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Rising PSA's after treatment - an answer
Prostate Cancer | Last Active: Jan 11 8:59am | Replies (31)Comment receiving replies
Thanks for the quick reply. I am also lucky as my Urologist was at a center of excellence and world-renowned for his robotic surgery skills. 18 months later my erectile function is about 85-90% with no drugs and just about 100% with Cialis. I know I'm getting ahead of myself (which is easy to do with anyone experiencing a cancer diagnosis) but the reason for my curiosity is my uPSA was < 0.02 for 18 months and just today it came back =0.02 instead of < 0.02. I realize 0.03 is a more reliable early-sign of biochemical recurrence but I'm trying to mentally prepare. (History: pre-RP, 3+4 Gleason, 7 of 12 cores, tumor in the middle area instead of peripheral which typically has higher chance of cure but ironically higher PSA, mine was 29 (54 yo) so technically that alone classified me as "high risk." But post-RP Pathology was excellent. No extracapular extension, seminal vesicle invasion, no positive margins, and nothing in my extended lymph node removal. But there is such a thing as micrometastases.)
I moved out of state since the RP so I just was having my Primary Provider order the uPSA so the downside is I don't have a Urologist to give me a call to say, don't read too much into the test result change to try to calm my nerves.
I was just pondering long term if this wasn't just an anomaly in the test result what I'm in for down the road if it keeps going up. I'm also curious at what point does private insurance cover salvage RT? I hear Viewray went out of business so guided MRI is not an option right now, not that I'm anywhere close to needs that. But at least your story gives me comfort that sounds like worse-case in X years, I may need salvage RT and may just need to up my Cialis dose a bit.
Again, getting ahead of myself but needed to get this off my chest without any Urologist to talk to right now. I guess not at least starting a patient relationship when I moved wasn't wise but wishful thinking I'd never need one, at least for the PCA diagnosis, for the rest of my life.
Another issue is I'm on the most expensive private medical insurance plan you can buy in case I needed salvage RT. Was looking forward to downgrading from Platinum to Gold and save some money but now I'm thinking I should stay on Platinum even though on Gold out of pocket costs on PSA tests are $28 instead of $0. (My platinum plan covers all labs and imaging 100% regardless if deductible has been met.) But at my levels, I'm even wondering what is the chance I'd need salvage RT next year? Imaging is worthless at the lower PSA levels they generally recommend starting salvage RT at. I guess it's really a guess not knowing your velocity yet or if it was just an anomaly.
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The standard and generally accepted definition of BCR for single decimal PSA tests is .2, with a 2nd PSA tests 90- days later of .3 or higher.
For USPSA, two decimal points, no such consensus exists. Add to that, the newer imaging generally cannot locate recurrence at the two decimal place whether it be .02 or .03.
You may want to check the NCCN guidelines for BCR and SRT, they are considered the SOC and insurance companies generally, sometimes with prodding, abide by them.
More and more. doublet and triplet therapy is mainstream clinical practice today, not monotherapy such as SRT to the prostate bed. Should you reach a point where treatment is needed by on clinical data - PSA tests, PSADT and PSAV, GS, imaging, any symptoms you are experiencing, I would discuss with my medical team as a minimum doublet therapy, some form of ADT combined with radiation. If for some reason that does not knock down the PSA, you can then add a triplet, ARI, Docetaxel...
For now, relax, enjoy life, actively monitor , develop and discuss decision criteria with your medical team.
Kevin
So, what to do?
My medical team and I had decision criteria:
No reacting to single lab results.
Any decision to image would require three or more consecutive increases in PSA, spaced 2-4 months apart with PSA between .5-1.0. Why you ask, greater than 60% chance of locating the recurrence.
In march of this year, that decision criteria was met, we imaged with Plarify, it showed a single PLN which we treated with SBRT. For the micro-metastatic disease, we added 12 months of Orgovyx, not Lupron. Why, well...
Lower CV SE profile.
Faster castration Higher sustained castration while on it.
Faster return of T when stopping.
PSA tests can vary even if you use the same labs, they don;t change the assay method, follow TMDE calibration requirements...same pre-test routine...That's why my decision criteria was 2-4 months apart. If a lab showed an "increase," we tested again in two months, if it "decreased" or stayed the same, we tested in four months.
Interesting, even while on Orgovyx and T< 9 which is the lowest my lab can measure, I can still achieve erections, though with physical stimulation, not just visual. This of corse dismays my wife, but, that's a different doctor...