PSA Doubling Time Under Active Surveillance
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?