PSA Rising

[TheTopBanana]

Asking for a friend of my father this time. He had surgery in december 2022 and everything was removed including glands. Gleason 4+5. His PSA has risen från 0.1 to 0.14 in 12 months. His doctor says to do nothing until it hits 0.2. But shouldn’t he do more? Maybe he doesn’t have advanced cancer yet.

[Tall_Allen]

Persistent PSA after prostatectomy should trigger salvage radiation.

[GP24]

Usually one waits until the PSA value rises above 0.2 and then schedules salvage radiation, i.e. radiation of the prostate bed to destroy remaining cancer. You can get ADT after the radiation if you want to do more.

[Justfor_]

A bit more aggressive than mine as my 0.14 was reached at 25-26 months.

Interested in what I did after the 0.17 of the graph? It's all detailed here:

healthunlocked.com/prostate...

PSA

[dans_journey]

I posted this in response to another person's question on the same topic:

I had a prostatectomy and 54 months later, my PSA came in at 0.05 ng/mL. I went into full panic mode.

My PSA bounced up and down between 0.04 and 0.08 for the next 18 months, so we opted to just monitor it. But then it started a steady but slow upward climb. It took 6 years for it to get to 0.20.

At that point, I paid out of pocket for a PSMA PET scan to see if we could located the cancer when my PSA was 0.22. The good news was that the scan didn't light up like a Christmas tree; the bad news was that it didn't provide any useful information to the radiation oncologist.

I really wanted the RO to know that he would be zapping in the right location, and one of the reasons for the delay was my hope that the PSA would get high enough for the PSMA PET scan to be able to determine the location. I mean, why zap the prostate bed and risk damage to the surrounding area if the cancer has already moved elsewhere?

Six months later, just before starting salvage radiation therapy (SRT) to the prostate bed only, my PSA increases had accelerated and it was at 0.36.

The SRT knocked my PSA down to 0.13 and then two months later to 0.11. It was good to see a downward trend. My next PSA test six months later nearly doubled to 0.21. That was disconcerting, so we retested five weeks later, and it was up to 0.33. That was in November 2023.

We're in the process of trying to figure out the next steps. I go for a bone scan next week and, while it likely won't show anything at my PSA level, it's part of the protocol where I'm getting my treatment. If it's negative, I should be able to get another PSMA PET scan, this time paid for by my insurance.

BTW, my initial diagnosis was Gleason 3+3 that was upgraded to 3+4 after surgery. My prostate came out cleanly—negative margins, no ECE, LNI, SVI, nothing.

Obviously, it appears that the SRT failed, so that raises the question: Should I have started SRT sooner? I don't know. Maybe. Maybe not. I do know that I had 6 years of a decent quality of life while waiting for my PSA to hit the traditional definition of biochemical recurrence at 0.20.

I was worried about suffering side effects from SRT, so that was another factor that went into the delay. That worry may have been unnecessary.

The SRT has been completed 18 months now, and fortunately, the side effects have been minimal. My stress incontinence has grown slightly and my ED has worsened slightly. Fortunately, no bowel control issues (but I understand those can pop up years down the road).

In your case, keep PSA testing and try to determine the PSA doubling time to see how rapidly it's growing. The PSA doubling time calculator on the MSKCC website needs PSA values of 0.1 or above to do the calculations.

For me, it was important to preserve my quality of life for as long as I could while not letting the cancer get away from me. It was a crap shoot that I was willing to take. You may have other priorities or desires.

If you watch the video from the Prostate Cancer Research Institute in my post here, Dr. Scholz talks about the value of letting the PSA rise to the point where newer imaging technologies can detect the location of the cancer. It runs counter to the traditional standard of care, which is to start salvage radiation after three consecutive increases in your PSA after a prostatectomy.

dansjourney.com/2023/11/14/...

[j-o-h-n in reply to dans_journey]

Well written post, thank you........... Did you retire last year (age 65)?

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 01/07/2024 7:52 PM EST

[robert570]

I was between .18 and 2.65 for 10 years until recently. Still going strong, unfortunatly my PSA now stands at 20.83 because of a treatment that failed me and made my PSA rise. I'm back on Jevtana, a chemo drug that targets prostate cancer cells. PSA still at 20, but stable and not quickly rising. I've been in stage 4 for 10 years now.