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PSA Too Low To Be Treated With Radiation?

Fox2018
Fox2018

Hello All,

My radiation oncologist thinks my PSA level at .8 is too low for radiation treatment. It has doubled from .48 in 2010 to .80 in 2018. This trend alarms her (it was .70 in 2017). Her concern is that after radiation it will be difficult to measure a significant enough of a drop in the PSA level to declare "success".

She does not recommend AC, wanting to cure me at my "relatively young age" of 65.

Again, I had a 12 core biopsy with 1 cancerous tissue sample at 11% with a Gleeson score of 6.

She is recommending surgery and then follow-up radiation if a rising PSA score after surgery.

Has anybody heard of a similar situation?

23 Replies
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It is pure nonsense that you are too young for AS. Read these:

pcnrv.blogspot.com/2017/08/...

pcnrv.blogspot.com/2016/08/...

I think it would be tragic to risk permanent impotence and incontinence on surgery with so little, low grade prostate cancer

There is no need to rush into surgery or any other treatment with just one core of Gleason 6. Active surveillance is the default treatment for you, based on what you know now. You need to consult with other specialists. It sounds like she is not well informed about radiation, of which there are five different types, all of which are as, if not more, effective as surgery, and with low side effects.

Not understanding those readings you quote at your age 65 the expected PSA age related reading ng/ml would be considered here in UK to be normal at >>>> 4.5 ng/ml<<<<<< Active surveillance is the way to go Beware of medics seeking to delve into your wallet

I agree with the others and I’d get a second opinion fast. Maybe a third. Something sounds very wrong to me.

Hidden
Hidden

I understand this is a difficult decision for you. The good thing is that there are many options open to you at this time. As others say, you need more information to judge what you will feel most comfortable with.

Your PSA is low and Gleason doesn't suggest your cancer, only one core, is aggressive so AS is one of your options.

If and when the time comes, you need to find out more of the pros and cons of all active treatment options from unbiased sources.

The feared consequences of surgery are not necessarily inevitable and radiation treatment is not without its own consequences.

Given the low PSA, why the biopsy in the first place? Felt something on DRE? That's a pretty long not-even-doubling time for the PSA.

Fox2018
Fox2018 in reply to dentaltwin

primary care physician felt a small nodule at annual physical - wan't there (or not felt) last year.

dentaltwin
dentaltwin in reply to Fox2018

Agree with the others--unless there are other issues you haven't stated, I'd go slow, get another opinion. Looking back over my PSA figures over 7 or so years, I'd been steadily increasing, from under 1 to 7.2, before I was sent to urologist. Maybe I should have gone sooner (had I known--my doc didn't think anything under 4 was worth talking about). But sounds like you've got plenty of wiggle room here.

Fox2018
Fox2018 in reply to dentaltwin

Did you have a palpable node on any of your DRE exams?

dentaltwin
dentaltwin in reply to Fox2018

No, I did not. (I don't know which, if any nodes can be evaluated by DRE). While this certainly isn't in my wheelhouse (I'm a dentist) I CAN say that palpable nodes I DO know about (head and neck) can mean a lot of different things--hard vs. soft vs. "rubbery", tender vs. non-tender, movable vs. fixed, but usually you can't be really sure what's going on unless (if malignancy is suspected) you biopsy the thing. At the same time, though my tumor was apparently considerably more advanced than what you have, there was nothing picked up on DRE (my first urologist said "nice, small gland, 20 gms., no lumps, no bumps"--all that in about 2 seconds). There was little doubt on MRI that I had a tumor "suspicious for extracapsular extension". So I was pleased that the postop path. showed no spread beyond the gland and clean surgical margins.

This is no guarantee that you shouldn't have surgery (nor that my luck will hold up), but it certainly sounds to me as if you're starting off early, and probably have time to consider your options.

Best of luck to you!

Fox2018
Fox2018 in reply to dentaltwin

Thanks for your advice and concern.

I agree with the others here. Active surveillance. Only 1 core Gleason 6 and .8 PSA? I wish that had been my biopsy and PSA! I wouldn't have gone ahead with RP! AS sounds logical, with an annual biopsy. And get a second opinion from an oncologist specializing in PCa!

Fox2018
Fox2018 in reply to Jeff85705

What do you mean by aa oncologist specializing in prostate? Different from a urologist, surgeon, radiation oncologist? Thanks!

Jeff85705
Jeff85705 in reply to Fox2018

When I had my biopsy results, I asked my urologist for a second opinion. He referred me to a radiation oncologist and a CLINICAL ONCOLOGIST, a physician who specializes in cancer treatment (as you must know). The one I saw had a subspecialty in prostate cancer treatment. I thought he would be the most fair and one who could give me his opinion while having no necessary bias toward surgery or radiation. That's what I meant. He gave me the best advice. In my case (Gleason 7, PSA 10, age 67), he said if it were he in my place, he would choose RALP, because it gave the best chances of cure, and the prostate would be removed. After seeing a radiation oncologist, I picked surgery. I don't regret it.

Fox2018
Fox2018 in reply to Jeff85705

Thank you - I will search one out.

radiation can cause problems later cancer for example

Iodine is very important for anyone undergoing radiotherapy iodine as well as chlorella and spirulina

Do you have HIFU as an option you seem like an ideal candidate for HIFU

FWIW:

>>>

. . . My radiation oncologist thinks my PSA level at .8 is too low for radiation treatment. It has doubled from .48 in 2010 to .80 in 2018. . . .

<<<

So your PSA doubling time is around 9 years, and the tumor is Gleason 6? You're likely to die of old age, before it grows large enough to be worth treating. I think your PSA is lower than most 62-year-old men. (You should check that . . . )

One caveat:

. . . A small percentage of prostate cancer tumors don't give off much (if any) PSA.

So an MRI (which detects tissue changes, not PSA) would be worth doing. If it doesn't show anything worth treating, I'd believe it.

. Charles

PS -- no letters after my name, and this is not medical advice.

Fox2018
Fox2018 in reply to cpcohen

Thanks Charles, I will be going for a multi-parametric MRI of my prostate gland soon - we'll see what it shows...

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Hidden

Something Charles said prompted me to ask if the biopsy showed what "type" of cancer you have. There is a rare type that doesn't raise PSA. It is very rare and very aggressive. Most men have adenocarcinoma, the rare one is "small cell carcinoma", but don't panic your oncologist should know this.

Fox2018
Fox2018 in reply to Hidden

adenocarcinoma type - Gleeson 6 in one of 12 tissue samples

Hi Rich,

Nodule was felt 05-22-18 at annual annual physical. The .8 PSA Test done on 05-22-18 as well. Biopsy was done on 08-14-28.

Thank you for your comments!

I agree AS ..your PSA is way low and with just 1 Core Gleason 6 ... you are probably below average of most men who even have biopsy ‘s good luck

My take:

At your age, with one Gleason 6, and that low PSA, how could you not be a candidate for Active Surveillance? Or at least on Active Surveillance until your next biopsy or MRI?

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