Rising PSA levels after surgery

[jdfamily]

I had protrate surgery 15 months ago, complete removal of the prostrate. I am doing well, but my psa level is slowly nudging upwards, it is at .10 right now. My questions are related to how serious is this? When should I be concerned? I go every three months to have it tested. My doctor says if it goes higher the next intervention would be radiation and I know that carries significant side effects also. Would appreciate any thoughts suggestions anyone might have. Thanks.

[Magnus1964]

I was I the same situation a long time ago. Your PSA score is still low. Watch for three consecutive rises from.1. Radiation has come a long way since I had it. It's more precise and less side effects. Keep us updated.

[Justfor_]

Traditionally, it was 2 or 3 rising tests over 0.2 PSA as a confirmation for BCR and salvage treatment start. Latest years, some but not all have lowered the trigger value to 0.1. Your doc follows this school of thought. I have set my own rules that are quite different: a) Monthly tests alternating two different labs because I have found differences up to 0.03 for two tests one day apart. Consequently, hard defined limits at round magic numbers like 0.1 or 0.2 can only serve as a bureaucrat's delight. b) PSMA PET /CT before salvage RT. c) Best tool in the patient's toolbox is PSADT (doubling time), for a good assessment of which at least 6 time samples are required. d) Low value time samples suffer from the test's accuracy plus the rounding error for labs reporting to the second decimal figure. Long story short I was waiting for 0.2 to get the PSMA scan, reached 0.15 and then my PSA started declining 0.15, 0.14, 0,13 from labA and 0.12, 0.12, 0.11 labB.

[jdfamily in reply to Justfor_]

Thanks

[Tall_Allen]

Talk to a radiation oncologist, not a urologist, about salvage radiation.

[Stepping2]

The same happened to me. I had negligible psa for a while after a prostatectomy but over 6 years it built up to 9. I had 33 sessions of radiotherapy then hormone treatment for 2 years. Now my psa is almost non existent and I have just had my last hormone implant.

The radiotherapy is no walk in the park and the hormone treatment was tiring but both were better than the alternative if you get my meaning.

[fluffyfur]

I would line up a visit to a radiation oncologist now. My husband was in the same situation, rising PSA after prostate surgery. He completed 35 sessions of VMAT radiation last year.

[jdfamily in reply to fluffyfur]

Thanks and how did the radiation go? What were his side effects?

[fluffyfur in reply to jdfamily]

His big side effect was and is fatigue. So far he has no urinary or bowel issues. But he still gets tired easily despite a daily exercise program, and he has to lie down some days. This August will be one year since radiation.

The bowel and water prep is very important and I do attribute it to helping keep his side effects down.

I looked through your old posts. If you're specifically asking about ED, yeh radiation doesn't help in that regard, but my hubs had ED even prior to RP.

[susycarol]

My husband completed his 35 radiation treatments seven months ago. They say he is cancer free now. His PSA number before the treatments .1. After the treatments, very little to no side effects. The worst part was the prep he had to do every day.

[dentaltwin in reply to susycarol]

What prep (other than hydration)?

[susycarol in reply to dentaltwin]

He had to drink 50 oz of water and make sure his bowels were pretty much empty. He did this five days a week for seven weeks. You had to hold the water until the radiation treatment was over.

[jdfamily in reply to susycarol]

Thanks, so he had radiation after his prosectomy? I have heard some night mare stories of people who had radiation. Kind of scares me.

[susycarol in reply to jdfamily]

Maybe thing have improved over the years. He had his seven months ago. I would find out how long ago their treatment had been.

[tallguy2]

Almost always salvage radiation to the pelvic area and the prostatic bed is recommended in your situation. See a radiation oncologist as noted by Tall_Allen.

[MrkP]

I had a PSA of .1 after my surgery when I got salvage radiation. I had no side effects from the radiation.

[ragnar2020]

Hi jdfamily,

Shortly - hopefully by the end of this calendar year - you should be able to obtain a PYL PSMA-PET scan at a facility near you. The scan has been approved for use at UCLA and UCSR by the FDA.

A PYL PSMA-PET scan will reveal any suspicious micro mets that may be growing within your body. The accuracy of the scan is dependent upon the size of the suspected micro met. A PYL PSMA-PET scan can detect mets as small as .5mm.

I would investigate both ART using IMRT and proton beam (PBT) therapy at one of the thirty-five PBT centers around the US. PBT is being used successfully for local treatment of micro mets found using PYL PSMA-PET scans following BCR with greatly reduced toxicity to the surrounding tissues.

An RO at a PBT facility may want you to use ADT for six months prior to local ART to provide the best possible results of local RT following BCR. Each RO has their own opinions about the value of ART used in combination with ART.

This is my planned protocol if BCR occurs in my own situation. I am twenty-one months post RARP with a uPSA of .033. My uPSA has risen from .017 to .033 during the past nine months. My own PYL PSMA-PET scan is schedule in ÇA next month. My RO at UFPBI in Jacksonville made the referral for me to obtain the scan.

[jdfamily in reply to ragnar2020]

Thanks for the information

[Justfor_ in reply to ragnar2020]

Within no time from "bellow PSA of 0.2 or previously 0.5, PSMA scan is useless" someone is now prescribing the pattended radioligand at 0.033. Mother nature doesn't function in the binary domain nor is driven by kickbacks. There is a probability that scales with PSA and more importantly with PSADT.