Persistent PSA after RARP. Rapid rising in one year from 0,33 to 19,7 and then falling without treatment to 11,4 in 7 month!

[Knallkopf]

Me, 68 years old, know my PSA since 2012

6/2012 = 6,13, 1/13 = 5,13, 9/13 = 6,311, 5/14 = 6,34,10/14 = 6,72, 4/15 = 7,98,

10/15 =7,75, 7/16 = 9,40, 12/16 = 9,30, 3/17 = 9, 87. That was the boring part. I did nothing, just watching. I suspected cancer, but I didn't care. Then I got cystitis (4/17), I believe from my heavy urethral stricture and 5 bladder stones, diameter about 1 cm, which the doctors found out close to the operation. They looked for cancer, I did a in bore biopsy, three stitches, that's how I wanted it, two made it to G4, the third was a failure. To make it short: RARP 11/2017, pT2c, GS7 (4+3). ISUP3, pN0(o/22), L0, V0, Pn0, R0, all fine, I let it check twice. Non nerve sparing OP, sex is over but I'm continent. BUT NOW: persistent PSA: 1/18 = 0,33, 2/18 = 0,47, 4/18= 1,59, 4/18 = PET/CT 68 Ga-PSMA: Nothing to see but a lymphocele (200 ml), from which I knew already and didn't bother me after about 3 month. Then PSA again: 5/18= 2,31, 6/18 = 4,47, 7/18 = 9,16, 8/18 = 12,4, 9/18 = 12,3, 10/18 = 19,7. There I had enough from my PSA and paused 4 month. 2/19 = 16,05, 5/19 = 11,4 PSA

No treatment at all. I drank pomegranate juice, I like it, and for several months now I take melatonin 20 mg in the evening, because for both I found scientific studies, which showed some usefulness and I didn't sleep well anyway. I don't feel anything bad in connection with my cancer.

Is anybody out there, who knows scientific works about similar cases? If one is interested I can tell a little bit more. I didn't even find a physician, who knows such a case.

[Tall_Allen]

It isn't unusual for the cancer to put out sometimes more and sometimes less PSA. Maybe some of the cancer is in a more dormant stage. More likely, maybe some of the cancer is changing genomically to a type that doesn't put out as much PSA .The fact that it doesn't show up on a Ga-68-PSMA-11 PET scan suggests this too. NEPC, for example, puts out no PSA and is not PSMA avid. You might want to get an FDG PET scan instead.

[Knallkopf in reply to Tall_Allen]

Thanks a lot for the quick answer.

[Knallkopf in reply to Knallkopf]

Since I had a PSA reading of about 1,5 at this time, you can usually finf something in this kind of PTE-scan.

[wuwei37405]

I had a PSA that hovered between 9 and 15 for over a decade. Then, suddenly it went up to 138 over a period of four months. Lupron decreased it to 2. Now, after 8 months on Lupron, I am going to take a ADT break and see what happens.

[Knallkopf in reply to wuwei37405]

Thank you for your answer. Did you have a surgical prostatectomy and immediately afterwards such PSA swings without taking any treatment? Was it at a later time? Or did you practice a decade long watchful waiting and then without operation you went right away to Lupron? That would be interesting for me. Thanks in advance.

[Knallkopf]

6/4/2019 PSA was 13,7 . I had increased Melatonin from 20 to 30 mg and PSA has increased 2,3 points in three weeks. Not so good. Go back to 20 mg. My case seems to be unique. Can't find anybody, who has the same history. So far no symptoms no pain and no treatment.

[Knallkopf]

Sometimes the idea overwhelms me, that this usually slow progressing cancer is a boon for the medical and pharmaceutical community. There you have patients, who anyway will live a long life with or without treatment. So you can cash in big. Those who die from the treatment and those who are helped by it may be evenly balanced.