It's a year out from my Robotic Surgery (Feb 2018)
The last two months I have had a consistent rise in my PSA level. The last month-six weeks in particular the numbers have gone from .15 to .27 to .34. Those are not good numbers for a man with no prostate. I have had 2 MRI's, a Cat Scan, A Bone Scan and a PSMA Pet Scan. (That one is a highly sensitive nuclear scan)
All the scans are clear. No sign of cancer. Still, the radiation oncologist wants to get me on hormone treatment and salvage radiation in the next few weeks. The problem I have is that they want to radiate the prostate bed but they are not sure even if cancer is in the prostate bed. The could radiate that area, then find out cancer has moved to another location.
Anybody in this group know other men in similar situations? Could something else be causing my PSA to rise?
Thanks
Written by
fairyman
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This is the most common recurrence situation, and your radiation oncologist is giving you good advice. You want to treat the cancer before you can see it. This is something you want to tackle ASAP. Your chances of a cure are cut in half again if you wait until your PSA rises to above 0.5:
Prostate cancer follows a predictable path from the prostate to the prostate bed to pelvic lymph nodes and bones. Even if you had found a detectable mass in the prostate bed, you would have to treat the entire prostate bed. Most of the cancer is smaller than the 4 mm detection limit of PSMA PET scans.
I guess you didn't understand my reply. I understood your point - your scans couldn't detect the cancer. But the cancer is certainly there. The masses are just too small to be detected by any of those scans. The best scans have a tumor size detection limit of 4 mm. As I said, yours is the most common situation.
Of course the cancer is causing the prostate specific antigen to rise. There are no benign sources that cause a rise like that.
PSA from benign prostatic sources (tissue left behind) dissipates quickly and does not increase. The amount of PSA from non-prostatic sources is less than 0.001 ng/ml. Inflammation of the prostate (prostatitis) and BPH go away after the prostate is removed.
Hello. Sorry to hear about your diagnosis. I am currently experiencing something similar only my PSA was never low after robotic RP. I’ve previously posted about my diagnosis. My scans too were not able to detect any cancerous growth. Still, given my age (50) and PSA, multiple recommendations were to undergo ADT plus EBRT. I’ve started ADT and am part way through EBRT. Wish you the best on this tough decision.
This has happened to me. My prostate is removed my levels have risen. Ive had salvage radiation but the levels have continued to rise. The Doctor's know there is no cancer in the prostate bed or pelvis. We are watching the PSA levels for now. If this trend of rising continues I will have a full body MRI before we attempt hormone treatments in hopes of finding where the cancer is hiding.
I had the same situation with a steady rise in PSA one year on from my nerve sparing RP. On the 3rd anniversary of my RP my PSA was 1.11 and, like you, scans detected nothing sinister elsewhere. I had radiation of the prostatic bed but asked if I could forego the hormones and just have the treatment immediately. My Oncologist reluctantly agreed but the radiation did bring my PSA down afterwards so they had hit the right place. My subsequent PSA nadir was eventually 0.17 but never knocked it out completely and it has risen slowly again since, albeit a lot slower rate than post RP. Hope that helps! All the best - Brian.
So, i have wondered whether, since we are talking about very small (but concerning) blood concentrations of PSA, whether ingesting semen (which contains PSA) either through oral sex or through unprotected anal sex might affect PSA readings. I don't engage in unprotected anal sex, but with my partner I do sometimes swallow after oral, and there could plausibly be some absorption in the mouth through the mucus membranes. I have started abstaining from oral for a few days before my PSA readings, just to try to eliminate this as a possible confounding factor
So my doc says if there is a rise of 0.1 to 0.3 then to 0.4 and its consistent for a few weeks or months that is the trigger. It means the cells are growing, cell are microscopic they are not going to show up. The fact is the numbers don't lie. They are just giving you the facts. It is the time for you to consider what is next.
it could be radiation, and a six month course of hormone suppression . That may be all you need. No one can make these choices for you. I am having trouble with my own choices if my PSA goes up. One thing that hit me after a year of dealing with this shit is that I will never be done with this, thinking about it, trying to figure out whats next. That is the boat we are all in, this is journey. I am a nurse and healer and many other things guess what I am having issues with my healing for myself. It has taken me a year just to get grounded and centered again. Take your time talk to as many people as you need to and then let your answers lead you to your path. This is time to discover and take your self. There is also clinical trial out there called restore look it up and get involved, there is a lot of resources out there keep looking! Good Luck!
This is very common and your doctor's advice is standard of care for rising PSA after surgery. I had it done myself. I still don't have evidence of disease on scans, but my PSA continues to float around 0.2 so I know it's there somewhere. I am currently on Lupron (standard) and Erleada, which is for patients with no evidence of mets but castrate resistant cancer.
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