Bahhhhhh, uPSA going up : / ...

@surftohealth88

Glad to share my post RP pathology. I keep it handy. Btw, my highest PSA prior to the RARP was 5.2. My PSA had been rising for several years with an extremely linear velocity (see attached plot).
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AJCC Pathologic Stage: pT2c pN0 pM
Adenocarcinoma, acinar type
Gleason 3 + 4
6% of prostate involved by tumor
No EPE
No seminal vesicle invasion
No lympathic/vascular invasion
Perineural invasion: present

*Positive margin on right apex*

Right dominant tumor with minimal left side involvement.

*Prolaris Score 1.7 with 53% probability of BCR in ten years*
——

Despite my 3+4 Gleason score, the positive margin and Prolaris Score were concerning for recurrence. Post-RP, I did quarterly PSA testing for two years, then semi-annual testing for three years, then annual testing for five years. Always had a DRE with each PSA test.

The good news in all this is that my recurrence came ten years later, and when it did, my PSA was barely over the limit of detection (0.1).

I will add that on the PSMA PET scan from last June, the palpable nodule in my fossa had an SUVmax of 13.3. I agree with my urologist and RO that PSA is a much more robust biomarker with decades of science backing it up than any reading of uptake intensity on a PSMA PET scan. The scan provided strong evidence that the nodule is indeed a cancerous lesion/local recurrence. The PSA scores are more telling of the aggressiveness of the cancer.

And yes, despite my sub 0.5 PSA, the PSMA PET scan detected the recurrence. And insurance did provide coverage.

Back in 2014, when I was first diagnosed with PCa, I recall telling my wife and friends, “It’s all just a numbers game with probability tables until you hear the words, “You have cancer”. Then, the numbers are still the numbers, but your emotional reality changes.”

As a career scientist, I tend to stayed focused on what hard data are telling me (and what they aren’t telling me), but the data are only part of the reality of living with cancer. Your post was a powerful reminder of that. Thanks for sharing and bringing that fuller reality to the forefront of my consciousness. I am sure that I am not the only nudged by your post.

Hope the nausea has settled today.

High surf to health, I think our paths are going to continue to cross for quite a while I'm a year out of Arp.And now , my undetectable p s a is detectable , not what I wanted , let's keep hanging in there and supporting each other. Ed in Maryland

I agree about the anxiety risk of the ultrasensitive PSA test, but still, it has its benefits.

Last fall, scans showed a lucency in my spine at T3, the former cancer spot (obscured by screws and cement holding my spine together, which would also prevent a biopsy).

If my PSA had been undetectable just on the regular test (< 0.10), there would have been a very, very small chance of NEPC, so we might have ended up giving it a cautionary zap of radiation just to be safe But with my PSA undetectable on the ultrasensitive test (< 0.01), we were pretty confident it couldn't be even NEPC.

In the event, by adding the head camera for follow-up MRI in January and shooting downwards around the hardware (??not quite sure how that works), they were able to confirm that it's just benign bone remodeling. But if they hadn't, there's a chance I might eventually have ended up with an unnecessary session of radiation.

I'm a special case, but the uPSA test adds an extra layer of confidence when deciding whether a new lucency on a scan might matter.

I agree about the anxiety risk of the ultrasensitive PSA test, but still, it has its benefits.

Last fall, scans showed a lucency in my spine at T3, the former cancer spot (obscured by screws and cement holding my spine together, which would also prevent a biopsy).

If my PSA had been undetectable just on the regular test (< 0.10), there would have been a very, very small chance of NEPC, so we might have ended up giving it a cautionary zap of radiation just to be safe But with my PSA undetectable on the ultrasensitive test (< 0.01), we were pretty confident it couldn't be even NEPC.

In the event, by adding the head camera for follow-up MRI in January and shooting downwards around the hardware (??not quite sure how that works), they were able to confirm that it's just benign bone remodeling. But if they hadn't, there's a chance I might eventually have ended up with an unnecessary session of radiation.

I'm a special case, but the uPSA test adds an extra layer of confidence when deciding whether a new lucency on a scan might matter.

@melvinw

Thanks so much Melvin for additional information < 3

If it can make you feel any better I think that you have very special guardian angel ; ) who made sure that all is discovered on time against all odds and treated with great success ; ) !!!! *knock the wood

They found a nodule and knew exactly where to treat and as a result cancer was zapped and obliterated once and for all : ))) The only place where you had positive margin was at the apex and it is actually part that is lowest on a gland and closest to rectum and muscles there, so I am sure that nodule was the last remnant and is now eliminated forever *puffff : ))) !
Cheers to that ! : )

@edinmaryland

Ed, I am sooo sorry to hear that : (((. What are your numbers now ? I will be there for you, of course : ) ! We will endure this, whatever comes , same as we endured surgery - you will see < 3.

@surftohealth88
went from four tests- same lab- undetectable to recently detectable 0.014 (same lab)
not what I wanted on top of abscessed (infected) lymphocele ( after RARP) and lymphedema
As I am learning about this, radiation can make the lymphedema and lymphocele worse yet for the BCR salvage radiation may be on the table. I have no idea where this will lead. I will see my urologist NP this week. But as of now, I will also seek additional opinions