Increase in TPSA from 3.45 to 4.31 ng/ml. Should I be worried?

[Adam10]

My total PSA has risen from 4.31 ng/ml from 3.45 ng/ml An increase of 25%. Reference range is 0–5.4 for my age group (64 years).

I underwent HIFU treatment for focal PCa 3+4 Gleason and had half my prostate zapped (ablated) in November 2018.

PSA test results since then were 5.94 (Jan 2019), 4.66 (Mar 2019), 3.51 (June 2019), 3.45 (Nov 2019). I was getting comfortable with gradual reductions so this sudden increase of 25% has hit my confidence.

Not sure if relevant, but my creatinine levels increased to 120.7 from 98.8 micmol/L (ref range 71–115).

I’ve gained 3 kg and had stress about work during the lockdown. I’m clutching at straws, but could this have contributed to the 0.86 or 25% increase in total PSA?

Any comments and thoughts gratefully received.

[Adam10]

To add, my Free PSA levels were 0.47 latest and 0.40 ng/mL previously. So FPSA and TPSA levels have increased and FPSA-TPSA ratio has fallen 0.12 to 0.11. My urologist gives much attention to movement of the ratio. Why is that important?

[Tall_Allen]

Who knows what your PSA should be? With RP, if it worked, PSA becomes undetectable, and we consider salvage treatment when it rises. With whole-prostate radiation, ideally, the PSA should reach a nadir below 0.5 and not go up more than 2 over the lowest point. With focal HIFU -- who knows? Each case will be different, and there is not enough accumulated data to know what the signals are for salvage therapy. That is a risk you took when you decided to opt for a therapy not approved for treatment of prostate cancer in the US (the fine print reads it is approved for removal of prostate tissue, as a TURP is). I think at some point, if it keeps rising, you will want to have some imaging done - an mpMRI or a PET scan - and possibly a biopsy of any suspicious area.

[Adam10 in reply to Tall_Allen]

Thanks for your prompt response Tall Allen. Yes I knew the risks when I had HIFU, not RP. It seemed a good idea at the time. I’m beginning to regret it now. At least with RP you get greater assurance.

I agree, an MRI scan is the next action. I am somehow reassured that PSA of 4.31 might be okay for an ablated prostate but am upset at return of further anxiety and uncertainty. I realise it could be worse and that this is life as a cancer patient.

Thanks again for your valued comments and input.

[Magnus1964]

If you next PSA is higher again I would say it is time for action, maybe an ADT drug.

[Adam10 in reply to Magnus1964]

Thank you Magnus. How long until next PSA test do urologists suggest. Can’t see my urologist for while due to lockdown.

[Magnus1964 in reply to Adam10]

You should be able to have your Urologist send an order for a blood test anytime. You can have the blood draw any where and send him/her and call you with the results.

[Adam10 in reply to Magnus1964]

Thank you Magnus

[JRPnSD in reply to Adam10]

Post RP, I am on a quarterly PSA test cycle

[Hidden]

What you may regret is having focal / half-prostate HIFU ablation. It is possible that there was undetected tumor growth in the untreated half of the prostate. I had full-gland HIFU, as recommended by my experienced surgeon. 3 1/2 years later my PSA has stabilized at 0.5. TA believes that everyone who opts for HIFU is a fool. I guess that makes 50,000 of us, around the world. I've had almost 4 years of excellent quality of life following the procedure.

cliffordgluckmd.com/wellnes...

[Adam10 in reply to Hidden]

Thank you WSPPeddie. I wondered about half or full prostate HIFU but UK expert surgeon said only needed focal HIFU so by having ‘entire’ half of prostate ablated was being cautious. Surgeon said there was 1 in 4 risk of needing second HIFU which if not successful would lead to radiation treatment. Apparently my focal PCa was perfect for HIFU. UK trained Urologist in Middle East says he is not worried by PSA result. He said have MRI scan which I will. Guess I knew it would never be worry-free. Thanks for your thoughts.