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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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Download a January 17 2023 webinar from the Prostate Cancer Foundation titled Rising PSA. It's helpful and gives some numbers when the Urologists and Oncologists want to tale action. Your numbers so far look pretty good. Hopefully your Jan 24 result will be lower.
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2 ReactionsGoing for my first bloodwork since my PC surgery to remove the little bastard on Aug. 3rd and Doc said he feels good no move up from hopefully 0. If it is even .1.2.3, I will have a PMSA Pet Scan and look for spots of cancer. If any are found where the prostate was, I get foul Lupron for a year to a year in a half. If a spot or spots is found outside where the prostate was, then I get Targeted Beam Radiation as the PMSA PS would mark where to blast and poison the nasty little spots. I hope it is 0. i had a 7 Gleason Score but Bone Scan and CT said no cancer outise at all.
God Bless you all.
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4 Reactions@jackiepie I'm about a year and a half behind you--meaning my PSA hasn't started rising yet. For that reason, I'm very interested in what you will discover in your journey. It looks like you switched PSA tests starting in 4/5/22 because all your results are lower than 0.1, but those from then on have values given. The same thing happened to me, but closer to the surgery. Starting out about six months I switched to an ultrasensitive PSA assay from labcorp, which drops out at .006 (my actual results since: 0.012 ng/mL, 0.016 ng/mL, 0.012 ng/mL, now 0.006 ng/mL). If you're using a similar uPSA, your results are maybe 5x higher.
However, the level of fluctuation you show is similar. One of the things clinicians and researchers may look at is doubling rate, but you have not yet had a doubling (first double would be .05x2=.10, but you have always been below .10).
So, trying to understand my numbers, I found some results, perhaps on this forum?, showing that even after RP prostate numbers fluctuate, and perhaps more so when they are very, very low--may have to do with factors that do not relate to prostate cancer.
So, like you, I am very aware the cancer is both elusive and persistent, so that day will come. Yet I also wonder if your cancer is not yet in need of treatment, and this is a good time to enjoy life in your time under the sun as a good gift :-).
Still, a sword of damocles hanging over my head does not immediately induce carefree thoughts :-). All the best, and I hope you will follow up when the decision to treat is made.
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5 ReactionsI just saw this discussion from a current medical conference (ESMO 2023), which relates directly to this thread:
A couple notes:
1) PSA failure is defined as >.1 or 3 consecutive rises. This thread starts with two consecutive rises and PSA just below 0.1 (after RP=radical prostatectomy, the question would be different after initial treatment with radiation.)
2) There was increased toxicity, but no significant advantage found in giving radiation sooner, specifically for people like myself and @jackiepie who have "intermediate unfavorable outcomes."
"Dr. Sartor: At ESMO 2023, an important long-term follow-up was presented with the RADICALS-RT study. This examined the optimal timing of radiotherapy after radical prostatectomy. It has been common in years past to give adjuvant therapy for patients who had poor-risk disease at the time of radical prostatectomy; things like positive margins, pathologic T3/T4, Gleason 7 to 10 disease.
"In this study, patients were randomized to receive adjuvant radiation or radiation at the time of PSA failure. Now, PSA failure was defined by a PSA of greater than 0.1 ng per mL, or three consecutive rises.
"This was a large study, 1396 patients. The primary endpoint was metastasis-free survival, which, as you probably know, has been linked to overall survival in a variety of studies.
"No advantage gained with adjuvant radiation
"What did they find? They found that there was no advantage to giving adjuvant radiation. The overall survival at 10 years was 88% versus 87%. And the freedom from metastatic disease at 10 years was 93% versus 90% — no difference. And I'm simply going to say that waiting until PSA relapse is perfectly appropriate for patients after radical prostatectomy; that you do not have to use adjuvant therapy.
"Adjuvant radiation led to greater toxicity
"By the way, and I didn't mention this, urinary incontinence and fecal incontinence were worse with adjuvant radiation therapy. So, the patients not only did the same, they actually had more toxicity.
"This is the largest study ever conducted with adjuvant radiotherapy and prostate cancer. And these results show no evidence of a meaningful benefit for adjuvant as compared to salvage therapy. And in my opinion, salvage radiotherapy, not adjuvant, should be the standard of care."
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4 ReactionsI sincerely thank all who have responded to my post. I read each reply carefully and learn from each. I particularly want to thank @perrychristopher for reminding me of the Prostate Cancer Foundation and their webinars. I urge you to get a copy of the Prostate Cancer Patient Guide (www.pcf.org). It is full of useful information. The webinar suggested there (Jan 17, 2023) addresses a most crucial issue: if and when to address a rising PSA after RP. From the many posts I have read over the past two years, I haven't seen much attention given to the side effects from salvage radiation. The natural reaction to getting a cancer diagnosis is to quickly and totally eliminate the cancer but in certain milder cases it might be better to just live with it. Of course, it depends on age, health, doubling time, aggressiveness etc. I don't know how my case will progress, the Decipher results and the next PSA will tell a lot. When those results are in, I'll consult with my urologist, medical oncologist and radiation oncologist and decide a “best course” of treatment.
Also, thanks to @spino for pointing out the work by Dr. Sartor at ESMO 2023. It appears that we are in similar “boats” and you have thought about it a bit.
I truly wish the best of outcomes for all in the prostate cancer community.
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5 ReactionsActually that was a comment by Dr Sartor on the results presented at the conference.... 🙂 As a "medical professional" (unrelated field) I get "practice updates" from a service and follow prostate cancer related posts because of my personal interest. All the best, @jackiepie
And I totally agree with your comments about side effects from radiation. I have begun to think about radiation as something that can be used infrequently with the goal being to deploy it at the most optimal time or times.
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1 ReactionThank you so much. Best of luck to you in the future.
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1 ReactionI learned a lot in the above comments. I had a Gleason 7, and had the little nasty taken out
3.5 months ago. I just had my first Bloodwork today. The PSA came in at 0,0022
Doctor said this was not undetectable but that 0,020 are less is undetetable. I mean it seems like mine is so very close. I have to have another BW in 3 months and if it has gone up even a ,001 ie. any rise at all, it will mean cancer is there and I have/had a very aggrestive one. I have one friend who had it taken out 8 years ago and his PSA has remained very low but if it bumps up any what so ever, he gets a Lupron shot and then it is normal for a long time and passive. You know even a tiny tiny bit of cancer left will eventually kill you if you don't act so now I know just why 40% of worldwide deaths is cancer.
If you haven't already, I would read the PCF Prostate Cancer Patient Guide starting at page 61. That part of the guide considers rising PSA after a prostatectomy. Also, watch the webinar mentioned earlier. If you are considering further treatment, you should assemble a team: urologist, medical oncologist and radiation oncologist, discuss the findings with them and then think carefully about how you want this treated. Good luck in your next PSA measurement.
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2 ReactionsGreetings:
I am almost in a similar situation. I had a radical prostatectomy on 07/05 and on 8/24 my PSA came back as < .01.
In the meantime I have been on a plant based diet with no red meat. In addition I have been working out in the gym doing heavy workouts 3-4 times a week because "they" all say diet and exercise is the best way to reduce the chance of it coming back.
In the case of a slowly rising PSA I think it might be best ride with it until it becomes detectable by a PSMA-PET, (about .PSA .05), then hit it with pinpoint radiation. If you do that now it is just a shot in the dark because you don't know exactly where it is.
An alternative position, may be to hit it now with the triplet, ADT+ chemo + something else.
Best wishes