Bahhhhhh, uPSA going up : / ...

@edinmaryland

Ed, I was thinking - since you have so much inflammation and infection going on in that area, the tiny rise in uPSA might as well be just a result of all those processes that are going on. It is known fact that inflammation or infection in general can cause PSA increase even after RP. It is actually great possibility that that is the case *knock the wood, and I know that it is unnerving never the less but try to think about that possibility too < 3

@edinmaryland

Ed, I was thinking - since you have so much inflammation and infection going on in that area, the tiny rise in uPSA might as well be just a result of all those processes that are going on. It is known fact that inflammation or infection in general can cause PSA increase even after RP. It is actually great possibility that that is the case *knock the wood, and I know that it is unnerving never the less but try to think about that possibility too < 3

@surftohealth88 thanks so much surf to health. That would be wonderful if that turns out to be the case. And I' absolutely welcome it at this point.

I don't know what's going to happen, I'm just trying to hold on, and wait and see .

I know, I'm going to have to get another cat scan for what's going on with the abscess and everything, if the cancer has returned, then I just have to go to plan b. plan a was find the cancer and get rid of the prostate, I guess plan b is going to be find where the cancer went, if it went someplace and find a way to get rid of it if possible, I know that a lot of these cancers are slow, growing and all that, but I'm going to wait and see what the urology outfit I'm seeing says and then I'm going to go see a person that I think is one of the specialists Within 500 miles around here and get their opinion as well.
This last year was no walk in the park. I sure hope Round two is a little easier. Thanks. Ed

@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).
---
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.

@edinmaryland
You want a really great oncologist in Maryland?

Bethesda Maryland
Sibley memorial hospital
Johns Hopkins, school of medicine
GU Oncologist
Dr. Channing Palmer

One of the best.

@melvinw
That's pretty linear, but with a slight upturn. Do you have a logarithmic graph of that? I always graph my PSA logarithmically, but then I have much larger excursions (see my profile).

@xahnegrey40

Still waiting for doctor's reply .
Nurse sent message that we need to do test again next month since it is climbing. We do tests every month anyways (on our own dime) - we were supposed to do test every 3 mos, but since that long span made me nervous I decided that we should test uPSA every month.
Thanks for words of comfort.

@melvinw
That's pretty linear, but with a slight upturn. Do you have a logarithmic graph of that? I always graph my PSA logarithmically, but then I have much larger excursions (see my profile).

@jeffmarc
Jeff thank you so much I was going to see Tom Jarret at Sibley ( also with Hopkins) However, he is with urology maybe it is time for me to switch to oncology.
I really appreciate it