Rising PSA after RP June 2018 - Prostate Cancer N...

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Rising PSA after RP June 2018

Tonik25
Tonik25

My husband had a robotic RP back in June 2018 with following PSA results after surgery - Aug 18 <0.0008 Nov 18 <0.0008 Feb 19 <0.0008 May 19 0.0008 July 19 0.001 Whilst I know these numbers are still considered somewhat undetectable with the removal of the prostate I believe the only thing that can be causing the rise is the cancer. So I suppose my question is with such low numbers at what point would you seek further trae t to stop what seems like an inevitable progression. He has only ever seen a urologist and since he performed the surgery I feel like his work is done but he has not referred my husband he has said he will keep testing the PSA and see him in another year. At what point should my husband see or be referred to an oncologist. It bothers me that a referral to a specialist prostate cancer oncologist has never been me toked and with a rising PSA it worries me that my husband could miss the boat on a potential curative therapy like salvage radiation just because he is not speaking to the right person. For info he was Gleason 9 at diagnosis. Clear margins but some SVI. 39 lymph nodes removed and all clear.

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I’m not sure how to edit my post just notice typos. trae t Should read treatment.

Small increases like that could be caused by inflammation. Consider taking a daily analgesic, low dose aspirin etc. Watch for a progression of PSA over a few tests before pushing the panic button.

You are vexed. The real problem is that the super-sensitive PSA testing can show changes within the "undetectable" range, and that does not mean anything except more worry for you. I urge you with all my heart not to let these numbers drive your life. The "rising PSA" is an artifact, nothing more. Deep breath.

Tonik25
Tonik25 in reply to dadzone43

Thank you breathing has been reinstated. 😀

One added thought: he should see an oncologist when he has cancer. Right now, he does not have any evidence of cancer and his urologist is following a clear and respected pathway.

No one should be using a superultrasensitive PSA test- it is not validated for PC.

Tonik25
Tonik25 in reply to Tall_Allen

Thanks. I’m not sure what other type of test there is. Can you ask for a non ultra sensitive one?

Tall_Allen
Tall_Allen in reply to Tonik25

Just a conventional PSA test with lowest value of 0.1 ng/ml

Tonik25
Tonik25 in reply to Tall_Allen

My husband just gets paper emailed with a referral for a blood test every 3 months. No one actually explained that there are different types of PSA tests in terms of sensitivity.

Hidden
Hidden

You are probably adding an (erroneous) zero into the PSA decimal figures.

To my knowledge, the resolution of the most sensitive PSA test is 0.001 with the undetectable cut-off value set at 0.003.

My urologist maintains that the accuracy of the last (third) digit is debatable and should only watch for the first two.

Applying this rule to your husband's numbers he is still at the 0.01 level with some intermediate measurement variance.

But even if we assumed the figures as being accurate to +/- 0.0005 (rendering the last digit valid) his PSA doubling time comes out TOO long.

Finally, the other usually cited criterion indicating a recurrence, i.e. three consecutive PSA rises has not been reached at this point in time.

There are quite a number of studies concluding that adjuvent or early salvage RT bears better overall outcomes, but I don't thing that your husband is already there.

Keep watching at it.

Thanks for all your replies. I suppose we just go back to living our lives which to be honest has been pretty easy for us having 3 young children we don’t have time to worry about it. 😀 All tour replies are very much appreciated. I suppose the question is then if the rise continues to be upward tending at what level do people actually start to think about doing radiation treatment to get the best outcome. I have heard 0.2 and 0.1 is there a general consensus?

dadzone43
dadzone43 in reply to Tonik25

0.1 on the non-super sensitive test.

I agree that there should be an oncologist on your husband's team. I was being treated by a urologist who thought it unnecessary - which is why I am now being seen by a wonderful oncologist who has on his team a urologist.

best to you and your husband

P

A reading of 0.001 (accurate to the fourth digit) is still considered undetectable.

FYI, I was also a G9 with node involvement (N1) at my Dx 2 years ago.

I have quit my ADT ( less than 1 year ago) while my 'T' slowly recovers and my PSA rises (already at 0.04).

I was told to consider anything above a 2.0 as a sign of recurrence.

Note that I did not have an RP.

IF the PSA numbers keep rising significantly, that would point to having missed some spot or location that has avoided detection.

You need close monitoring (over time), while avoiding the panic.

It is too early to draw such negative conclusions.

On behalf of the myself and the others, we wish you well in your recovery.

Best of my knowlege the numbers you posted aren't possible. Please go back, check the numbers, and also find out (and post) the type of test and machine used (Roche ECLIA methodology, xxx??? machine). Then repost on this thread. Like someone said above, if you are off by one decimal, depending on the machine, he is well within the range of nothing to worry about untill then numbers truly change - which hopefully never will.

I'm not a doctor but this very subject was pointed out to me by my doctor. There is a significant element in these measurements; that is the "<" symbol. That indicates the lowest level the test was capable of detecting, or put another way. the test reveals an undetectable PSA level above the specified level. It does NOT suggest there is any PSA at or below that level. Your husbands tests show undetectable PSA which is what you want post-prostectomy. My situation/history is the same. The standard approach is to monitor PSA at 6 or 12 month intervals, depending on after the operation and results of previous test.

Agreed. Although there should be concern with a Gleason 9, as long as the PSA numbers stay in the virtually undetectable range I wouldn't concern myself. Be vigilant and INFORMED....you are correct that the doctors don't/won't manage your overall journey (I hate that word with cancer). You have to know what when and why, and get as much info (this site is great) and speak with other doctors. Not sure about your health care system...most of us in the States can get 2nd and 3rd opinions.

Anything under 0.1 ng/ml is considered undetectable. The extremely low numbers you are sharing seem well within a range of error.

Hi Tonik25, my situation is nearly the same. I too was Gleason 9 and had my RP June 4th, 2018. I too had all my pelvic region lymph nodes removed during surgery. Negative margins were reported for all. Pathology afterwards however found PCa extra-capsular. So going into surgery, my Dx was T2d ... yet after surgery it was found to be T3a.

Since surgery, I have had PSA tested every 3 mos. Every test has come in below threshold. Threshold at UW MedCtr for PSA tests is (<0.03). I was told lower measurements are not meaningful. If my PSA were to rise above threshold, they will monitor it close where they look for a doubling factor (increase over a short period of time).

Fortunately, for me it has stayed below threshold. During my last checkup (last month and one year post surgery) my urologist said I can now get my PSA tests less often. That is, instead of every 3 months, every 6 months. When I asked about potential reoccurrence, he typically tells patients if no signs in 5 years, this is the best reassurance.

Live each day to the fullest, and I wish you both best of health!

Tonik25
Tonik25 in reply to tkalaf

Wow that is so weird my husbands surgery was 4th June. Probably other side of the world though we are in Australia. I’m glad to hear you are doing so well. Yes we do try to live life to its fullest. My husbands attitude is “I’ll worry about it when it happens”. I do the worrying in advance for him. 😉

tkalaf
tkalaf in reply to Tonik25

Yes, I live in Washington State, near Seattle.

It is good thing that he has you standing by his side. Support from ones closest around means so much. I am fortunate as well, as my wife has been very understanding and supportive. Kudos, to all those who read this that are there in support of their loved ones. You are all Angels!

From what I've read, the PSA .001 is still technically "undetectable", even with the rise. Some studies suggest that .03 would be the point at which there is a possibility of recurrence and .2 is typically when additional treatment is considered. If you and your husband are worried, you can certainly meet with a med onc and it never hurts to get additional doctors on your team for now and for the future. If you get a med onc, ideally you want one with PCa experience - this is not necessarily an area where they all have expertise. Good luck.

I'm bouncing around the 0.03 - 0.05 range after 2.5 years undetectable < 0.03. I'm planning to get salvage RT if I get to 0.1 rather than 0.2 as a paper I read shows better outcomes plus if you rise to 0.1 the logic is that you are very likely to get to 0.2.

Tonik25
Tonik25 in reply to julianc

I’m sorry to hear about the rise but sounds like you have a plan. When is your next PSA test due?

Well just to give you an update the numbers kept rising and my husband is now at 0.1 PSA and being booked in for salvage radiation. Specialist appointment next week to work it all out. What questions should I ask??

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