what’s the likely cause of an increase in Psa 16 years after radical prostatectomy. Gleason 3/4 negative margins no lymph or seminal vesicle involvement. Last psa was .06 up front .05 6 months earlier. Usually undetectable but have had psa scores at .04 and .05 10 years ago.
I saw a post 4 years ago in which TA replied that it wasn’t even necessary to get annual testing anymore after 10 years. I thought the recommendation was at 20 years when you could safely discontinue psa testing unless you were a Gleason 6. I’m close to that but not there yet. I have seen some cases in which men had a recurrence 15 to 20 years after surgery. I’m scared I am headed down that path. Another poster in the same thread stated that there is a slight chance if it turns out to be a true bcr when and if it hits .2 it would be indolent. How likely is that. That’s what AI says but I don’t believe half the things that come out of ChatGPT
Also I am a needless worrier, hence the name but should I switch to the standard Psa test that only measures to .1? And should I test every 6 months or stick with annual.? If the next test is .08, I will have anxiety beyond belief.
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I think ultrasensitive PSA tests cause needless anxiety. Remember that about 60% of low risk men never have any progression worth doing anything about with 20 years of follow-up so far.
Thanks TA. so what do you think is causing this increase now. And are you saying that if it is a progression to bcr greater than .2, 60% of men won’t even treat. How is that decision made?
I'm saying that for most untreated men with low risk PCa, treatment is unnecessary. Your PCa is obviously very indolent and may similarly never need salvage treatment.
I guess I am needlessly worrying at this point. Is there a method that oncologists use to treat or not treat. PSADT? What if my next psa test is over .1?
Hi TA - I’m still a little confused about your 60% of low risk men never have any progression… I thought that progression only happens in about 5 to 10% of cases in low risk men.
1. Did you mean for men that have progression in low risk cases, 60% don’t need treatment?
2. What defines progression?
3. How do you determine treatment or surveillance?
Patients in most current active surveillance programs need treatment when pattern 4 increases, showing progression. I only raise that fact to you because even if there is a little pattern 3 left behind, it may never progress and never need treatment.
Thanks so much for your thoughtful replies. last post- so in your opinion you see no benefit to radiate between .2 and .5 even though it’s unlikely that the scans would show anything. Doesn’t research show that’s the optimal time to treat. You wouldn’t empirically radiate the prostate bed at say .3.
And if in your opinion that you wouldn’t treat until .5 at the earliest I assume you would even stick with annual testing.
At 0.05 the rounding error is 20% on a test that also has a 20% advertised measurement error. Lay man's summary: 0.05 to 0.06 stands equal chances of being an actual increase or a numbers artifact. Silly docs and their parrots find this too mind boggling to comprehend. If you had been taking tests to the 3rd decimal place, instead of to the second, the rounding error would had been 1/10 of the current, than the increase would had taken precidence.
I agree, probably a nothing burger, but interested to see a timeline of your PSA’s over the 16 years period if you can screen shot it and post. God Bless
hope it’s a nothing burger but I’m still worried that it’s not. I’m perplexed as to why it would suddenly jump from undetectable for the last 5 or 6 years to detectable at .05 then .06. Obviously if I had been using the standard test I would not have anxiety. I understand that 15 years out is very different than have a recurrence in the first 5 years. I have spoken to a top dr at John’s Hopkins albeit a oncological urologist robotic surgeon and he has also said it’s a nothing burger ( not his exact words) and to switch to the standard test to avoid unnecessary anxiety. He said the likelihood of this progressing to .2 is exceedingly low. Treating with radiation before that would not be wise and carries much more risk than benefit. All that said, who is to say that it won’t rear its ugly head necessitating radiation and life changing ADT down the road which is why I worry.
What is your age? As was stated your progression could easily be within rounding errors also the fact that you had .04-.05's 10 years ago? In your shoes, based on the rate of progression of your latest tests, I'd go back to living life stick with yearly testing!
We are all different in how we approach life and cancer.
Not sure this will help but I am fast approaching 80 and my PSA bounces around from 0.05 to 0.09. I figure I will be dead from something else before I need to worry about that.
Besides going back on ADT is going to take some really serious thinking.
Needless worrier or on diligent watch? Can one be certain any remaining cancer perceived as indolent will remain so?
Since my third treatment seven years ago, salvage ePLND, my uPSA has been very low sable, slowly rising from ePLND nadir of <0.010 into and holding 0.03X range since June 2021.
I have no anxiety with ultrasenstive testing - whereas giving this beast time and obscurity would give me anxiety. But then, I am just 67YO with a very active and fit lifestyle. I choose to keep a close watch on this beast with regularly testing. Twice now I have done liquid blood biopsy testing and had multiple PSMA PETS at 0.03X; yes, despite naysayers, 0.03X range. All the best!
I see in your bio you are dealing with CR and you have lost friends to this beast. Several of my friends face CR and I too have lost friends.
I did self-pay for my first Ga68 PSMA PET CT that I had done concurrently with Ferrotran nanoparticle MRI, in Jan 2018 in Europe. Neither methods were available in the US at that time and my private insurance coverage was limited to US. As I share, the Ferrotran successfully identified multiple cancerous pelvic mets at uPSA 0.131– whilst the Ga68 was clear. As I also share, my intent since my Dx ten years ago is to, if it comes to it, defer ADT/CR for as long as possible. I strive to do this by removing tumor burden – guided by imaging.
Based on my pathology findings it seems my flavor of prostate cancer is one that produces a lesser amount of PSA relative to cancer volume. So, in Dec 2021 I had my first Ga68 in US, when my uPSA rose into the 0.03 range. I had learned to not give this cancer time and obscurity. We were grateful it was ‘clear’ – a very informative finding and IMO a very good use of mine and insurance coverage monies. A year later, I had Pylarify for comparison – it was clear as well. Again, very useful finding and great value.
In July 2024 I had my next Pylarify, uPSA still holding 0.03X. I also had my second liquid blood biopsy. Our anticipation was both would be clear – further validation my treatment path achieved what we wanted and that I had no imageable cancer volume out ahead of PSA.
But neither were clear. As I share, turned out a 2cm metastatic melanoma met was identified in my liver. How valuable was this (insurance covered) imaging? Pricelesss!! It once again confirmed NED for prostate cancer and the very early detection of a singular melanoma met has given me a fighting chance against this beast as well.
Hi, as mine have been in US, no. The two I am familiar with are GUARDANT360 Cdx and FoundationOne CDx. I tried a quick search - here are links: guardanthealth.eu.
I don't understand your logic or reasoning. Help me understand "waste of money at those numbers". What are your acceptable numbers for the best bang-for-the-buck?
I had a doc order my psma at .3 and some would say that it was a waste money or only worth it at .5. My psma showed a pelvic lymph node. A friend at the Mayo Clinic has a doc who will start imaging at .1.
PSMA has to be ordered by a doctor, so his doc must believe there's still a benefit. As tough as the healthcare system is on cost savings I'm sure the doc would have to explain why they ordered at such a low psa. I hear about plenty of situations that are kicked around by an insurance company - my Mom has worked for a neurosurgical group for 39 years this year.
Hi see my profile for slow moving psa after rp. I don't think a recurrence is defined until 2 or 3 increases above 0.1. Plus, I think it would need to show a doubling time to be worrying. That's my take anyway, I may be on the road to SRT but let's see.
anxiety….interest paid on a debt not owed……im VERY confused at your Hx. Did you get a RP with a Gleason score of 3/4? Let me look at your profile before saying anything else.
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