 6 years ago for prostate cancer, Gleason score 6. PSA went down to under 1. Now it has risen over the years to 10.8 but all scans, PET, CT, and biopsy of prostate are totally clear. My urologist want to put me on Elegard (hormone therapy) that will make my quality of life terrible which he admits. He is so hung up on the PSA and admits they cannot find any recurrent cancer but don't like the rising PSA. I am 71 years old and am leaning toward not taking the hormone therapy until they can prove to me via scans that the cancer has returned and is life threatening. Anyone else have some thoughts on my situation or have anything similar.

[tango65]

Did you have a PSMA PET/CT?

[Tall_Allen]

What you can't see can kill you.

[LowT]

what does your prostate mri now show?

[Hidden]

In the blind with some assumptions. Let’s just take the last six months; maybe even last nine months. My assumptions for the last six months, your PSA is 10.8. You have had a PSMA Pet. Finding nothing, you had a Nuclear Medicine Bone Scan. Finding nothing, you have had an MRI of the Prostate, commonly called a MRI of the Pelvis, with and without contrast, Prostate Protocol. The reason for the third scan is that if there is a recurrence and finding nothing with the other two scans, a recurrence is likely to be a new cancer in the Prostate. Then there is a strong possibility that you are dealing with BPH. The last assumption is that you have never had metastatic disease because you are not seeing a Genitourinary Medical Oncologist.

What I have written is not heresy, however it is a logical and methodological process Prostate Pros will do to understand the rise in PSA. This does not mean that you don’t have micro/metastasis and the little bastards have found a place to colonize and grow into metastatic lesions during the intervals of what ever scans/mri that you have had.

Guessing that your Urologist has ruled out other bad stuff with a Urogram and a Cystoscope.

Testing to rule out is the only mechanisms available to the medical community. If the test have been spread out of the last couple years, you only have a baseline to work with.

Factors outside of metastasis to be considered could be parathyroid, infection, prostatic hyperplasia, etc., as all can account for a rise in PSA . At 71 you are at the age where PSA can rise for non-cancerous reasons - again, being an old man, BPH, UTI, Prostatitis, Parathyoid hormone, prostate trauma are all reasons

As Allen wrote that it is the stuff you can’t see that with kill you…….

I wish you the best. I am 76 and started with metastatic disease in 2004. I have had two medical oncologists (the first died), both Genitourinary Professors at major medical schools. I see my oncologist quarterly. I am not an expert, but over the years have gained insight from those who are.

Gourd Dancer

[ron_bucher]

Your bio in your profile states you have liver disease. In the short term, I might be more concerned about that.

[j-o-h-n]

The following data is in you bio, is this really your bio? Or was there a mix up?

Bio

30 year old male and I am on my second liver transplant and now have been diagnosed with cirrhosis. I am really jaundice and my doctors don't seem to know what to do next.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 02/23/2023 7:19 PM EST

[RusLand]

Hello, planetman! I can assume that PET/CT was performed on you with the PSMA ligand, but meanwhile, almost 50% of prostate cancer cases develop in a mixed mode. This is when, together with a pool of PSMA-positive cells, there is a pool of PSMA-negative cells on the surface of which there are no PSMA receptors (protein) and which for this reason do not accumulate diagnostic rfp with PSMA ligands on their surface. Such foci can be detected using PET/CT with rfp 18F - FDG. Below I will give an example of scanning a patient with prostate cancer on PET / CT with rfp 18F - FDG , the foci of which intensively accumulate this fraction of glucose and which are not visible on PET/CT with 68Ga - PSMA-11.. And it turns out that with the positive dynamics of PET with PSMA, the patient's PSA level in the blood increases. Conclusion, you need to exclude this particular scenario.. My opinion!

Accumulation of rfp 18F - FDG in the foci of a patient with prostate cancer.

[Margoto]

Why would you wait until it's too late to start treatment?

[bluesnjazz]

It appears that you and I have a lot in common, planetman, so let me tell you about my experience. Discovered C-cells in only a quarter of my gland in 2005 (at 57 years old, now 74), Gleason 5, no tumors, had brachy about a year later.

In 2009, by PSA had dropped to .0003 so I though I was home free. However, despite being at such an early stage with no sign of a tumor anywhere, by 2014, my PSA had jumped to over 7. Had another biopsy which showed nothing amiss in the gland, so doc says micro metastasis--C-cells loose in my body but not yet forming tumors. Neither the doc who did the brachy nor the other one who tested me could explain how it could have metastasized when treated so early and neither CT nor MRI scans showed any sign of a tumor, so being the skeptic I am, I refused hideous treatments, instead focusing on treating it with diet and supplements that have been shown to hold PCa back. That seemed to work for a while, but after a year and a half, my PSA had shot up to over 40 and a scan showed a tumor in a lymph gland near my prostate.

I started double ADT then, continuing for 6 months while my PSA dropped by 70%-90% each month and the tumor vanished (it's still gone) so started on intermittent ADT, basically at my choice of when to stop and when to start taking it. I've continued that path tumor-free until I got too self-confident about it during the last couple of years and have gone from 9-11 months with no treatment and have just discovered a tumor in a ureter. Will start double ADT again to get rid of it.

[pipeorgan]

Have you had a Pylarify Scan, I think it is more advanced then the PSMA.