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Rising PSA years after radical prostatectomy
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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Rising PSA after treatment
That is why you always go to the same lab; hopefully one that does a sensitive test where your reading is down to 0.010 and you avoid sex and bike riding for one or two days before your test.
Can you provide some history as to your prostate cancer journey.
2017 radiated prostate 40 times then zolodex
2020 met to L1 so radiated 1 inch out and back on Zolodex
2023 Jan MRI L2 met 1 inch no radiation T 10 and T11 small bit put me on Xtandi and Xgeva
PSA was 9.8 in Jan then Mar 1.7 then 2.3 and now3.0 on Zolodex still
Your results look fairly consistent to me. Lab results vary a little each way. I would be happy with what I see if it were me. I've been told by my urologist and my oncologist that if the numbers double in any 10 month period then, it's time for some other type of testing.
I had BCM at the end of 21' of .2, then .3 by the time of PET scan and prior to that that relatively new Versa system. I'm presently 63, but had RP at 53 yo and Gleason 9. My PET scan read inconclusive? (Level/grade 3), but they all seemed to believe that was it. I haven't asked, but had it been too small to catch, they may not have extended the treatment area as they ended up doing. It's a double edge sword for me. I wish they had acted quicker, but i waited a few weeks to retest and it had risen to a ,3 when they did the PET scan. My Oncologist suggested there was about of 40% chance of them seeing it. So, it has recently been a year of completing the radiation and Orgvx last month, and extremely grateful to get an undetectable on the sensitive one. One thing I see that does concern me sometimes, is not using a well credentialed Institution, seems like they have the most cutting edge technology. Forgive me, I digress, but these community hospitals scare me. I can understand if there's nothing within a hundred miles or something, but I believe these institutions have local help with temporary housing for the patient. I personally had a friend recently diagnosed with a cancer, I suggested JHH because only 60 miles way, but they chose local. I say no more because I don't want to get in anyone's business, but they approached me, I shared it once. There may be components I'm just unaware of. Best wishes to you!!!
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3 ReactionsI am in complete agreement - When you are diagnosed with a life threatening condition, do your research and go to the best center of excellence you can find. To address my prostate cancer (radical prostatectomy), I drove 4 1/2 hours to Mayo-Rochester. The drive is a small inconvenience to support the quality of life for the rest of your life.
Best of luck,
Jim
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4 ReactionsCryptic isn't for everyone, but my MD already told me that's what I could expect, and it hasn't happened yet. (I ask a lot of questions, but I prepare them ahead of time because I know his time is very tightly scheduled. I also know it is the charge nurse who will handle any out-of-appointment questions, so I'm guessing she is sitting there with the MD once a day, going through the questions as quickly as possible, and he's answering as quickly as possible.
So what I'm saying is you got the answer to your question, and nothing else is needed since it's still early to either radiate or test further.
It's early to radiate because it's expensive, you can't go back and do it willy-nilly, and you want to radiate at the time it will make the most difference in the progress of the cancer. (But if you ask for it, they could still do it now, they just focus where they think the cancer might be. And it will affect quality of life.)
It's early to do a PET scan because they are notoriously poor at finding the cancer until levels rise as your MD specified. Of course, they are also expensive, so you want to do them at the best time, especially if you're planning that insurance (or medicare) will cover it.
I drove 10 hours to Mayo Rochester. Best decision ever. My doc’s approach was to go at the cancer aggressively so that you get ahead of it and stay clear for 10 years +. My University docs wouldn’t do this. I went from stage 4 to clear. Do your homework and ask lots of questions.
My wife asked our university doc why he wasn’t doing a PSMA PET scan instead of a regular PET scan. He agreed it was better but since the insurance generally won’t cover it, they don’t mention it. (We called the insurance and paid the $300 premium. My life is worth it.)
Good luck.
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2 ReactionsThanks
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