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Post prostatectomy: What do rising PSA levels mean?
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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Here's an article which may be of use when talking with your medical teams about micro-metastatic disease- https://www.ajmc.com/view/novel-assay-detects-and-characterizes-even-microscopic-prostate-cancers
Unfortunately, even with the newer imaging, locating micro-metastatic PCa can be daunting.
A rising PSA is one piece of the clinical data. You can image though obviously at lower PSAs, the probability of locating sites of PCa is less. Generally, bellow .5 around 30%., then . 5-1.0, roughly 60%, of course, the probability rises as your PSA climbs above 1.
For myself and my medical team, we agree to image between .5-1.0 for two reasons:
Greater probability of the imaging locating the recurrence.
Waiting to image then doesn't impact the progression of my PCa in terms of risk of spread that wound change the treatment decision.
There are factors in play, the cost depending on your insurance, deductibles and co-pays and your financial situation.
Sadly, approval by your insurance company if the first one comes back negative, will they or won't they...?
A lot of info.....lots to think about! Thanks!
Obviously, no sense getting too worked up about this until I have feedback from my PET scan and next PSA test.
Kevin, thanks so much for the detailed summary. Looks like you had a great post RP pathology report. Curious, was as there any indication of cancer making it out of the prostate, to the prostate bed or lymph nodes? With the micro-metastatic disease, have you found any data that shows when there are indications to be concerned with post radical prostatectomy? Are pathologists able to see micro-metastatic cells during the post-surgery pathology? I am assuming this is not possible but can't find anything online. I am 56 and had a RP in November 2022 (Gleason 4/3). Pathology was similar to yours - Negative margins, no cancer found in the 7 lymph nodes that were taken, etc... I will have my first post-op PSA check in early March and wanted to educate myself on micro-metastatic disease so that I can include this topic in my list of questions to ask my doctor.
Have a great week,
Jim
Well, the .3 meets the criteria for a BCR, a 2nd one in six weeks will confirm the BCR.
Attached is my clinical history. I remember well, the moment 15 months after a very "successful " surgery and pathology report (or so my urologist said, me, looking at the pathology report, GS 8, T2CNoMx, thinking the GS8 means I have a 30% probability my PCA returns and the Mx, meaning they don't know if it has spread already, in part because of micro-metastatic disease too small to be seen by any imaging, especially in 2015!).
I had my pity party, picked myself up off the floor and got to work learning all I could about BCR, standard of care and emerging clinical trials that might play a role in my treatment decision.
What I learned, the standard of care was SRT to the prostrate bed, 39 treatments, 70 or so Gya...emerging clinical trials indicated something different. Mayo was accumulating data showing when there was BCR and when SRT failed, it was because the PCa had already infiltrated to the PLNs. Their data indicated that often, the PLNS where the recurrence was were outside standard treatment fields for whole PLN radiation treatment. Data from clinical trails was showing that the addition of six months ADT to SRT significantly improved outcomes.
I discussed with my medical team the Mayo data and the emerging clinical trials. They dismissed it, saying there was not "long term data" to support it. Sadly, I listened, from my chart you can see Mayo was right as were the emerging clinical trials combining short term ADT with the SRT. That was the last time I let my medical team make the treatment decision, from that point forward we made joint decision based on their recommendations, my homework and treatment preference, in this case, aggressive.
You ask what level of concern, that's hard to answer, given that the word cancer strikes fear into many of us, in a way, you should be "concerned." But only in the sense that work lies ahead of you to inform yourself, gather clinical data and then in concert with your medical team, make the best possible treatment decision.
You may be in a "curative" stage where informed by the imaging and other clinical data such as PSA doubling and velocity, location(s) of the PCa, doublet or triplet therapy may either cure you or provide a durable and long term progression free survival.
The changes in knowledge, imaging and treatment options over the last 5-10 years has been exponential, opening up the possibilities of either a cure or managing this damn cancer as a "chronic" disease, say, like diabetes or AIDS.
One think to think about is changing your horizon for deciding on treatment. Depending on your life expectancy, your medical team may think in 10, 15, 20 year periods...I say, ask, will this provide progression free survival for the next 3-5 years, if so, we can expect new treatments to emerge.
So, do not hit the panic button, I know, don't 27K men a year die from PCa, yes, but how many are living with it and for how long? I have pretty aggressive PCA, coming up on nine years since my diagnosis and first treatment.
I believe you are doing the right thing, having a 2nd PSA, if that shows another increase, image, then informed by clinical data, homework, and your medical team, make a decision about whether to treat, when, with what, how long, what criteria do we use to come off the treatment (anyone on your medical team start talking about lifetime of ADT, fire them!).
Kevin
@bud3 Wish I could help but I had SBRT only back in 2020. Still have my prostate with a PSA remaining at <.01. Hope others will be able to answer your questions and best of luck.
Welcome @bud3. You ask a good and commonly asked question among men who have had a prostectomy for prostate cancer. For this reason, I moved your post to this exising discussion:
- Post prostatectomy: What do rising PSA levels mean?: https://connect.mayoclinic.org/discussion/post-prostatectomy/
You will find many helpful responses from fellow members like @kujhawk1978 @web265 @spryguy @dandl48 @hoard @horace1818 @oumike @itterac and many more.
As to your question about level of concern, I would say you can have confidence in the fact that your doctor is being thorough. Are you able to put concern out of your mind until you have more information?
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1 ReactionI had a RP in June 2022. My PSA level of 10.2. Had my PSA tested in September 2022, the result was a 0.09. Had it retested again last week (Jan 23rd), the result was 0.3. Not what I was hoping for. I met with my Urologic Oncologist yesterday to discuss. He wants me to retest again in 6 weeks and has scheduled me for a PET Scan (PSMA). Not really sure what level of concern I should be having right now. Thoughts anyone?
My friend ( Mentor), there is a so called standard of care. I did not need this info but I am sure I could answer since you said nobody can. Yes, I am a medical professional, not doctor and not practicing. My advice: whenever you have doubts, go get a second opinion. Please.....
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2 ReactionsYour results from 2015 through 2/21 indicate you and your medical team were using a standard PSA test that only detected to a single decimal. So, <.1 meant it was "undetectable" since it could not measure below a single decimal point.
Now you appear to be be using an Ultrasensitive PSA test which can measure to two decimal points...
A couple things to think about. If you were still using the standard test your lab result's would say <.1 and you would smile, set your next appointment and enjoy life.
With your USPSA test now comes "worrying" about every change in your results. As you can see from my attached clinical history, once my medical team and I switched to USPSA my results have been up an down.
With the standard PSA tests there are pretty agree upon definitions of BCR, a PSA of .2 (assuming you had surgery) with a subsequent PSA of .2 or higher usually 90 days later. There is also a wide range of discussion abut whether or not you can use USPSA in calculating PSADT and PSAV at such low levels.
Not so much agreement with the USPSA...What you and your medical team have to decide is what do you do with the results of an USPSA given the variability? What in your minds will constitute an contiguous upward trend - how many USPSA tests, how far apart...? What are the decision points, at what PSA, then to image, What PSA constitutes a decision to treat, 2, 4, 10...Some of that may be based on your decision on when to image, below .5 and current FDA scans have roughly a 30% chance of locating PCA, around .5-1 it climbs to around 60% and of course after that, keeps going up. Imaging can be a powerful decision tool in your treatment plan as long as you and your medical team believe the results may change your treatment plan. I believe it does, particularly if radiation is involved as then your radiologist can build a plan that includes boosts and wider margins around the identified sites.
With your PSA results, I would just continue to actively monitor,2, 4, or 6 months and based on your decision points about the results, act when you need to.
Kevin