PSA Doubling Time Under Active Surveillance

Posted by peekaafighter @peekaafighter, Mar 17, 2019

Dear Group Members,

I was diagnosed as a case of BPH in 2011. With a rising PSA from 2011 to 2017 (app 5.5 to 8) a PSMA Ga68 PET scan was prescribed in Dec 2017, which revealed an organ confined lesion in the prostate. A TRUS guided biopsy revealed an Adenocarcinoma in the prostate with a Gleason score of 3+3. A mpMRI also revealed a prostate confined neoplasm. Staging was at T2aN0M0 (Intermediate risk) at an age of 67 years.

Following the biopsy, the PSA settled above 12 and after one spike to 14 showed a decline, followed by a slight uptrend in tests now done at 3 monthly intervals. The treating radio therapist agreed to active surveillance after the PSA had touched below 10 levels and an Oncotype DX Prostate GPS revealed a very low risk (1%) of metastasis, though the PSA slowly climbed back to 12 levels. The PSA doubling time, from the first post biopsy PSA score in Feb 2018 to the last one in March 2019, taking all the intervening scores into account, is in negative figures, (-) 6.7yrs with a velocity of (-) 1.3ng/ml/yr.

Are there any formal guidelines that would govern active surveillance under such conditions?

Also does anyone have a view on whether the elevated PSA could be a combination of other factors along with the elevation caused by P Ca by itself?

Thanks,

PeeKaa Fighter

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

Colleen Young, Connect Director | @colleenyoung | Mar 18, 2019

Welcome to Connect, @peekaafighter.
Fellow member @cayandray asked a similar question here:
- Dropping PSA score with Gleason score of 7 https://connect.mayoclinic.org/discussion/dropping-psa-score-with-gleason-score-of-7/

I'd also like to bring members @predictable @philn @dglass4040 @donnelson @flor @BuckyFestoon into this discussion.

PeeKaa, here are some published guidelines regarding active suveillance:
- Clinically Localized Prostate Cancer: American Urology Association/ASTRO/SUO Guideline (2017): https://www.auanet.org/guidelines/prostate-cancer-clinically-localized-guideline
- Active Surveillance for Low-risk Prostate Cancer: The European Association of Urology Position in 2018 https://www.europeanurology.com/article/S0302-2838(18)30433-0/fulltext

As you likely know, PSA levels can be affected by a number of factors. What other tests do you have for active surveillance?

peekaafighter | @peekaafighter | Apr 1, 2019

In reply to @colleenyoung "Welcome to Connect, @peekaafighter. Fellow member @cayandray asked a similar question here: - Dropping PSA score..." + (show)

@colleenyoung Hi. Thank you for the valuable links to guidelines and the discussion.

Post biopsy, DREs, monitoring of PSA and imaging (mpMRI) were used over the past year for active surveillance. Another PSMA Ga68 PET scan is scheduled after two months.

The "Very Low Risk" / "Low Metastasis Risk" result of the Oncotype DX GPS has contributed to continuation of Active Surveillance, my personal hope being that current trials on immunotherapy, such as the one currently in progress on Prostvac for localized P Ca, could yield a viable modality for enhancing probability of keeping the disease confined to the organ. The active surveillance guidelines do not yet specifically mention GPS in their recommendations for active surveillance, risk being low or intermediate based on PSA score, Gleason score and viewability of lesion in a scan.

The PSA hovering at 12 levels after the biopsy, therefore, remains a concern.