PSA Bounce, Any Suggestions?

[davenj]

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?

[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]

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]

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 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 in reply to chrisNYC]

Did Dr Eric Walser at UTMB do your FLA

[davenj in reply to Bigm789]

Dr. Sperling in FL

[Bigm789 in reply to chrisNYC]

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

[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 in reply to chrisNYC]

Thanks. Sounds similar. Who did the FLA?

[chrisNYC in reply to davenj]

dr walser, UTMB

[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 in reply to chrisNYC]

Dr. Eric Walser. @ UTMB , houston tx

[davenj]

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

[Bigm789 in reply to davenj]

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

[davenj in reply to Bigm789]

You think the Nitazoxanide dropped your PSA?

[Bigm789]

Its helps try 3 week course