Rising PSA after RP

[jctaylor]

My diagnosis began in November of 2018 with a rising PSA detected at my yearly physical. It had reached 6.2 when my TRUS biopsy was scheduled. Of the 12 cores taken, 11 were positive as follows:

1 G 3+3

5 G 4+3

2 G 4+4

3 G 4+5

My RP was in May of 2019, margins, seminal vesicles and lymph nodes were negative. My pathology report was summarized as "Gleason 3, 4, and tertiary 5." My 3 month PSA was undetectable (<.014) and my 6 month PSA was = .014. I just learned that my 9 month PSA is .021. My uro says anything less than .1 is normal post RP, however my trajectory seems clear and I feel like a sitting duck just watching the cancer progress. I don't know if I should wait another three months for my 1 year PSA or seek other opinions now.

Am I overreacting?

I'm in western North Carolina. The closest PCa center of excellence is at Duke University. Does anybody here have experience with them?

Any thoughts and comments are welcome. Thanks!

[Hidden]

The only sensible means for confirming an advancing PSA trend is by increasing the sampling rate, i.e. shorten the sampling period. It lowers the noise and brings up the useful information. This is what I am doing for my self. Monthly PSA tests.

[Tall_Allen]

You gain nothing by treating earlier. That was the new learning from 3 randomized clinical trials:

pcnrv.blogspot.com/2019/09/...

Note that 3 consecutive rises justifies intervention, and you've had two. So you can wait for your 12-month PSA before deciding - if it rises, it is time for SRT; if it doesn't, you can monitor every 3 months.

[jctaylor in reply to Tall_Allen]

Thanks, I'll chill (or try to) 'tll May...

[Claud68]

Hi, to avoid cancer coming back too fast you could take some complements, curcumin, resveratrol, quercetin, modified citrus pectin.... you will find a lot of interesting studies and advices in this forum.

[Steve507]

It's hard to stay objective, I know. After 11 months, I went from 0.01 to 0.02. I'm comfortable with the conventional wisdom of .1 or 3 consecutive rises +.03.

Also, I want a second opinion 9n my post RP pathology. Any suggestions as to where one might send the material.

Thanks

[MNFarmBoy]

I'm in a similar position of sweating out the quarterly PSA test results. If I see that PSA is definitely increasing above the limit of detection (0.014 for the lab that has been analyzing my samples), I plan to start looking for a RO, and to incorporate their judgement in considering whether to include ADT, which technique and facility to use for SRT, and when to begin SRT.

The plan that I am following includes genomic testing upon post-RP increase above the limit of detection, to help judge whether ADT would be beneficial in addition to salvage RT. The idea would be, if there appears to be no potential benefit from ADT, consider avoiding the side-effects of ADT. Thankfully, so far (13.5 months post-RP), I have not faced that decision, so I don't know, upon being advised that there would be low but significant probability that ADT might be beneficial, whether I would forego ADT, or whether I would undergo ADT anyway, in the hope of maximizing the probability of a benefit in longevity, albeit at the expense of poorer quality of life.

The urologist who performed the RARP recommended not performing genomic testing until the results could affect decisions regarding treatment, in order to potentially benefit from increases in knowledge from additional data and analysis of outcomes vs. traits in the genomic databases. He favors early SRT, (certainly by PSA of 0.2 but trending toward earlier); however, I don't know at what PSA level he would advise pulling the trigger on genomic testing and selection of RT technique and facility.

Best wishes in making the decisions that you are facing!

[j-o-h-n]

It is my unlearned opinion but experience that it's normal.... but still have it investigated by a qualified oncologist who specializes in Pca... I have never been to Duke but I read good things here about their medical facilities. Also you may want to direct your questions to our resident expert here "Nalakrats" who I believe lives in western N.C.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 02/27/2020 2:17 PM EST

[cyber1]

Is there an update to your situation?

[jctaylor in reply to cyber1]

My PSA seems to have settled in around .02. Following my jump from .014 to .021, the next three month values were .019 and .022. My URO thinks anything below .1 is fine. I just had my yearly physical with my PCP and he's suggesting that I consult with a MO. I'm seriously considering it but will wait for my next PSA at the end of this month.