Husband's elevated PSA level: What could it mean?

@bens1
This is so enlightening! We haven't heard of a PSE test, and will research it right now! We are so encouraged and grateful by the amount of help here we're already receiving! Thank you!

@katebaker
It is the Episwitch PSE test found here https://www.94percent.com/

@trtupper
You should’ve had salvage radiation a long time ago. It should be done when your PSA hits .2 and yours hit 1.6. Where are you being treated? Something is wrong with your treatment if they are allowing you to have such a huge rise In PSA without being treated. You need to get a second opinion from a center of excellence, Actually, not a second opinion you need to change your place of treatment if they have anything to do with treating you after you’ve had this huge rise in PSA.

3 1/2 years after my prostatectomy, my PSA started rising and hit .2. At this point, my medical team put me on a six-month shot of ADT (Lupron) Followed by two months later eight weeks of salvage radiation. That is the standard of care.

At a minimum, you need a PSMA Pet test immediately to see if there are metastasis that can be zapped and Thus reduce your PSA significantly.

You also probably need to be on hormone therapy ADT, Which will reduce your PSA to close to undetectable pretty quickly.

If you tell me where you live, I might be able to recommend somewhere to go for treatment, Do not delay this you are facing the equivalent of a firing squad.

Here is the recommendation from the American Society of clinical oncology for what you are supposed to do when your PSA starts to rise after a prostatectomy.

From Ascopubs about what PSA to do salvage radiation.

≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.

0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.

0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/

@jeffmarc Thank you so much for your information. I agree with you about the salvage radiation. This hospital isn’t the same place I had the prostate surgery. I used to live in Lacrosse Wisconsin where I had the surgery and now live in Newport News Virginia.
Unfortunately it has been difficult to have the care team here take this serious. I feel like they really are not that concerned otherwise they would have looked into my PSA numbers more and care more seriously.
Either way, I believe Hampton University has a cancer research center. I am thinking about starting over and get a second opinion. The odds are against me but I feel this is a better solution because I don’t feel there hasn’t been a true effort with the care team I now have. I sent a message to both theNP and the doctor in Urology a message last Wednesday hoping for a callback. All I got was the NO is out until next Monday. I would have thought someone would have called me back if they were concerned! So with that said I am going to bring up my concerns with this care team and ask for the radiation! If they feel I should wait until next next PSA blood test, then I will be done with that facility. Thank you again for your advice and concern!!! I really appreciate it.

Lots of great thoughts as usual from the treasure trove of experience of members....

I posted this before...

We've gotten better at determining, do I have PCa, if so, what...

We've learned that DRE may not be a definitive answer...

From the Prostate Cancer Foundation website on screening...

...DRE cannot feel prostate abnormalities in the anterior (forward) area of the prostate, away from the rectum, and is often most useful only when the prostate cancer has grown sufficiently to cause cancer that can be felt with a finger. The DRE is no longer recommended as a standalone screening test for prostate cancer.

The blind TRUS we all grew up on back in the day has been improved with MRI guided, yet, still, is it definitive?

Today, thanx to ongoing medical research, there are better ways and means to determine if one has PCa and if so, what?

Links to ways to determine if one has PCa.

medpagetoday.com/urology/pr...

google.com/gasearch?q=4k%20...

google.com/gasearch?q=prost...

google.com/gasearch?q=pse%2...

pmc.ncbi.nlm.nih.gov/articl...

Of course, one has to know about these, ask one's medical team about the next step, a treatment decision, how best use them and then understand the results.

Still, I see a large number of posts that use DRE and TRUS (ok, MRI or MPRI guided) as the basis for decision making. Is that wrong, not necessarily. Is it the best way to know in order to make an informed treatment decision, I'm on the side that says no.

Finally, we see literature on the use of PSMA PET in initial staging but not mainstream.

My thought is use all the tools in the tool bag to answer the question, do I have PCa, if so, what?

Kevin

@kujhawk1978
I’m not sure what happened, but none of your links work.

Would’ve been interesting to review them.

@trtupper
Two good cancer care centers in Virginia are

VCU Massey
Comprehensive Cancer Center
Virginia Commonwealth University
Richmond, Virginia
Comprehensive Cancer Center

University of Virginia Cancer Center
Charlottesville, Virginia
Comprehensive Cancer Center

Not sure either of those would work for you, but I thought I’d at least mention them. National Cancer Institute recommends them

Lots of great thoughts as usual from the treasure trove of experience of members....

I posted this before...

We've gotten better at determining, do I have PCa, if so, what...

We've learned that DRE may not be a definitive answer...

From the Prostate Cancer Foundation website on screening...

...DRE cannot feel prostate abnormalities in the anterior (forward) area of the prostate, away from the rectum, and is often most useful only when the prostate cancer has grown sufficiently to cause cancer that can be felt with a finger. The DRE is no longer recommended as a standalone screening test for prostate cancer.

The blind TRUS we all grew up on back in the day has been improved with MRI guided, yet, still, is it definitive?

Today, thanx to ongoing medical research, there are better ways and means to determine if one has PCa and if so, what?

Links to ways to determine if one has PCa.

medpagetoday.com/urology/pr...

google.com/gasearch?q=4k%20...

google.com/gasearch?q=prost...

google.com/gasearch?q=pse%2...

pmc.ncbi.nlm.nih.gov/articl...

Of course, one has to know about these, ask one's medical team about the next step, a treatment decision, how best use them and then understand the results.

Still, I see a large number of posts that use DRE and TRUS (ok, MRI or MPRI guided) as the basis for decision making. Is that wrong, not necessarily. Is it the best way to know in order to make an informed treatment decision, I'm on the side that says no.

Finally, we see literature on the use of PSMA PET in initial staging but not mainstream.

My thought is use all the tools in the tool bag to answer the question, do I have PCa, if so, what?

Kevin