Hi-I apologize if I am taking up your time to simply satisfy my curiousity. My post is not seeking advice or suggestions just thoughts on what think is a bit strange.
I am curious about my most recent PSA test after being treated on Lupron and Abirarterone for more than 12 years. My PSA started rising about 3 years ago beginning with very low decimal numbers and finally reaching about .35 or so before my left acetabulum (hip) was radiated. Following the radiation it became immeasurable for about 6 months or so and then started it's most recent climb about 2 yrs ago.
The more recent numbers progressed in an expected manner from: .05, .06, .07, .09, .14, .20, .35. A PSMA was done showing activity from my tumor in my spine at L2 and radiation was recommended.
It's been 7 weeks since my .35 and I was tested again yesterday to get a baseline before my radiation begins next week and my PSA was at .34
Seems strange to have a steady progression for about 21 months with almost a doubling from .20 to .35 only 7 weeks ago and THEN have it drop to .34
Any thoughts? Thanks to those who respond
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jfoesq
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I appreciate your response but it was not responsive to my question. My PSA has continually increased for over 18 months, and most recently almost doubled from .20 to .35. Isn’t it strange that it didn’t continue to increase yesterday?
The problem is we drive ourselves crazy over how the velocity of the Psa is determined. In my opinion, it’s extremely hard to find a scientific and realistic reasonable answers. No one can.
The most recent PSA tests you’ve had are equal. The difference is nothing in the scheme of things.
Based on what you are sharing 12 years on ADT and radiation to areas when needed seems to be working well for you.
I would consider moving forward with your radiation plan unless where you are radiating is dangerously close to areas in your body that you don’t want to possibly damage. Possible side effects from radiating your tumor are always a concern.
Scared? Sorry, but I was asking a pointed question about the fact that my PSA level for the first time in over 18 months did NOT increase despite no changes in my treatment or lifestyle. Isn’t that strange?
I'll take a stab. My PSA has increased from a low of 0.5 in April 2021 to 2.23 December 5, 2024. Along the way, though, it's bounced up and down. In early October it hit post diagnosis high of 2.72, then dropped to 2.46 in early November and 2.23 in early December. Checking it again next week and again in early Feb.
PSA is strange. No one knows the answer to your question based on that one reading of what is still a low level. Watch the trend over time and don't worry too much about a single stable reading.
Thx for your response. BTW- I wasn't scared by it not continuing to rise on the most recent PSA test, I was just curious. And to be clear- Good luck to you.
There has not been a “drop”. With every test there is an error of measurement intrinsic to the test, there is no significant difference between 0.35 and 0.34.
Lab tests have a so called normal range usually expressed as 90 or 95% confidence limits. If you take one sample from a normal individual and test it 100 times each result will be slightly different. The range of 95 of those results will be the normal range. Just by chance a few (5%) will fall outside it.
Generally it is the trend of readings which is important and in the case of PSA , the doubling time. This is best seen by plotting results on a semi- log graph. Time on horizontal axis and psa on the vertical log axis.
That …. And every lab analyzer is reported to a local regional authority that analyzes “ all “ lab testing reporting for groups of similar patients. Old people, young adults, children etc . All the results are plotted on localized regional scattergrams to establish the “ typical “ or. expected result for each category of test . If the tests you sent in are outside the scattergram cloud, the authority reports back to you that you have a machine / machines that need attention ( after correction for the specific patient load ) . That they aren’t falling within the normalized expected result for those kinds of tests.
If you move from one analytical cloud region to another different one, your tests could come back slightly different.
It’s perfectly ok and normal for these exclusions to exist. They are usually very minor differences.
Thx for your response. I didn't realize that once there was an upward trend in PSA that it could pause when no changes in treatment or lifestyle had taken place.
I once had a rise in PSA after temporarily stopping Lupron, and I was trying to determine if I could lower my PSA through high lycopene diet. In four years, I lowered my PSA slightly two times, but it continued to rise exponentially, afterwards. My PSA eventually rose to 36 .when I resumed Lupron and it fell to undetectable. That is 100 times what you are talking about. Your fall from .35 to ,34 might have been caused by diet, or some kind of boost to the immune system. Your situation is small, by comparison, but if you are getting such a rise, it would indicate castrate resistant PC, which is a big deal, suggesting a change in treatment.
I get what you're saying...Your PSA was increasing and now it hasn't on that last 7 week test right before your radiation. It's a very small amount as you know but I see what your concern is. Perhaps that particular tumor has reached the point where it responds to the Lupron? Whatever it is, I'd take it as something positive! Good luck to you and your RT coming up!
Any thoughts? We both had our RP's nine years ago and were not 'cured'. This long battle raises many questions - and I appreciate your bullseye focus. Adding to IMO some good replies:
I learned one data point does not make a pattern. I have experienced a few drops and bumps over my years of what is likely too many tests. I accept hydration and changes in cancer volume are two reasons. PSA has a 2-3 day half-life, even in the collection tube. Think of a 0730 draw versus last draw of the day then your tube has a long drive/flight to testing site, and it is last in the batch to be tested. I don't subscribe to lab error theory (of course it can happen - repeat testing resolves this). If errors were common which number would we trust - the one we like best? I have also learned we may think we use the same lab because we go to the same draw location, but blood samples can be sent to various analysis sites for variety of reasons. Because I use many different draw labs I always ask where mine are going for analysis.
Being post RP I test to thousands. Since June 2021 holding very low stable 0.03X range; X = fluctuations in thousand value. I have seen several dips into 0.02X and two bumps to 0.04X. Both times I got 0.04 value I retested twice, each week apart. Those four retests dropped right backed into 0.03X range. My last test, 11 December, was a drop from previous 0.031 to 0.029. I like these slight drops - not the fortunately rare bumps to 0.04X (these seem massive
If you tested to the thousands you might have seen 0.351 "only 7 weeks ago and THEN have it drop to" .349. I hope this additional reply is helpful. All the best!
Thx for your response. But- I think MSKCC must have their own lab as I usually receive my results in a matter of hours from when the blood draw was taken. And- BTW- my prostate removal surgery from 12 years ago was "experimental" since I was metastatic from the start. My MO at the time explained that the surgery was NOT SOC and that there was a good chance it would not be helpful but thought there was a possibility. Since I was 54 and otherwise healthy, he "recommended" it and I went ahead with the surgery while fully aware of this and the possible side effects. I was only his 13th patient who he had have the surgery while metastatic. Fortunately, my own side effects were quite minimal as I only leak a teaspoon of urine less than once a month and can still get erections (although the ADT has ruined my libido so that doesn't really matter much). Anyway, I will just accept what others have said about the "pause" and that is that it sometimes happens for unexplained reasons or, that the tumor responsible for the increase is now responding to the ADT.
12 is greater than "I was diagnosed with Metastatic PC 9+ years ago" I read your bio as 9ish, as is mine. My RP was also done knowing my cancer was likely out, I wanted removal of the tumor burden for several smart reasons. "SOC" is such a broad spectrum - I consider my RP done knowing it would possible not get it all to be within legal framework of SOC - but certainly not common care here in US. All the best!
I experience the same thing. Although my numbers are smaller in magnitude they reflect the same issue you are asking about.
PSA kind of bounces around. As you look at the numbers you can see a rising trend then a decreasing trend. For example 0.05, 0.07, 0.11, 0.09, etc. over monthly intervals. Last one was 0.07.
Hello, I understand where your coming from on this point, my PSA bounced about for about 12 months, then settled again. It didn't double though. We felt the reason was pain and stress related, I had a replacement knee, before it was done I was in agony and again during recovery.
For you, obviously I can't say, but perhaps after radiation it may improve again and stabilise.
Yes- your situation is similar to mine, although with me, the increases took place steadily and over a longer period of time, amd the amount of the increases was greater each time, eventually approaching a doubling from ,20 to .35 in 11 weeks.
It's very worrying for you and I really do understand your concern, I would be exactly the same. The PSA has come down a little, but not as much as you would like. Perhaps, although I don't know, after the radiation it may improve.
At the moment there isn't any real explanation 😕. Continuous monitoring is essential and I really do feel for you. Please keep us updated.
Thx. And- good luck with your new knee. I had mine done 8 years ago. I guess he answer could be as others have suggested: unknown, the tumor responsible for the increases is NORW responding to ADT, and possibly I am having slightly less stress as my youngest was accepted into the college of his choice for the Fall.
PSA can increase due to infection and inflammation, as well as from PCa. You need 3 consecutive increases in PSA to confirm a trend. Don't worry too much about it and relax. I would go ahead with the RT.
Thx. I am not worried and will be going ahead with the RT. BTW- if you look at the numbers I presented, my "trend" was for more than 3 consecutive increases. It was more like 6-8 and the amount of each increase also increased each time with a near doubling the last time when it went from .20 to .25
The answer to your question is due to the summertime reason.................. summertime it is and summertime it ain't. See ya at Kimmel on 68th street, I'm the Handsome guy....
And I almost forgot............. How about an updated picture of that cute kid in your picture. (and I don't mean you or your wife). Kids are my favorite....grownups are just tolerated. .
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Is this castrate resistance?
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