Post prostatectomy: What do rising PSA levels mean?

Posted by hoard @hoard, Sep 10, 2019

New to group! Wish I had checked this out 2 years ago while supporting my husband! Now over e years post prostatectomy, wondering what might make psa go from all 0 to 2.6…

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kujhawk1978 | @kujhawk1978 | Feb 20 6:51am

Yes and no…the medical community in the past few years revised the grading system…

A 5 Grade Group System was created to have a better way to describe how a cancer will behave and respond to treatment.
Grade group 1: Gleason score 6 or lower (low-grade cancer)
Grade group 2: Gleason score 3 + 4 = 7 (medium-grade cancer)
Grade group 3: Gleason score 4 + 3 = 7 (medium-grade cancer)
Grade group 4: Gleason score 8 (high-grade cancer)
Grade group 5: Gleason score 9 to 10 (high-grade cancer)

A lower group indicates a better chance for successful treatment than a higher group. A higher group means that more of the cancer cells look different from normal cells. A higher group also means that it is more likely that the tumor will spread aggressively.

So, you re more likely…then again, you may have been in the less likely. My pathology report said GS 4+4 which when I fed the data from the pathology report into MSKCC's nomogram, margins, SV, ECE…it said 30% chance of BCR. Statistically that also meant a 70% chance it would not. Alas, I was in the 30% and thus why I am not a gambler.

What it does mean I think is you and your medical team should consider more aggressive treatment if the clinical data supports it.

I may be facing a similar decision, labs today, if my PSA goes up again, my radiologist, urologist and I agree it may be time to scan and then decide based on the results, my labs and clinical history. One thing we do know, one's PCa does not get "less" over time in terms of the grade group.

Kevin

itterac | @itterac | Feb 19 4:44pm

In reply to @kujhawk1978 "Next steps - gather clinical data, consider bringing a radiologist and oncologist on to your team,..." + (show)

Will do at next appt. Does second bcr after rp salvage and adt mean my 7 4/3 is particularly aggressive?

kujhawk1978 | @kujhawk1978 | Feb 19 8:16am

In reply to @firespooks "Yes. They have discussed PSA doubling time and rise and scans and testing. I’m just not..." + (show)

Great!

firespooks | @firespooks | Feb 19 8:05am

In reply to @kujhawk1978 "What are they "waiting and watching" for? Have they discussed with you the clinical data which..." + (show)

Yes. They have discussed PSA doubling time and rise and scans and testing. I’m just not ready for further treatment.

kujhawk1978 | @kujhawk1978 | Feb 19 7:55am

In reply to @itterac "Rp in 2018. 36 radiation and 3 mos orogovyx in 2021. Psa undetectable until 12/15/22 then..." + (show)

Next steps – gather clinical data, consider bringing a radiologist and oncologist on to your team, a multi-disciplinary approach.

Gather the clinical data to inform any decision between you and your medical team to start treatment – at what PSA, will PSA doubling and velocity times be a factor, when and with what will they image…will they do any genomic testing…?

Having that type of clinical data combined with your personal health and preferences for quality of life, aggressive treatment or not…can inform any decision between you and your medical team.

The imaging could show recurrence in only the lymph nodes, if so, how many and where. Or, it could show bone and, or organ involvement. If so, where…depending upon the PSADT and PSAV, you and your medical team may decide to not doing anything and continue to actively monitor, if the PSADT

kujhawk1978 | @kujhawk1978 | Feb 19 7:52am

In reply to @firespooks "I’m in the same situation. Had RP in 2006. 39 radiation treatments in 2013. Now my..." + (show)

What are they "waiting and watching" for?

Have they discussed with you the clinical data which will cause them to recommend you start treatment – at what PSA, will PSA doubling and velocity times be a factor, when and with what will they image…will they do any genomic testing…?

Having that type of clinical data combined with your personal health and preferences for quality of life, aggressive treatment or not…can inform any decision between you and your medical team.

firespooks | @firespooks | Feb 18 4:23am

I’m in the same situation. Had RP in 2006. 39 radiation treatments in 2013. Now my PSA is 0.73. My doctors are just waiting and watching me . They both said the next treatment would be LUPRON.

itterac | @itterac | Feb 17 10:51am

Rp in 2018. 36 radiation and 3 mos orogovyx in 2021. Psa undetectable until 12/15/22 then .26. Psa on 2/15/23-.32. Urologist appt on 3/6. Thoughts , suggestions ,treatment recommendations , next step?

natem | @natem | Feb 14 5:32pm

In reply to @shelby29 "What do most Gleason 8 patients do for treatment" + (show)

I was Gleason 8 & 9 in 2013, then had RP. Just had recurrence of .2, .3 late 2021. Then radiation early 22'. Had my 6 month PSA about a month ago and fortunate to have undetectable. Next 6mos is July. Hopefully your medical team is working with you. One thing I learned is to ask the doctors questions, and not afraid to ask "why and what are options."

All the best to you!