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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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Bettwils, getting a second opinion is often a good idea to discuss treatment and specifically radiation options. Hhere's more information about getting a second opinion at Mayo Clinic. http://mayocl.in/1mtmR63
Sorry about that, no, that was supposed to mean three quarters finished. I had 40 treatments, now finished.
Mike
Hi, you only needed 4 SRT's?
Hi, thank you for your response. A PSMA Pet scan is going to be ordered once insurance approves. PSA now 0.24 and Radiation Oncologist (met today) suggested 39 Radiation Treatments. Once the PSMA results in, would like to go to the Mayo for second opinion. How did you do with Radiation Treatments? Thank you!
I know this was for someone else but...my PSA was .091 (without a prostate) when I was referred for salvage radiation (SRT) treatment. 3/4s finished at this point
Looking for some others experience with this scenario...
Had RP, Gleasons 4+3 (8 of 12 cores)
PSA went down to .039 over the next 6 months, then at 9 was .091
Referred right off to the Radiation Oncologist
My team told me that the ultrasensitive test is not worth retesting as the trend was more important than the actual number at this point. (assuming I understood them correctly, I also have hearing issues)
Have any of you had the experience of such a reading being an anomaly? Maybe poorly calibrated equip or something?
Do most Dr's suggest another test just to be sure? (mine did not)
I'm just curious at this point, I'm 27 radiation treatments as of today.
As with others, I am not a trained and certified medical person so just my experience.
As you can see from my attached clinical history, I have surgery, SRET and then triplet therapy.
Since switching from the standard PSA which measures to a single decimal point to the ultrasensitive PSA which measures to two decimal places, my PSA has been variable, a high as .36 and as low as .06.
I and my medical team decided not to act on any one reading. If the reading is up from the previous one we schedule a lab and consult two months from that, if it's down, four months. They have no explanation for the variability, that's the art versus science in medicine, I'm ok with "we don't know why...!"
What we do know is we have decision criteria for what we do.
We would need consecutive readings, 34 that showed continuous rise.
We would image when it gets above .5 and continues to rise. Somewhere between .5 and 1.0
Informed by the continuous rise which would indicate doubling and velocity and results from imaging, and any other clinical data, we would make a treatment decision.
You may not be at that point and can continue to actively monitor with labs and consults. Work with your medical team to have decision criteria that would inform any decision to treat and with what.
Here's links to some articles which may be pertinent to your decison making.
https://www.urotoday.com/video-lectures/apccc-2022/video/mediaitem/2646-who-needs-early-salvage-radiotherapy-and-who-needs-adjuvant-radiotherapy-in-2022-kosj-yamoah.html
https://www.urotoday.com/center-of-excellence/imaging-center/video-lectures/video/mediaitem/2566-higher-rates-of-metastatic-disease-on-psma-pet-for-biochemical-recurrence-risk-groups-journal-club-christopher-wallis-zachary-klaassen.html
https://www.urotoday.com/conference-highlights/eau-2021/eau-2021-prostate-cancer/130825-eau-2021-gaps-in-the-evidence-adjuvant-versus-early-salvage-radiotherapy.html
https://www.urotoday.com/conference-highlights/asco-2022/asco-2022-prostate-cancer/137633-asco-2022-salvage-treatment-for-biochemical-recurrence-after-radical-prostatectomy.html
https://www.urotoday.com/conference-highlights/apccc-2022/136843-apccc-2022-who-needs-systemic-treatment-with-salvage-rt.html
https://www.urotoday.com/conference-highlights/apccc-2022/136842-apccc-2022-biochemical-recurrence-after-definitive-radiotherapy-of-the-prostate-what-are-the-local-treatment-options.html
Kevin
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Hug
2 ReactionsThank you!
My radiation oncologist is Dr. Choo. Wonderful team. 507.284.9428. Mayo Rochester
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Hug
1 ReactionI can help you get started with requesting an appointment at Mayo Clinic. Click this link for all the information you’ll need, including FAQs http://mayocl.in/1mtmR63
The first step in to fill out the online form (or call if your prefer) to schedule a discussion with the coordinator. Let me know if you have any questions.