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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@rti2

I appreciate it, Kujhawk. I was just able to access my old lab results, going back to 2017, which I list below.
I am pretty sure that the last one came out of a different lab (based on the other blood results). The one I just got this month, 0.04, is also from a new lab, as I have moved to a new city. My worry is that if the 0.00 was accurate up to 2 decimal places, then the 0.04 would indicate a jump. I am hoping that the 0.00 is just their way of saying "undetectable" but that it is not actually accurate through 2 decimal places.
9/2017 < .1
4/2018 < .1
10/2018 < .1
4/2019 < .1
10/2019 < .1
11/2020 < .1
8/2021 0.00 (looks like a different lab)
8/2022 0.04 (different doctor and different lab)

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It appears you were checked at .1 for quite some time.....and there did not seem to be a concern (as far as I know).....now you are at .04 and that is less than .1 ......if you are concerned and it appears you are...,I would have another test shortly and see the results. Was the Dr. concerned about the change from .1 to 0.00 and then up to .04 and is your Dr. a Urologist....if not, maybe he would refer you to one.

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@gfletch

After prostate removal 2019 all psa tests have been 0.01 new test 9/2/22 psa 0.10 at a different out state lab , been reading that a sera psa reading of 0.10 is negative or same as native psa of 0.01 is this true

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Edited this to update. It looks to me like you asked the question twice with two different sets of numbers.

If all those tests were 0.01 I'd and now you're getting <0.1 I'd suggest the new test is not ultrasensitive, in other words the two numbers might actually agree. < 0.1 could easily be 0.01.

#1 I'd take a deep breath as the new test as written <0.1 isn't really telling you anything other than you're not over 0.1.
#2 I'd call my urologist and see what they had to say, ask for his on call or person listed as replacement/stand in while on vacation.
#3 I'd suggest having another test in 2 or 3 months with the same (new) lab and look for movement in the number. If it's still 0.1 then it's likely not increasing. ...or go back to lab #1 and see if you still get 0.01. (second method preferred)

The issue here is making sure you're comparing apples to apples.

To answer your question literally, I've always understood anything in the non sensitive test realm less than .2 (post surgery) to be considered negative (at least the government thinks that). However, I believe that to be based on old technology testing wise.

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After prostate removal 2019 all psa tests have been 0.01 new test 9/2/22 psa 0.10 at a different out state lab , been reading that a sera psa reading of 0.10 is negative or same as native psa of 0.01 is this true

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@gfletch

Prostate removed 6/14/19 all psa tests since have been.01 had another psa Friday 9/3/22 came back <0.10ng/ml can’t get ahold of dr on vacation concerned about new results

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Hi @gfletch, I can imagine you're concerned about the rise in PSA. Not being able to get a hold of your doctor who in on vacation compounds that concern. You've come to the right place to get some guidance and reassurance.

You'll notice that I moved your message to this existing discussion:
– Post prostatectomy: What do rising PSA levels mean? https://connect.mayoclinic.org/discussion/post-prostatectomy/

I did this so that you can read previous posts and see the multiple reasons that may cause a rise in PSA. And also so you can easily connect with fellow members like @ken82 @mrbill @hoard @bruto1 @oumike @itterac @dandl48 and many more

As @kujhawk1978 advised @natem: "No reason to hit the panic button" to which @jdill added "but you should learn the facts and work with your doctor."

There are several reasons why one's PSA level may rise after being stable for a time. This article explains it well:
– PSA levels after prostatectomy https://www.medicalnewstoday.com/articles/323899.php

Was this recent test evaluated by the same lab as previous tests? Were you scheduled for a followup test?

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Prostate removed 6/14/19 all psa tests since have been.01 had another psa Friday 9/3/22 came back <0.10ng/ml can’t get ahold of dr on vacation concerned about new results

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I appreciate it, Kujhawk. I was just able to access my old lab results, going back to 2017, which I list below.
I am pretty sure that the last one came out of a different lab (based on the other blood results). The one I just got this month, 0.04, is also from a new lab, as I have moved to a new city. My worry is that if the 0.00 was accurate up to 2 decimal places, then the 0.04 would indicate a jump. I am hoping that the 0.00 is just their way of saying "undetectable" but that it is not actually accurate through 2 decimal places.
9/2017 < .1
4/2018 < .1
10/2018 < .1
4/2019 < .1
10/2019 < .1
11/2020 < .1
8/2021 0.00 (looks like a different lab)
8/2022 0.04 (different doctor and different lab)

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@rti2

I had prostate removed in 2015. Since then, my PSA results had always come as one of the following (I guess depending on the lab): < 0.1 , < .05, < .01, or simply "undetectable". But my latest, using a new doctor, says simply "0.04" (without the < symbol). . I am worried. Any advice?

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With USPSA comes "sensitivity" about changes in our PSA results. Think about this, were you using conventional single decimal place PSA tests which many do, you would be consider undetectable, <.2 and you would be having your next PSA tests in 6-12 months.

Since you are using USPA, every change becomes something to worry about. As you saw from my post and clinical history chart, there can be variability in an USPSA test which can be a function of different labs, type of assay used, calibration of equipment, pre-lab activity and routine...

My medical team and I continuously monitor my PSA every 2-4 months using USPSA but no action unless it continuously rises, no imaging until its between .5 and 1 and no decision on treatment until we image.

With the clinical data you shared, I would consider not doing any treatment and continue to actively monitor, determine decision criteria for when you would act - image, with what, where, at what PSA, what constitutes a cintinuos increase vice random variability...

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I had prostate removed in 2015. Since then, my PSA results had always come as one of the following (I guess depending on the lab): < 0.1 , < .05, < .01, or simply "undetectable". But my latest, using a new doctor, says simply "0.04" (without the < symbol). . I am worried. Any advice?

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Here's my clinical history.

First, side affects of ADT that I experienced

Penile and testicle shrinkage
Hot flashes
Moderate fatigue
Moderate joint and muscle stiffness.

I did not lose my libido, some statistics say 20% of men do not.

I pretty much maintained my normal lifestyle while on ADT, well during radiation no travelling and during chemotherapy the fatigue was moderate to severe. I exercised - rode my bike, went skiing with friends, hike in Colorado and Nevada, lifted weights, played basketball, swam, yardwork, walked the dog...

You don't say how long your medical team wants you on ADT. From my readings and what you describe, that could be as "short" as six months or as long as 18-24 months. They may be recommending you do ADT because of micro-metastatic disease, too small for any scans to show.

At no time during ADT did my testosterone rise, the Lupron kept it <7.

I would consider getting some baseline clinical data based on the cardiovascular and metabolic side affect profile of ADT. Consider a CBC, metabolic panel and a consult with a cardiologist.

Kevin

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@web265

Hi @isrexpo ,
Sorry to hear your having to go through all that. Had RP about a year ago. I'm on orgovyx. The side effects for me have been fatigue, shrinkage and hot flashes (although I just finished a round of radiation so some of the fatigue may be that), I guess I'll know more in a few weeks. I do seem to have joint pain as well.

Testicles have definitely shrunk, I'm guessing the orgovyx is the culprit there. I can still get erect (with a little more effort as opposed to before). There's shrinkage there as well but again, how much did the surgeon take vs the hormone therapy, my two treatments are so close together it's hard to tell.

"Also does light exercise cause testosterone to rise, which defeats the purpose of the hormone treatment" this is a great question I've asked my Radiation oncologist, he claims that the answer is not enough to matter. He feels that if exercise helps you mitigate the side effects or just helps you deal with them, it's better to do so. I lift 4 days a week and run 8-10 miles a week. Having said that, in lifting you I've had no gains in muscle mass or actual lifting capacity since on the orgovyx, is some of that psychosomatic, possibly.

I really believe for me, the worst side effect is the hot flashes when they happen at night effecting my sleep. It has gotten better (less frequent) over time. (approx 5 mos at this point)

I just had a blood test, before radiation and orgovyx my level had snuck up to .091, now it's back down to .014. My PSMA was negative.
Good Luck !

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Hi. There are great meds for your hot flashes. Megesterol twice per day. I was on it for 2 years. Works great.

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