Confusing PSA results: Is it possible side effects could inflate PSA?

Posted by whatthef @whatthef, Jan 6 1:44pm

I had prostate cancer in 2018. I had brachytherapy and 5 1/2 weeks of IMRT Radiation. My original gleason score was 3+4 and out of 12 core samples three spots showed up Cancer all of them 3+3 except for one. My original PSA was 5.63 and over the next 3 1/2 years after treatment , dropped down to .10. Since that time it has slowly increased and now is 2.95. I had a PSMAPET scan and showed several spots , 2 lymph nodes and T7 in my back. With the scan, they didn’t show a number to indicate the SUV only said mild uptake. I chose SBRT to those spots. 30 days after SBRT I did another PSA check and it was 2.82 no significant difference. And just two days before doing sbrt my psa was 2.76. In the past 5 months, I’ve had four PSA checks and they’re all between 2.76 and 2.95 not much difference. They seem to have leveled out. I’m 74 1/2 years old and Since my original prostate cancer treatment side effects consist of constipation, difficulties urinating, and has been a constant battle during this petiod of time. Is it possible these side effects could be inflating my PSA? I’m scheduled to do another PSMAPET scan soon. Are there any other tests I can utilize to find out if I have recurrent prostate cancer. I might be fooling myself maybe ,but somewhere in my mind tells me I don’t have cancer. Your thoughts please, Bob

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

jeff Marchi | @jeffmarc | Jan 6 2:17pm

Unfortunately, you are one of those people with a 3+4 that has an aggressive cancer of some sort. Because you didn’t have a prostatectomy, you don’t really know what the true nature of your case is. There might’ve been a higher Gleason somewhere in your prostate Or you might’ve had one of the aggressive things that aren’t always caught in a biopsy.

The side effects you mentioned would not increase your PSA, That’s due to metastasis somewhere. Many times they are too small to be seen by the PSMA pet scan since it can’t see metastasis smaller than 2.5 mm and even if they are 5 mm they are difficult to be seen in the scan.

The thing is, your cancer has become aggressive, and you have had a lot of spots of metastasis so you don’t really need a test, History has proven you have a case that continues to be aggressive and you definitely have active prostate cancer. The question is what are you doing to treat it and manage it. It has to be in your bloodstream at this point, so it can reappear at any spot in your body.

Are you taking ADT or at least an ARPI like Nubeqa That can control your cancer growth without having to reduce your testosterone? You don’t mention taking anything to try to keep this under control. When my cancer came back the second time after radiation I was put on Lupron and it kept my PSA down for 2 1/2 years. I’m now on Nubeqa, After 16 years of prostate cancer and four reoccurrences, And it has kept me undetectable for the last 26 months. The drugs do work, but you need to take them.

Have you used Flomax to Help with your urinary issues? That can make a real big difference for a lot of people.

brianjarvis | @brianjarvis | Jan 7 5:25am

A few questions that might help provide answers:
> did you use a rectal spacer with your initial radiation treatment? (Did they overshoot your prostate?)

> with your initial 3+4, was there any mention of cribriform pattern, perineural invasion, Intraductal carcinoma, extracapsular extension, or seminal vesicle invasion in the MRI of biopsy reports?

> did you have a biomarker (genomic) test? What did that test show?

> did you have a genetic (germline) test? What did that test show?

Your PSA of 0.10 would’ve been your nadir. Certainly, as your PSA passed 1.0 and approached 2.0, they would’ve suspected biochemical recurrence.

> along with your salvage SBRT, did you also do hormone therapy?

Yes, these side-effects could be inflating your PSA. However, the PSMA PET results were definitive - the fact that the PSMA PET scan showed several spots, indicates that it is recurrence.

Have they diagnosed specifically what’s causing the side effects (constipation, difficulties urinating) in order to recommend treatments? (Urinary issues are a common side-effect with brachytherapy, especially if the seeds are near the urethra. Constipation wouid be from the radiation overshooting your prostate and hitting your intestines.)

(If the PSMA PET scan lights up, there is prostate cancer.)

Next steps would depend on the PSMA PET scan results (and the other test results mentioned earlier).