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Possible Causes of rising PSA 18 years post prostate removal

Posted by stu6060 @stu6060, 3 days ago

Hello All,
I had my prostate taken out 18 years ago. I was 46.
About a year ago my PSA came back as 0.1 for the first time. Previously everything was reported to me as "undetectable less than 0.1."

In the last 15 months I have been somewhat obsessed with getting tests and trying to make sure I am in position to get treatment if/when I hit, what seems to be the generally agreed upon trigger number of 0.2

Depending on where I go (doctor's office or $24 private lab test) my PSA is hanging around 0.9 to .110.

It seems most likely at some point in time ( months?? a couple years??) I will find my PSA is 0.2 or more.

I am however curious, has anyone had an experience like mine and found the PSA numbers just kind of stayed at the "low numbers" for an extended period of time? Is it possible I have a small amount of normal prostate cells left that have grown and now kicking off some measurable PSA, or is the most likely case happening in that I have something small brewing and if I don't step in front of a bus sometime soon I will have a treatable condition again? thanks

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stu6060 | @stu6060 | 1 day ago
In reply to @kujhawk1978 "Yeah, just when you think... First thing to think about may be discussing and developing "decision..." + (show)
Profile picture for kujhawk1978 @kujhawk1978

Yeah, just when you think...

First thing to think about may be discussing and developing "decision criteria" in coordination with your medical team - when to treat, if so, with what, for what period...

Part of that is what clinical data to you want to have in making any treatment decision?

Some you may already have from the pathology report and labs and jabs since, GS, GG...

Some you can determine from the data you have, PSADT and PSAV.

Some you may not have, Genomic testing results, testosterone levels, CV health, Lipids, CMPs, etc. that show liver, kidney function and other useful health data in making treatment decisions.

Then discuss the criteria...

How many PSA tests, spaced how far apart and that show a continuous increase? As others have said, to the extent possible, you want to control the conditions of labs and jabs, same lab, same time of the day, same pre-draw routine.

At what PSA will you act? That may depend on what treatment you and your medical team are thinking about. If SRT to the prostate bed, the decision is made for you, .2

If something else, then the sensitivity of imaging maybe a factor. At below .5, generally a 1/3 statistical chance of PSMA imaging showing recurrence, if .5-1.0 you double the statistical chance.

So, if your decision is SRT, you're not going to wait for PSA to rise above .2 and likely not use imaging. Here's the contra to SRT at .2, it's like dropping dumb bonds, hoping to hit the target. You can choose to be more aggressive and include te pelvic lymph nodes, ratchet up the aggressiveness even further and add short term systemic therapy, six months, though 12-18 is in play depending on the clinical data. Then again, if you miss that "golden" window of .2 for SRT, there is the possibility you lose an opportunity for that elusive cure. Put me in the group that says if surgery doesn't bring you that cure, SRT is not going to either. You are now into managing your PCa as a chronic disease requiring lifelong vigilance and treatment decisions at various points, though not continuous, maybe intermittent. Terms like progression free survival move go the forefront in your decision making.

There is some data from clinical rials that indicates MDT only may push back the need for systemic therapy. That argues for letting PSA rise to between .5-1.0, image and then treat with MDT.

Depending on your PSADT and PSAV, you may consider doing nothing but continuing to actively monitor as PSDAT >12 months supports that. You can always act later if the clinical data indicates.

Read through the NCCN and AUA guidelines, avail yourself of resources from organizations such as PCRI and PCF.

Kevin

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@kujhawk1978 Kevin,

Great information. Sobering for me as I come to realize I am in the group that may/does have a chronic condition requiring intermittent treatment.

65 now.. shooting for 80. When I first got PC I prayed that it be God's will that my son could see me through the eyes of a man. He is now 22. So I feel really blessed to have discovered my PC before it advanced. At the time of discovery, I had no symptoms.

So I really appreciate yours and everyone's input.

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kujhawk1978 | @kujhawk1978 | 1 day ago
In reply to @stu6060 "@kujhawk1978 Kevin, Great information. Sobering for me as I come to realize I am in the..." + (show)
Profile picture for stu6060 @stu6060

@kujhawk1978 Kevin,

Great information. Sobering for me as I come to realize I am in the group that may/does have a chronic condition requiring intermittent treatment.

65 now.. shooting for 80. When I first got PC I prayed that it be God's will that my son could see me through the eyes of a man. He is now 22. So I feel really blessed to have discovered my PC before it advanced. At the time of discovery, I had no symptoms.

So I really appreciate yours and everyone's input.

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@stu6060

Yep, you're entitle to a "pity party..." We've all had them is my guess at some point in our cancer journey. Then, we pick ourselves up off the floor, dust ourselves off and get about the business of managing and living with our PCa.

These forums are invaluable as sounding boards for our thoughts and ideas, There's nothing quite like the school of hard knocks for "lessons learned!"

There are no guarantees obviously...on Sunday I experienced a sudden onset of weakness, balance and coordination issues on my left side. Immediately my thoughts went to, crap, are you having s stroke!? There were no other symptoms, and they resolved quickly so I went about my day, even went to the gym.

Monday morning I'm taking a shower, and the same thing happens, only very severe. I yelled down to my wife, take me to the ER now, threw some clothes on. They did their thing over three days, CTs, MRIs, CV Echos, labs, jabs, physical exams, consults...Finally, they determined what happened, I was experiencing multiple TIAs, the cause, likely I was under medicated with respect to my blood thinners. My cardiologist had reduced my daily dosage from 5mg 2x daily to 2.5mg 2x a year after my cardio ablation when I had no further episodes, they tested my INR, low at 1.3.

They discharged me, put me back on my original dosage.

If it's not one thing, it's another... ever vigilant!

I do believe thanx to medical research, we and our medical team have more tools in our toolboxes to manage our PCa, albeit with the side effects that go with treatment.

Shared files

New Prostate Cancer Treatments Offer Hope for Advanced Cases (New-Prostate-Cancer-Treatments-Offer-Hope-for-Advanced-Cases-1.pdf)

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jeff Marchi | @jeffmarc | 1 day ago
In reply to @stevesien "I had proton radiation and adt 1.5 years in 2009-2010. My psa went from 9.7 to..." + (show)
Profile picture for stevesien @stevesien

I had proton radiation and adt 1.5 years in 2009-2010. My psa went from 9.7 to .02 . Stopped adt in 2010. Psa went to around .2 occasionally jumping up to .3 ( after sexual activity) then back down to .2 . Level around .2 for 15 years now. My Dr says my chance of recurrence is about 1%

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@stevesien
The standard for further treatment for your cancer is not until your PSA hits 2.02. Sounds like you’re doing great and have a low chance of having a reoccurrence, like the doctor says.

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