PSA dissapointing

Posted by ezupcic @ezupcic, 5 days ago

My most recent PSA increased 30% over the last 3 months from 6.3 to 8.1. However, over the course of 16 months it has fluctuated from 8.1 to 4.4 and now back to 8.1 again. I've tried supplements from the evidence zone, exercise, diet modifications and reduced alcohol but nothing seems to have a significant impact on decreasing PSA . My most recent MRI was a Pirads 2 with no focal lesions and a prostate volume of 70ml. So I guess I'll continue with the PSA until my next MRI in October and then see if anything has changed. I'll be 63 soon. Right now I'm just trying to manage some anxiety but if the MRI shows any changes or suspicious areas I'll do a biopsy.

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diverjer | @diverjer | 3 days ago

They did 3 biopsy of lesion and they were all 3 +3, no big deal. Then from other areas 4+3, I think 6 and some 3+4 . Also 2 large cribriform. Was done rectal. Didn't hurt just lots blood. Seems PSA was 5.2

drcopp | @drcopp | 3 days ago

Go for the PET Scan, as it pings the prostate cancer cells in your body with about 95-99% accuracy.

ezupcic | @ezupcic | 3 days ago

In reply to @drcopp "Go for the PET Scan, as it pings the prostate cancer cells in your body with..." + (show)

@drcopp Not sure if I could get that before a diagnosis.

wheel1 | @wheel1 | 3 days ago

Definitely get another MpMRI, I went from PIRADS2 to a PIRADS4 in my MRI 18 months later after my 1st one. Also no reason to wait for the PSE test or ExoDx. I agree I don’t think prior to a prostate cancer diagnosis insurance companies will pay for a PET. Your erratic PSA behavior is concerning. Also I really did not want the biopsy but continued results of erratic PSA, ExoDx, and second MRI all pushed me into it. Also just because the MRI does not give a lesion to focus on a random grid biopsy of the rest if the prostate can find the cancer. The MRI identified PIRADS4 lesion turned out benign, but the random cores caught my cancer. I think what really tipped me was a high 72 ExoDx score to get the biopsy.

northoftheborder | @northoftheborder | 3 days ago

In reply to @handera "@ezupcic You’re exactly right! Being your own advocate means insisting (or being thoroughly convinced otherwise) of..." + (show)

@handera There's standard of care, and then there's Standard of Care. My goal has been to stay close to the new, emerging SoC rather than the old, lagging one from 5–10+ years ago, especially since it is changing so fast.

Unfortunately innovation doesn't happen everywhere all at once. Unless the 60 year old urologist at your local hospital is especially devoted to attending oncology conferences and reading the latest research journals, their idea of "standard of care" might be a bit outdated compared that of the research oncologists at a major cancer centre (or "center of excellence" in the U.S.).

wheel1 | @wheel1 | 3 days ago

All the long term randomized clinical trials are obviously necessary but you hit the nail on the head. Those studies don’t change SOC or especially NCCN guidelines for years. My oncologist just told me this week that often times as guidelines are changing you get two sides to an treatment based on a lot of anecdotal evidence favoring a new one but it is not what the NCCN guidelines or long term studies show yet. He said when you get two schools of thought by outstanding oncologist’s clearly debating something up and coming, their is a reason. He cited the example of PSA driven imaging and PET driven imaging for beginning BCR treatment under the guideline recommendation’s optimum before PSA reaching .2 in patients having higher risk and studies showing better outcome. He said it will be a long time before PET has been around for long term randomized clinical trials establishing maybe it is better. He said most recurrence’s are believed in the prostate bed, but not all of them and can also be in other places simultaneously. He said currently treatment for BCR is with radiation and ADT clearly regardless where the cancer is and your PSA will drop regardless if the radiation was hitting the prostate bed with no cancer their as the ADT is systemic and will reduce the PSA from the true location of the cancer which received no radiation. He said most patients understandably go along with the NCCN guidelines for good reason. He also cited that ADT is being found to not be needed as long in cases but not necessarily updated in SOC.

ezupcic | @ezupcic | 3 days ago

In reply to @wheel1 "Definitely get another MpMRI, I went from PIRADS2 to a PIRADS4 in my MRI 18 months..." + (show)

@wheel1 this will be my 3rd MRI in 18 months. First was Pirads 3 then 6 months later Pirads 2. Prostate volume went from 95ml to 70. PSA density still below 0.15.