PSA from secondary deposits!

[Barnarjo]

I had a radical prostatectomy in 2012 and my PSA levels until about a year ago were undetectable. I was then on annual PSA blood tests, but now they have put them up to 3 monthly as the PSA has risen, although still very low at around 0.2 . It was said at the time that the cancer had not spread beyond the capsule of the prostate, but I’m wondering now if there could be some secondaries forming after all this time. My question is if there are secondary deposits, do they themselves produce PSA?

[Atdabeach]

No expert here, but in a word, "yes." Prostate cancer, wherever it has spread, typically expresses PSA.

[Justfor_]

PSA of 0.2 isn't "very low" after a Radical Prostatectomy. It is , by definition, the confirmation point of a BCR. They will soon, if not already, advise you to have sRT (s for salvage). I have been there but followed a different route:

1) Switch to monthly Ultrasensitive PSA tests, min 2 decimal places reporting, or better 3 decimal places. In 6 months you can come up with a reasonably accurate PSADT (doubling time).

2) If this PSADT is over a year, you can go on watching out and setting plans for next steps.

3) If this is within 9-12 months you are in a gray area. I was there and elected a non-SoC way to stall progression. Details in : healthunlocked.com/prostate...

4) If it is less than 9 months you better proceed with a PSMA PET/CT scan and with this imaging on hand, meet up with a specialized Radiotherapist.

[Tall_Allen]

Yes, the only source of PSA after prostatectomy is prostate cancer. But if it is slow-growing pattern 3, it may never need treatment, just watching.

[dentaltwin in reply to Tall_Allen]

To your knowledge, how often is biopsy performed on either local residual disease or distant metastases? Can't be easy. (I was amazed enough when an interventional pathologist was able to locate and do a needle biopsy on a presumably primary lung cancer about 1 or 1 1/2 cm. in size on my father, and that was close to 20 years ago).

[Tall_Allen in reply to dentaltwin]

As PET scans get better, it becomes increasingly harder to biopsy because the sites are smaller. The CT done with the PET is often not good enough to completely localize it, so a more sensitive CT or MRI has to be done too. It gets really hard for small lymph nodes because they are squirrely. When my friend had a small lung met biopsied, the interventional radiologist did it in-bore.

[dentaltwin in reply to Tall_Allen]

Understood--and some of these mets are far smaller than my dad's cancer.

[ukpete]

Hi, I had a prostectomy in Sept 21, my PSA was undetectable but started to slowly rise, when it got to 0.18 I was referred to urologist who put me on hormones, I start radiotherapy in a few days, I’m on Zoladex injections every 4 weeks only 2 more to go, I go to the gym 3or 4 times a week which really helps, where in the UK are you? Sorry for the basic details I don’t usually comment on here because I usually get slated for my lack of medical knowledge, however if you need a chat inbox me, take care

[Farlo]

Grateful to see the support on here, wishing you the best Barnarjo.

[Barnarjo]

thanks for all the helpful comments regarding my PSA rise. My GP (I am in the UK by the way) is keeping a good eye on the levels, so I think I am content just to keep monitoring at the moment. I checked back in my records and my levels were <0.1 until about 18 months ago, when the results started to register 0.2ug/L which is where they have stayed up until now. I have my next PSA test in about six weeks so I will review it then. I think I have got some active cells lurking somewhere but given that my RP was over 10 years ago now I think whatever that is is fairly slow growing and it seems it doesn’t need action at the moment. Thanks for your help.