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Rising PSA years after radical prostatectomy
I am 60 years and I had radical prostatectomy on 23rd Nov 2018. I was told out of the 15 lymph nodes taken only one was affected less than a millimetre. It was Gleason score 7B with PSA around 13 at time of surgery but 11 at time of diagnosis in June 2018.
The PSA been fluctuating between 0.09 and 0.18 since surgery on 23rd November 2018
I have no incontinence as well as Erectile dysfunction. I take hypertension medication – Norvask Amlodipine 5mg daily and Cetirizine 5mg for allergy. Below are some of the test results. I have many of these test results – a few below
Jan 2019: 0.11
April 2019: 0.11
June 2019: 0.09
August 2019: 0.12
December 2019: 0.12
April 2020: 0.12
August 2020: 0.11
October 2020: 0.17
December 2020: 0.15
February 2021: 0.18
I am worried the cancer may be returning or might have spread. I met my doctor today and expressed my concerns. He has agreed to refer me to the hospital where I had the surgery. Any suggestions based on this brief history?
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You are correct. PSA .20 or more x 2, after a prostatectomy, is considered a biochemical recurrance. That is exactly what happened to me 8 yrs post op. I had a PSMA PET Scan that lite up 3 areas in my lung (lymph nodes). I had a bronchoscopy/biopsy but all 3 areas were negative. Nothing else lite up, not even the prostate bed. So, don't know why my PSA is climbing or where the recurrence is. Might have to have a repeat PSMA PET Scan as my PSA get's higher. Might be able to pick up something at that point. Have appointment's with my Pulmonologist and Urologist in a week.
Get on Zolodex to stop testosterone the fertilizer of PC
Thanks, Colleen, for your response. I was asked to go for a PSA test every three months next test will be on Jan-23. If it is >0.2, I will go for a PSMA test to see if they can find it. They are expecting near the prostate bed. My surgical margin was negative. But I had one regional pelvic left lymph node and EPE in my pathology. So I do not know yet but sure going for RT.
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2 ReactionsWelcome, @zj69. Rising PSA is a common concern among members here. For that reason, I moved your questions to this existing discussion so you can read previous posts and connect with members easily:
- Rising PSA years after radical prostatectomy https://connect.mayoclinic.org/discussion/rising-psa-2years-after-radical-prostatectomy/
I agree with @web265 that interpreting your pathology results is out of the league of fellow prostate cancer survivors. I also agree with the tips he shared with you here: https://connect.mayoclinic.org/comment/772319/
You ask the questions on everyone's lips:
1. is it curable after reoccurring?
2. Life expectancy rate: How many years can you survive?
I hate to be the one to tell you that you'll never get direct answers to those questions. Oncologist rarely use the word "cure". Cancer goes into remission. You can live with it. These are more likely the responses you'll hear.
While some might give you a statistical response to your query about how many years, but that is a population-based answer. Your doctor may have a better guesstimate based on your diagnosis, personal health status and existence or absence of other conditions. But it is only that - a guesstimate.
You are in good hands at UHN in Toronto. What treatments, if any, are being recommended after surgery?
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2 ReactionsI find it interesting that the PSA varies in individuals from very low (such as yours at .07 to .11) to extremely high in the hundreds (and even thousands). Also there is always a qualifier in medical literature that the PSA is not a reliable indicator yet it is used (almost arbitrarily) to start down a path of many tests and precedures looking for prostate cancer. Now it is recommended that it not even be looked at after a certain age (I think around 50). Very confusing and questionable.
This is out of my league at the level of detail in this report, but, after my RP, my PSA went up to .091 from .039 and we started salvage radiation therapy. My path report was similar to yours but no detected invasion in lymph nodes. (Right pelvic was removed to testing during the RP as the cancer was mostly on the right side of the prostate)
Before starting SRT, I point blank asked the radiation oncologist, who generally likes to answer questions with a statistic, if this treatment was considered "curative"? His answer was "absolutely." The quote regarding the PSA from him was that rate of doubling is not as much of an indicator in these very low number levels.
There are those here, and at this point I'm inclined to agree with them at this point, who might suggest it may not be time to do anything till you get another PSA test, maybe do it in three months if it makes you feel better. There are reportedly a lot of things that can have an effect on PSA, particularly in those low number realms.
My surgeon advised aggressive treatment as that is his style and I did the SRT. I had very minor side effects which have ended (except for the orgovyx occasional hot flash (or power surge as my wife calls it ).
Next question to the radiation guy was what if this doesn't work? he gave me a sort of "we'll cross that bridge.." answer but added that I'd most likely pass with PC as opposed to from it.
Sorry to hear that you're going through this and best of luck to you!
Hi
I underwent a Robotic-assisted Radical Prostatectomy on 15-Feb-2022 at UHN Canada. Surgical pathology on 15-Feb-2022 revealed adenocarcinoma, Gleason: 8 (3 + 5), and negative surgical margin involvement status. The disease was pathologically staged as T3a N1.
PSA RESULT
- PSA on 01-Apr-2022 (Total PSA is 0.017 ug/L).
- PSA on 12-Oct-2022 (Total PSA is 0.075 ug/L).
My Pathology report after surgery shows as under. My PSMA -PET test did not detect the Lymph node before surgery.
DIAGNOSIS
1. Soft-Tissue: periprostatic tissue: Mature adipose tissue, no lymph nodes identified. Negative for malignancy
2. Right external iliac artery node: Three reactive lymph nodes, negative for malignancy
3. Right pelvic lymph node: Four reactive lymph nodes, negative for malignancy
4. Left pelvic lymph node: Metastatic adenocarcinoma (diam < 1 mm) in one of six lymph nodes.
5. Prostate and seminal vesicles, weight 28 grams:
- Predominantly right posterior peripheral zone localization of adenocarcinoma, Gleason score 8 (3 + 5) with a high-grade component, comprising 60% of the carcinoma
- Positive for intraductal carcinoma
- Positive for (focal) extraprostatic extension, negative for bladder neck invasion or seminal vesical invasion (pT3a)
- Surgical margins negative for malignancy
- About 9% of the prostate volume involved by carcinoma
COMMENT
Immunostaining performed to exclude neuroendocrine carcinoma component: Both chromogranin A and synaptophysin are negative, while the androgen receptor is intense nuclear positive. The basal cell staining (HMWCK) highlights the intraductal carcinoma
component.
SYNOPTIC DATA
Procedure: Radical prostatectomy:
Prostate Size
Prostate Weight (g): 28 g
TUMOR
Histologic Type: Acinar adenocarcinoma
Histologic Grade
Grade Group and Gleason Score: Grade Group 4 (Gleason Score 3 + 5 = 8)
Tertiary Pattern 5 (less than 5%) in Overall Gleason Score 7:
Present
Percentage of Pattern 4: 40 %
Percentage of Pattern 5: 20 %
Intraductal Carcinoma (IDC): Present
Cribriform Pattern: Present
Tumor Quantitation: Estimated percentage of prostate involved by tumor: 9 %
Extraprostatic Extension (EPE): Present, focal
Location of Extraprostatic Extension: Right posterior
Urinary Bladder Neck Invasion: Not identified
Seminal Vesicle Invasion: Not identified
Treatment Effect: No known presurgical therapy
Lymphovascular Invasion: Not Identified
Perineural Invasion: Present:
MARGINS
Margins: Uninvolved by invasive carcinoma
LYMPH NODES
Regional Lymph Nodes:
The number of Lymph Nodes Involved:
Number of Lymph Nodes Involved: 1
Size of Largest Metastatic Deposit (Centimeters):
0.1 cm
Number of Lymph Nodes Examined: 13
PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition)
Primary Tumor (pT): pT3a
Regional Lymph Nodes (pN): pN1
ADDITIONAL FINDINGS
Additional Findings: None identified
SPECIAL STUDIES
Ancillary Studies: NGS prostate
Please can you tell me about the following?
1. is it curable after reoccurring?
2. Life expectancy rate: How many years can you survive?
Thanks
Hi - I am not a doctor. My situation has some similarities to yours. My PSA has gone up and down over the last 4 years or so after a RALP. You may want to check this out: https://prostatecancerinfolink.net/2015/01/14/low-detectable-psa-after-prostatectomy-watch-or-treat/
My most recent PSA was .07. It had been rising to .11, then it has been coming down since then. I have decided that if it does start rising and does so steadily, I will probably wait until it is .5 or so and then get a PSMA or similar scan to see if anything is found.
Best Regards
Its a minor change Yet ask oncologist if you should be on Zolodex Testosterone is the fertilizer of PC After 5 years since radiation cancer metastases to my L2 lumber which I had nuked a year ago with intense rad
Microscopic stuff floats around to kill off us old males Im 78 feel great but PSA 1.2 for years now 4.22
I would suggest the answer to that is no. There are so many little things that can effect your PSA level that I wouldn't think that less than .009 max of a change is significant. What would be more important is to see if there is a significant trend come the next one. Even then if it's that small of an increase again, I still wouldn't be too concerned.