PSA Still Going Up

[toyman79912]

I had RP on January 2023, started ADT in May 2023 and went through 38 sessions of radiation. In November 2023, my PSA went down to 0.005 ng/mL. My PSA went up to 0.015 ng/mL in January 2024 and went up to 0.035 ng/mL in my current test. I know Tall Allen said the previous number was negligible because the test was an ultra sensitive test. However, the latest number is worrying me because it has double from my previous test. My ADT ended in May and my testosterone is at 9 ng/dL. Should I be worry?

[God_Loves_Me]

It is my personal opinion

PSA is also going up, so it is time for action.

The doctor may not prescribe medicine but still ask for Zytiga or Bicalutamide.

Also, request a PSMA Pet scan. I hope it is easy to find something that can radiate on an immediate basis.

[Still_in_shock in reply to God_Loves_Me]

0.2 for RP patient. He has no prostate.

2.0 is for intact prostates.

[God_Loves_Me in reply to Still_in_shock]

I update my comment thank you

[Justfor_ in reply to God_Loves_Me]

No, you had it right before. SoC has 0.2 after RP for salvage RT, which he has already had. If sRT fails, old school's SoC next treatment is ADT for life (dubbed: systemic therapy) at some "magic" PSA number (2,4 or 5). Anything between sRT failure and systemic therapy is considered "experimental" by old school SoC.

[Cackalacky_cyclist in reply to Justfor_]

Justfor_ you are almost correct; the OP had salvage radiation to the prostate bed only (based on his Bio), so there is still the ability to perform whole pelvic salvage radiation. So in this case it is possible to:

A: "immediately" perform blind radiation to the pelvic area, which I doubt an RO would do

B: perform a PSMA scan (at whatever PSA level the OP & his team believe is beneficial) to hopefully find a target and then do whole pelvic rad. if the target(s) are in the proper area

c: Declare he's metastatic and start with systemic therapy.

I just went through this, picked B and got lucky (at a low PSA). So it is possible even if it's not probable.

[Justfor_]

God_Loves_Him gave you some solid pieces of advice. I only want to add emphasis on not allowing any sugar-coating.

[NanoMRI]

Different than some others, being post RP, I rely heavily on ultra sensitive testing and believe values rising above 0.010 indicate cancer activity; in fact just ordered my bi-monthly today. Gratefully, my usPSA has been holding steady in 0.03X range for three years now - no ADT.

My third treatment, salvage extended pelvic lymph node surgery, done six years ago at usPSA 0.11, confirmed six cancerous pelvic lymph nodes. So no question cancer was present, growing and spreading, below usPSA 0.11.

My answer, yes. All the best!

[Hawk56]

Like others, my assessment based on my experience, layman's understanding, I am a study of one.

There may not be any reason to hit the panic button, but it may be prudent to continue to collect clinical data, do homework on treatment options (read the NCCN Guidelines, the PCF has excellent patient guideline...), consult with your medical team and when the clinical data indicates, make a decision - treat, with what, for how long (or continuous...). If any treatment decision is for a defined period, have decision criteria to come off, actively monitor while off treatment and decision criteria to go back on.

From your description, it sounds as if you had surgery, then SRT to the prostate bed (only, not the PLNs?). If that is the case, your "increase" in PSA may be indicative of PCa activity in the PLN system or, worse case, bones or organs.

At your current PSA, unlikely any of the imaging today would locate where any PCa is.

You have choices and questions to ask yourself and your medical team.

How aggressive do you want to be with treatment? There are some who say you can delay systemic therapy until PSA hits some whole number, say 2, 5, I've even seen 10. I am not in that camp but my clinical history is one of an aggressive PCA, GS 4, GG 4, PSADT and PSAV very fast along with time to BCR after surgery. So, I am aggressive.

Do you want to know where the recurrence is. If so you will have to decide to let your PSA rise to a point where you have a reasonable probability of the imaging locating the recurrence. While that may be as low as .2, it could be be between .5-1. Again, questions you have to ask yourself:

Will the results of imaging inform the treatment decision?

Is there a risk of letting the PSA rise to increase the probability of positive imaging results cause an impact to the treatment outcome.

As an example, if you decide to do doublet or triplet therapy based on rising PSA alone, you may not need to image. If you are thinking of including radiation, either in combination with systemic therapy or alkone, SBRT, say, then you may decide to let your PSA rise to the point where you are comfortable with the probability of locating the recurrence.

There can be variations in PSA tests, particularly USPSA. You may want one or several more to confirm a continuous upward trend, then decide...

The clinical data you provide in your post does indicate you my have decisions to make on your next treatment. That's the "bad" news. the "good" news, you have time to make that decision, gather clinical data, inform yourself of treatment options, discuss with your medical team and together, make a decision informed by sufficient clinical data.

Kevin

Clinical History

[j-o-h-n]

Your question "Should you worry?" Of course, we all do....I am not a doctor, but I played one under the stairway when I was 6 years old and my neighbor Joannie was either 6 or 7 years old.

So I think your Psa is not in an emergency mode but you should consult with your Medical Oncologist on how to approach your current Pcan. Who is your medical team and where are you being treated and with what meds? All responses are voluntary.

You noted that you are ASIAN, so am I, I'm CaucASIAN.

Good Luck, Good Health and Good Humor.

j-o-h-n