PSA, 27 months after RP

[Paulo1968]

All,

Just received another quarter PSA result - 0.06.

3 months ago it was 0.05 and it has been around 0.03 for the previous 2 years ...

Not too pleased with this increase.

Happy Summer everyone.

[Dionysos]

No Paulo, this is not good. Important now to take action, and decide what step you want to take now. Take your future in your own hand, because action should have been taken already at PSA 0,05.

Para você também um bom verão

[Paulo1968 in reply to Dionysos]

Thanks for the input. I am worried, but my doctor considers levels till 0.1 undetectable.

I am triying in this fórum to have other views.

Thanks again

[Dionysos in reply to Paulo1968]

Hello Paulo, I know that. Here in the Netherlands also every value below 0,1 is considered as undetectable. But the ultra sensitive tests provide the possibility to detect very low values. In your case you can see that however very slowly the values increase. And as you say you are worried, and Iwould be that also in your case, it is the best to anticipate as soon as possible on additional actions. Also because your Gleason score was 8, and there was a positive margin.

[Paulo1968 in reply to Dionysos]

Yes all correct including my urge not to wait ...

[TimCo]

Hi Paulo, Your PSA value is small yes but headed in the wrong direction. Perhaps seek a second opinion for more input to base additional treatment, or not, going forward.

[Paulo1968 in reply to TimCo]

Thanks Tim, Indeed I am trying to find another opinion ...

I was wondering if it shouldn't be an oncologist? and not an urologist! Any view?

[Miccoman in reply to Paulo1968]

I had one urologist who knew a great deal about PC and treatments, the other not so much. All the oncologists I have dealt with, well 3 out of 4, had a better handle on what to do and when to do it. Of the 4, one was an idiot, one didn't like gay people, one (my local oncologist) seems fairly competent and one (a research oncologist at a major cancer center) is great -- he tells me what he knows and doesn't hide behind vague statements.

So I would definitely encourage you to get a second opinion from an oncologist as to what options are available to you and when to move forward on them.

[Paulo1968 in reply to Miccoman]

Thanks. I am waiting for a confirmation of appointment... thanks for your message.

[billd9946 in reply to Paulo1968]

Absolutely, I would seek the opinion of an oncologist. I’m in the same position with slowly rising PSA and my oncologist and I have decided to do a PSMA scan before I move toward Salvage Radiation and Hormone Deprivation Therapy. FYI, I started the therapy in preparation to begin radiation, but it was a nightmare for me. That’s when I decided to seek an oncologist’s advice. He was able to provide me with information that better informed my decision. You could also consider an Axumin scan before the PSMA scan, to see if there is anything detectable. I did so and the scan revealed nothing. I’m currently in limbo. Good luck moving forward... I know exactly how you feel my friend.

[Tall_Allen]

A recent study found that you can wait for salvage radiation for 3 consecutive increases or until your PSA reaches 0.1 ng/ml, whichever comes first.

[Paulo1968 in reply to Tall_Allen]

The mark of 0.1 is what my doctor says is his question point!

Do you have this study you speak about that you can share? Thanks in advance.

[Tall_Allen in reply to Paulo1968]

prostatecancer.news/2019/09...

[Bcgkelly]

Hi Paulo,

I’m sorry to hear your news. I think you saw this coming but it’s only a very small increase. My PSA went up to 0.035 last month which is the second increase in a row. The plan my consultant has is to wait until the PSA increases to the level when it can be Detected on a PSMA scan. He says that the level should be 0.5. He has however said that he suspects I’m heading for another biochemical re-occurrence. Even a PSMA scan may not find the cancer as low as your current level. He says next treatment will be definitely hormone treatments with possibly more radiotherapy ( as you know I’ve had radiotherapy already) and possibly chemotherapy. The decision I believe is making sure any treatment you get is effective while balancing the reduction in your quality of life & only you can make that decision for yourself. I can only speak for myself but every treatment I have had has reduced my quality of life while also I believe extended my life. Make sure you get all the facts and take your time before deciding your next steps and know I’m wishing that things work out for you.

Bill

[Paulo1968 in reply to Bcgkelly]

Hi Bill,

Thank your for your message. Hope all turns out for the better for you too.

I am having an appointment next Monday for a second opinion - a specialist in oncology for urology matters. However I fear given the low levels, there won't be much to say unless there is a further development. However I am interested in someone else's view about my story. I must say anyway that I am worried as I had hoped for a longer free biochemical re-occurrence. Keep you posted.

Paulo

[Bcgkelly in reply to Paulo1968]

Do keep me posted as we seem to be in a similar situation apart from me already having a reoccurrence. I believe at the low levels they won’t be able to tell you for definite where it is. You could have treatment now but it most probably be based on guessing where it is and adding hormone treatment for good measure. If you wait they may be able to find it but might want to give you pelvic wide radiotherapy and hormone anyway or just stereotactic radiotherapy like I had. It’s bought me time before hormone treatment which was what I wanted and I couldn’t have pelvic wide radiotherapy anyway because of my bowel. Best of luck and let me know.