PSA Bounce, Any Suggestions? - Prostate Cancer N...

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PSA Bounce, Any Suggestions?

davenj profile image
16 Replies

I had focal laser ablation in 2017. Since then, my MRIs have shown nothing suspicious, but my PSA has bounced around causing some angst. Somewhere between 1/4 and 1/3 of my prostate was ablated in the FLA procedure.

My latest MRI from 10/21 measures my prostate at 48cc. My latest PSA is 3.8. So, assuming that all 48cc is functional, my PSA density would be .08. Worst case, if 1/3 of my prostate is scar tissue that does not produce PSA, then the density would be .12 (3.8/32)

My PSA history (Post FLA) has been:

12/15/17 - 3.9

2/9/18 - 5.1

12/20/18 - 3.2

3/18/19 - 2.5

9/20/19 - 2.4

05/18/21 - 3.2

08/2021 - 2.6

10/25/21 - 4.5

01/25/22 - 2.7

05/09/22 - 3.8

I have an appointment with the Urologist next week to go over the PSA results. I assume the options at this point are 1. continue on AS, 2. do biopsy, 3. do another MRI, 4. do a PET scan.

The increase in PSA bothers me. I want to be proactive, but don't want to do unnecessary tests. Any suggestions?

16 Replies
Tall_Allen profile image
Tall_Allen

Suggest an mpMRI read by a radiologist who knows how to read ablated tissue and a PSMA PET/CT. If suspicious and equivocal, biopsy.

Magnus1964 profile image
Magnus1964

I would not worry over those PSA numbers. You have to look at the big picture. Your PSA is going nowhere. Look for three progressions in row, then see your doctor.

chrisNYC profile image
chrisNYC

DaveNJ-

i would say your PSA looks okay, especially as FLA do not reduce PSA to negligible numbers.

that said, i relate my experience as anecdotal info: i had a FLA in 10/2016 and my PSA fluctuated around 2 for several years, then started to climb. repeat MRIs were always equivocal and did not show any lesions. i was told i probably had BPH. PSA, however, continued to rise: 4, 5, 6, 7, 10. CT scan and Nuclear Medicine scan negative.

in AUG 2021, however, a repeat Biopsy (i hate those) showed a disease recurrence. much of the recurrence was IN the ablated tissue. not sure if the ablation obfuscated the MRI.

after alot of research, i realized i needed a full gland treatment and went with SBRT, which i just completed at NYU this past month.

our differences being, my PSA really spiked. continue to monitor, but at some juncture, if things mildly progress, you might consider a repeat biopsy. FLA are a nice low invasive alternative to kick the can down the road, but for a microscopic disease they are often not a cure.... best of luck!

chris

davenj profile image
davenj in reply to chrisNYC

Thanks. What was your Gleason?

I was diagnosed with 3+4, 2 out of 10 samples had about 5% 4. The biopsy was done with real-time MRI. My pre-FLA PSA was 6.6, so never very high. Also, the genomic test on the tissue rated it low risk.

Bigm789 profile image
Bigm789 in reply to chrisNYC

Did Dr Eric Walser at UTMB do your FLA

davenj profile image
davenj in reply to Bigm789

Dr. Sperling in FL

Bigm789 profile image
Bigm789 in reply to chrisNYC

Which Dr. did your focal laser ablation mine went from 3 to .05 in 6 mo.

chrisNYC profile image
chrisNYC

my pre FLA gleason was mostly 6, with some G7 (3+4). 5/12 in total. genomics low risk. PSA hit 7.2 at zenith. dropped to 2 after FLA and remained there for a few years.

davenj profile image
davenj in reply to chrisNYC

Thanks. Sounds similar. Who did the FLA?

chrisNYC profile image
chrisNYC in reply to davenj

dr walser, UTMB

Bigm789 profile image
Bigm789 in reply to chrisNYC

Just got my 6mo MRI , pre FLA 3 , post 0.5 , have no erectile function and ejaculate but its rather watery.

Bigm789 profile image
Bigm789 in reply to chrisNYC

Dr. Eric Walser. @ UTMB , houston tx

davenj profile image
davenj

Had an appointment with Urologist. He wants to test the PSA again in 3 months.

Bigm789 profile image
Bigm789 in reply to davenj

Nitazoxonide 1000mg 2x with meals 15 days. The. Retest

davenj profile image
davenj in reply to Bigm789

You think the Nitazoxanide dropped your PSA?

Bigm789 profile image
Bigm789

Its helps try 3 week course

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