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Rising PSA years after radical prostatectomy

Posted by olanordman @olanordman, Feb 22, 2021

I am 60 years and I had radical prostatectomy on 23rd Nov 2018. I was told out of the 15 lymph nodes taken only one was affected less than a millimetre. It was Gleason score 7B with PSA around 13 at time of surgery but 11 at time of diagnosis in June 2018.

The PSA been fluctuating between 0.09 and 0.18 since surgery on 23rd November 2018
I have no incontinence as well as Erectile dysfunction. I take hypertension medication – Norvask Amlodipine 5mg daily and Cetirizine 5mg for allergy. Below are some of the test results. I have many of these test results – a few below
Jan 2019: 0.11
April 2019: 0.11
June 2019: 0.09
August 2019: 0.12
December 2019: 0.12
April 2020: 0.12
August 2020: 0.11
October 2020: 0.17
December 2020: 0.15
February 2021: 0.18

I am worried the cancer may be returning or might have spread. I met my doctor today and expressed my concerns. He has agreed to refer me to the hospital where I had the surgery. Any suggestions based on this brief history?

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Jerry | @jerryegge | Aug 29, 2023

Hi,
There is so much variability in the world of PSA numbers. Then we try to analyze a lab result to the nearest hundredth. Results can vary from lab to lab, the time of day of the test, what you did yesterday or even the day before. Results from your normal labs do a regular test, not a sensitive one. Therefore their PSA test only reports down to 0. If your level is below that, then it’s reported as undetectable.
Sincere my surgery in Jan. 2022, I’ve been tested every three months with a variety of reports. At 74, I’ve decided to cling loosely to my death, for there-in you find life. Best wishes with you PSA management and health.

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1 reply
knoyes01 | @knoyes01 | Aug 29, 2023

<p>Rising PSA years after radical prostatectomy</p><p>Radical Prostatectomy surgery was in July 2020. PSA test results were less than .01 through Feb 2022. Then, Jan 2023 .04, Mar 2023 .05 and Aug 2023 .08</p><p>My Dr said (text message only) my two choices are radiation at the prostate area or wait until I am at .2 and then do a PED</p><p>I thought his response was way too cryptic and I am now searching for more information on my own.</p><p>I am healthy 63 year old male</p>

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13 replies
di341 | @di341 | Aug 29, 2023
In reply to @knoyes01 "Rising PSA years after radical prostatectomyRadical Prostatectomy surgery was in July 2020. PSA test results were..." + (show)
@knoyes01

<p>Rising PSA years after radical prostatectomy</p><p>Radical Prostatectomy surgery was in July 2020. PSA test results were less than .01 through Feb 2022. Then, Jan 2023 .04, Mar 2023 .05 and Aug 2023 .08</p><p>My Dr said (text message only) my two choices are radiation at the prostate area or wait until I am at .2 and then do a PED</p><p>I thought his response was way too cryptic and I am now searching for more information on my own.</p><p>I am healthy 63 year old male</p>

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So sorry but what is PED?

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knoyes01 | @knoyes01 | Aug 29, 2023
In reply to @knoyes01 "Rising PSA years after radical prostatectomyRadical Prostatectomy surgery was in July 2020. PSA test results were..." + (show)
@knoyes01

<p>Rising PSA years after radical prostatectomy</p><p>Radical Prostatectomy surgery was in July 2020. PSA test results were less than .01 through Feb 2022. Then, Jan 2023 .04, Mar 2023 .05 and Aug 2023 .08</p><p>My Dr said (text message only) my two choices are radiation at the prostate area or wait until I am at .2 and then do a PED</p><p>I thought his response was way too cryptic and I am now searching for more information on my own.</p><p>I am healthy 63 year old male</p>

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typo should be PET

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hbp | @hbp | Aug 29, 2023
In reply to @knoyes01 "Rising PSA years after radical prostatectomyRadical Prostatectomy surgery was in July 2020. PSA test results were..." + (show)
@knoyes01

<p>Rising PSA years after radical prostatectomy</p><p>Radical Prostatectomy surgery was in July 2020. PSA test results were less than .01 through Feb 2022. Then, Jan 2023 .04, Mar 2023 .05 and Aug 2023 .08</p><p>My Dr said (text message only) my two choices are radiation at the prostate area or wait until I am at .2 and then do a PED</p><p>I thought his response was way too cryptic and I am now searching for more information on my own.</p><p>I am healthy 63 year old male</p>

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I think that is may be time to get a new doctor or a new medical plan. You should be able to visit with your doctor face to face and not just text. At the least a video conference that allows you to have a decision. Also, a full body pet scan is a test to see what is going on and where and help to properly determine the best treatment. I think that something is definitely going on in your cancer department and addressing a new small problem before it gets big is best. Best of Luck.

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knoyes01 | @knoyes01 | Aug 29, 2023
In reply to @knoyes01 "Rising PSA years after radical prostatectomyRadical Prostatectomy surgery was in July 2020. PSA test results were..." + (show)
@knoyes01

<p>Rising PSA years after radical prostatectomy</p><p>Radical Prostatectomy surgery was in July 2020. PSA test results were less than .01 through Feb 2022. Then, Jan 2023 .04, Mar 2023 .05 and Aug 2023 .08</p><p>My Dr said (text message only) my two choices are radiation at the prostate area or wait until I am at .2 and then do a PED</p><p>I thought his response was way too cryptic and I am now searching for more information on my own.</p><p>I am healthy 63 year old male</p>

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I agree. I am searching for a new Dr

Thanks

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edmond1971 | @edmond1971 | Aug 29, 2023
In reply to @knoyes01 "Rising PSA years after radical prostatectomyRadical Prostatectomy surgery was in July 2020. PSA test results were..." + (show)
@knoyes01

<p>Rising PSA years after radical prostatectomy</p><p>Radical Prostatectomy surgery was in July 2020. PSA test results were less than .01 through Feb 2022. Then, Jan 2023 .04, Mar 2023 .05 and Aug 2023 .08</p><p>My Dr said (text message only) my two choices are radiation at the prostate area or wait until I am at .2 and then do a PED</p><p>I thought his response was way too cryptic and I am now searching for more information on my own.</p><p>I am healthy 63 year old male</p>

Jump to this post

Your numbers are low, so you fall in the category of early detection = many options. Definitely do your research and self-education and put focus into biochemical recurrence. Generally speaking, at least one prostate cell (or already cancerous prostate cell) remained in your body and it is slowly growing and shedding the antigen to give these PSA results. With this new found knowledge, you will be much better equipped to make an informed decision as to whether you need a new doctor, but in general you will need a health team.

Depending on the pathology from your surgery, Gleason score, decipher test, and genetic testing, that will create a solid foundation for next steps. Usually next steps would lean into imaging (bone/mri/ct), and while a PSMA PET scan will certainly give you the best input, your insurance may require a sequential approach. Some online videos of PSMA PET scan indicate doctors like to wait until the PSA is higher so that the test has more of a marker to find.

The cancer cells could be in the prostate bed area, it could have spread to one or a few regions elsewhere. You are in an excellent position to go the route of education, advocate, and make a decision, remember, you are at the point of many options, and the most important option is to live life to the fullest.

Sending all good thoughts.

REPLY
1 reply
knoyes01 | @knoyes01 | Aug 29, 2023
In reply to @edmond1971 "Your numbers are low, so you fall in the category of early detection = many options...." + (show)
@edmond1971

Your numbers are low, so you fall in the category of early detection = many options. Definitely do your research and self-education and put focus into biochemical recurrence. Generally speaking, at least one prostate cell (or already cancerous prostate cell) remained in your body and it is slowly growing and shedding the antigen to give these PSA results. With this new found knowledge, you will be much better equipped to make an informed decision as to whether you need a new doctor, but in general you will need a health team.

Depending on the pathology from your surgery, Gleason score, decipher test, and genetic testing, that will create a solid foundation for next steps. Usually next steps would lean into imaging (bone/mri/ct), and while a PSMA PET scan will certainly give you the best input, your insurance may require a sequential approach. Some online videos of PSMA PET scan indicate doctors like to wait until the PSA is higher so that the test has more of a marker to find.

The cancer cells could be in the prostate bed area, it could have spread to one or a few regions elsewhere. You are in an excellent position to go the route of education, advocate, and make a decision, remember, you are at the point of many options, and the most important option is to live life to the fullest.

Sending all good thoughts.

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thank you!

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melcanada | @melcanada | Aug 30, 2023

PSA 9.8 then Xtandi PSA 1.7 then 2.3 and now 3.0 three month intervals

Should I be concerned

REPLY
1 reply
michaelcharles | @michaelcharles | Aug 30, 2023
In reply to @knoyes01 "Rising PSA years after radical prostatectomyRadical Prostatectomy surgery was in July 2020. PSA test results were..." + (show)
@knoyes01

<p>Rising PSA years after radical prostatectomy</p><p>Radical Prostatectomy surgery was in July 2020. PSA test results were less than .01 through Feb 2022. Then, Jan 2023 .04, Mar 2023 .05 and Aug 2023 .08</p><p>My Dr said (text message only) my two choices are radiation at the prostate area or wait until I am at .2 and then do a PED</p><p>I thought his response was way too cryptic and I am now searching for more information on my own.</p><p>I am healthy 63 year old male</p>

Jump to this post

You may find a webinar helpful from the Prostate Cancer Foundation PC f.org go to the website click on the menu top right patient resources click on the arrow go to patient webinars and January 17

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