Is there anyone out there that has or knows someone with stable post-radical prostatectomy non zero ultrasensitive PSA levels?

[jronne]

If post-radical prostatectomy non zero ultrasensitive PSA levels are sometimes harmless I hope to be able to find someone that has safely traveled this path.

My current uPSA level 0.011

I am 60 years old

My uPSA was first detectable at 17 months (with b7 vitamin supplements being used)

These b7 vitamin supplements were subsequently eliminated with uPSA being detected again at 26 months post-op RP

Radical Prostatectomy 11/19/2015 with Gleason 3+4 at age 56

uPSA test result history

12/27/19 12/20/19 12/13/19 12/6/19 12/4/19 7/15/19

0.011 0.010 0.012 0.011 0.011 <0.006

4/3/19 11/29/18 11/16/18 9/21/18 7/16/18 4/30/18

0.008 0.007 0.009 0.007 0.007 <0.006

2/24/18 1/8/18 11/14/17 10/11/17 9/16/17 9/15/17

<0.006 0.008 <0.006 <0.006 0.009 0.010

6/5/17 3/3/17 12/1/16 8/29/16 5/4/16 1/14/15

<0.006 <0.015 <0.015 <0.015 <0.015 <0.02

12/27/19 12/20/19 12/13/19 12/6/19 12/4/19 7/15/19

0.011 0.010 0.012 0.011 0.011 <0.006

4/3/19 11/29/18 11/16/18 9/21/18 7/16/18 4/30/18

0.008 0.007 0.009 0.007 0.007 <0.006

2/24/18 1/8/18 11/14/17 10/11/17 9/16/17 9/15/17

<0.006 0.008 <0.006 <0.006 0.009 0.010

6/5/17 3/3/17 12/1/16 8/29/16 5/4/16 1/14/16

<0.006 <0.015 <0.015 <0.015 <0.015 <0.02

my medical history is as follows

Genomic Health Decipher test score 0.22 below-average risk, 0 to 1 scale

Genomic Health Decipher test predicts metastasis risk and longevity for 5, 7 and 10 years out.

11/19/2015 Radical Prostatectomy UCSF Dr Peter Carroll da Vinci robotic surgery

Synoptic Comment for Prostate Tumors

- Type of tumor: Small acinar adenocarcinoma.

Location of tumor: Single tumor. Left posterolateral midgland and base (1.2 cc; slides B10-12).

- Estimated volume of tumor: 1.2 cc.

- Gleason score: 3+4=7; primary pattern 3, secondary pattern 4.

- Estimated volume > Gleason pattern 3: 10%.

- Involvement of capsule: Tumor invades capsule: left posterior midgland (slides B10, B11).

- Extraprostatic extension: None.

- Margin status for tumor: No tumor at ink, but tumor into capsule is less than 0.1 mm from ink; slide B11.

- Margin status for benign prostate glands: No benign glands present at inked excision margins.

- High-grade prostatic intraepithelial neoplasia (HGPIN): Present, extensive.

- Tumor involvement of seminal vesicle: No tumor.

- Perineural infiltration: Present.

- Lymphovascular invasion: None.

- Lymph node status: Negative; total number of nodes examined: 1.

- AJCC/UICC stage: pT2aN0.

Johns Hopkins (Epstein) pathology 10/13/2015

Gleason Score: 3+4=7

Left Base

2 cores (60% + 20%) (30% Gleason pattern 4)

Kaiser pathology, 9/1/2015

STAGE: T1c

Gleason Score: 3+4=7

NUMBER CORES INVOLVED/TOTAL NUMBER CORES: 2 / 14

TOTAL CARCINOMA LENGTH: 10 mm

PSA 3.2 6/10/2014

PSA 4.8 6/8/2015

PSA 4.4 8/10/2015 (free PSA 7%)

PSA 5.0 9/28/2015 (free PSA 8%)

A) PROSTATE, RIGHT APEX, NEEDLE BIOPSY

-- ATYPICAL SMALL ACINAR PROLIFERATION

-- TOTAL SPECIMEN LENGTH, 44 MM

B) PROSTATE, RIGHT MID, NEEDLE BIOPSY

-- FOCAL HIGH GRADE PROSTATIC INTRAEPITHELIALMike smith (IL.)(70)

NEOPLASIA

-- TOTAL SPECIMEN LENGTH, 30 MM

C) PROSTATE, RIGHT BASE, NEEDLE BIOPSY

-- FOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA

-- TOTAL SPECIMEN LENGTH, 23 MM

D) PROSTATE, LEFT APEX, NEEDLE BIOPSY

-- BENIGN PROSTATIC GLANDS AND STROMA, 43 MM

E) PROSTATE, LEFT MID, NEEDLE BIOPSY

-- BENIGN PROSTATIC GLANDS AND STROMA, 22 MM

F) PROSTATE, LEFT BASE

ADENOCARCINOMA, GLEASON GRADE 3+4 = 7

ADENOCARCINOMA INVOLVES 2 OF 2 CORES AND 10 MM OF 30 MM

The first involved core from the left base contains 3 mm of Gleason grade 3+3=6 adenocarcinoma and the adenocarcinoma is located 6 mm from the presumed peripheral edge (see note).

The total core length is 17 mm.

The second involved core from the left base contains 7 mm of adenocarcinoma. Greater than 6 mm of the adenocarcinoma is Gleason grade 3 and less than 1 mm is Gleason grade 4. The Gleason grade 4

adenocarcinoma is located approximately 2 mm from the presumed peripheral edge (see note).

The total core length is 13 mm.

NO PERINEURAL INVASION IDENTIFIED

[OldTiredSailor]

I am in a similar situation - now 16-months post RP with a very small but rising PSA. I have been studying slowly rising µPSA since last summer and have read a lot of research papers. My RP surgeon and MO both think SRT is inevitable for me due to SM+, EPE+ and my µPSA that has been increasing, very slowly, since my 2nd PSA test 4-months post-RP. Therefore, this subject is of great concern to me.

Johns Hopkins defines the POST-RP doubling time as the the natural log of 2 (0.693) divided by the slope of the linear regression of the natural log of PSA vs. time (in months) since the RP.

I calculated your Hopkins PSA Doubling time as 83 months using ALL your PSA measures since June 5, 2017.

I could not use the data points prior to that since they were all <0.015.

Using the PSA RAW data I get a PSA Doubling time (in months) of 72 using the December 27, 2019 PSA measure of 0.11 as the dividend and the linear estimate slope of the 15-data points as the divisor.

If we use just your PSA data since April 30, 2018, (there is NO discernible trend in the data prior to that), we get a Hopkins doubling time of 55-months and a raw data DT of 45-months.

What does that mean for you?

The Hopkins DT of 55-months means your PSA will not reach a value of 0.1 ng/ml until about 10-years have passed.

Most current research recommends SRT begin prior to you reaching a PSA value of 0.1 so it appears you have a lot of time to think about this issue.

Another way to look at your situation is that the linear estimate of growth from June 5, 2017 thru July 15, 2019 shows no pattern and the JH doubling time is estimated to be more than 13-years. But, there is a definite pattern when looking at the period April 30, 2018 to present.

That growth since April 2018 is of more concern.

I have had several long and detailed discussions with my MO about pattern recognition and µPSA tests. (In a prior professional life I spent decades working on similar statistical pattern recognition software and statistics). He says that many of us post-RP men have little PSA growth for extended periods after RP but then the PCa comes to life and starts growing again.

And, once a µPSA growth trend begins, it never ends because PCa does not heal itself and does not spontaneously stop growing.

I am waiting to hear back from LabCorp about my sixth (16-month) µPSA test for which the blood was drawn yesterday, January 6. My current plan is to begin SRT (of some form) prior to my PSA exceeding 0.1 but, at least for now, I am giving my PCa one more chance to slow it's growth.

[jronne in reply to OldTiredSailor]

could you post your uPSA history please?

also I will post your observatons as a question as many here and other forums posit that uPSA growth can stop and hold indefinitely after rising post RP

[OldTiredSailor in reply to jronne]

PSA - Date of Test

2.0 2004 August

4.0 2010 April

5.8 2010 November

4.5 2012 November

5.6 2013 November

9.2 2018 May

10.2 2018 August

Robot Assisted RP August 23, 2018

0.022 Oct 6, 2018

0.018 Jan 6, 2019

0.023 Apr 4, 2019

0.028 Jun 26, 2019

0.035 Oct 6, 2019

0.050 Jan 6, 2020

It is not decreasing and will probably never decrease

[jronne in reply to OldTiredSailor]

btw my doctors office receives the uPSA results from labCorp within 24 hours, the pateint portal is days later, I login and get my chart test results the next day after the test, been this way for 3+ years

[OldTiredSailor in reply to jronne]

same here and they e-mailed me the results 24-hours after I had the blood draw