PSA rise

[Howard53545]

I have been undetectable for about 2 years. On Dec 6 my PSA was 0.04 then on March 19 it was 0.21 so this indicates a rise in Mets. Is this too low for a scan? What should be the next steps?

[Cabingammiex6]

My husband was on a med holiday for almost 2 years. His PSA has just risen from undetectable to .24. He has a PSMA scan scheduled in two weeks. His med holiday has probably come to an end.

[Sparrow47 in reply to Cabingammiex6]

I am in a somewhat similar situation, with a rise from undetectable high-sensitivity PSA to after nearly 8 years to .1. I have an appointment with an oncologist in the system for next week, but I do understand that PSMA scans do not detect below .2 Good luck to your husband and you.

[GP24]

"so this indicates a rise in Mets" Not necessarily, it could also result from some tumor left in the prostate bed. The 0.21 is very low for a PSMA PET/CT but it may indicate if the tumor is in the prostate bed or if there a mets present. This would change the plan for salvage radiation which will be your next treatment.

[ron_bucher in reply to GP24]

"it could also result from some tumor left in the prostate bed"

My understanding is that PSA would not rise like that if there is benign tissue left after surgery.

[GP24 in reply to ron_bucher]

I wrote tumor tissue left, not benign tissue left. The following study shows that radiating the prostate bed is effective even when a PSMA PET/CT cannot detect anything:

jnm.snmjournals.org/content...

[ron_bucher in reply to GP24]

Sorry I misread.

Yes, there is no doubt that radiation without visible tumors is often very effective. I experienced undetectable PSA for 7.5 years after my first radiation protocol (without any ADT) and 4+ years after my second radiation protocol on more lymph nodes (combined with docetaxel plus 9 months of ADT).

[Tall_Allen]

Nothing in your profile, so I can't comment.

[Yearofthecow]

When were you diagnosed, what was the gleason grade, did you have any genomic test, what kind of treatment did you have, did they put you on ADT and are you still on ADT, etc.?

How you answer the above questions will determine if this could be a PSA bounce or not.

Were the previous PSA's all done at the same lab. It is important to have the PSAs performed at the same reference lab.

At a minimum you should have the PSA redone, insuring you didn't engage in certain activities at least 48 hours prior to the PSA test.

[ron_bucher]

If you had a prostatectomy, my MO says the chances of PSMA scan showing any tumor(s) is about 20% at PSA 0.20, 40% at PSA 0.40, 80% at PSA 0.80, etc.

[Cooolone]

Post your pre-treatment diagnosis along with risk assessment, PSA history, adverse features if present, family history, general health history, etc.

Otherwise it's like asking about the weather when in a windowless basement... Lol

[lowT163]

mayo has required my neighbor to have a .60 psa to get the psma scan.

[Fortran1958]

I had 4 or 5 PSMA PET scans over a 12 month period after my PSA hit 0.2 6 years post surgery. The last scan I had my PSA was 0.34. Nothing definitive was found. My PSA is now 0.51 and my urologist is waiting until I hit 0.6 before next scan. I am now 8.5 years post op.

I mention this because the chance of the PSMA locating something increases with a higher PSA.

[Justfor_ in reply to Fortran1958]

With your PSADT of 1.5 to 2 years it is no surprise that you missed any positive detection. At low PSA, PSADT is equally, if not the predominant factor, governing the probability for a positive detection.