1. < Prostate Cancer

Rising PSA years after radical prostatectomy

Posted by olanordman @olanordman, Feb 22, 2021

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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scullrower | @scullrower | Apr 20, 2022
In reply to @scullrower "I’m with kujhawk. Get the best imaging you can as soon as you can. I was..." + (show)
@scullrower

I’m with kujhawk. Get the best imaging you can as soon as you can. I was fortunate enough to get the PSMA Gallium68 scan at PSA 0.10 and 4 cancerous lymph nodes were found. I got radiation and went on Nubeqa. Latest PSA <0.008. Good scans lead the treatment. Don’t treat blindly. If you can, get an opinion from Dr. Kwon at Mayo. He’s aggressive. I love his attitude.

Jump to this post

I need to make a correction. I was scanned at UCLA when my PSA had risen to 1.0 not 0.10. Sorry for the error.

REPLY
semeon | @semeon | Apr 17, 2022
In reply to @semeon "My PSA has been around .3 for 2years I monitor by taking my PSA every 6..." + (show)
@semeon

My PSA has been around .3 for 2years I monitor by taking my PSA every 6 weeks and a 3T MRI once a year which is the least intrusive and produces excellent image results beats biopsy all to hell. Anyway I was told not to take a PET Scan because it would produce false positives. Anyone else encounter such statements from your Dr.?

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Yup I am like you Although I did focal laser ablation 2 times and follow up with 3T MRI annually. They told me the same thing about having a PET scan and quite frankly I don’t understand false positives possible intermingled with positives does not seem like the radiologists can tell the difference. Same as you but I can’t offer any clarity .

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scullrower | @scullrower | Apr 16, 2022
In reply to @kujhawk1978 "Eight years is a good run, but... Just my thoughts as a layman who has traveled..." + (show)
@kujhawk1978

Eight years is a good run, but...

Just my thoughts as a layman who has traveled this path too.

It may be time to add a medical oncologist to your team.

It may also be time to throw the BS penalty flag on your urologist and find a new one. With your PSA, it seems inexcusable that he has not suggested imaging to locate where the recurrence is.
https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-second-psma-targeted-pet-imaging-drug-men-prostate-cancer
These scans, or the Aximun and C11 Choline scan can provide critical clinical data to inform any treatment decision such as where is the recurrence, prostate bed only, lymph nodes, how many, where, is there any bone or organ involved...any clinical data from imaging would be critical in a treatment decision.

Another piece of the clinical data may be your doubling and velocity times - https://www.mskcc.org/nomograms/prostate/psa_doubling_time

A general guideline is:

>12 months - monitor
6-12 months- consider treatment
< 6 months - treat.

There are other clinical factors involved, your age, life expectancy, health snd and morbidity factors along with your personal regarding quality versus quantity of life.

So, your Urologist handing you off as you described would constitute grounds for my firing him for failing to actively diagnose you using current NCCN guidelines - https://www.nccn.org/patients/guidelines/content/PDF/prostate-advanced-patient.pdf

Bring a medical oncologist on board.

Image - https://www.urologytimes.com/view/psma-pet-imaging-modalities-added-to-nccn-guidelines-for-prostate-cancer

Kevin

Jump to this post

I’m with kujhawk. Get the best imaging you can as soon as you can. I was fortunate enough to get the PSMA Gallium68 scan at PSA 0.10 and 4 cancerous lymph nodes were found. I got radiation and went on Nubeqa. Latest PSA <0.008. Good scans lead the treatment. Don’t treat blindly. If you can, get an opinion from Dr. Kwon at Mayo. He’s aggressive. I love his attitude.

REPLY
2 replies
kujhawk1978 | @kujhawk1978 | Apr 16, 2022
In reply to @bettwils16 "I just joined, not sure I'm writing this in the appropriate place. I had a Robotic..." + (show)
@bettwils16

I just joined, not sure I'm writing this in the appropriate place. I had a Robotic Prostatectomy 8 yrs ago. PSA started going up slowly last three years, .19, .20, 1.6. My surgeon told me because I'm stable, he is transferring my care to his APRN, that I won't be seeing him anymore. He will review my PSA and any issues with the APRN prior to my visit. I feel uncomfortable with this arrangement and I think I'm at a point where I need to find a Medical Oncologist to continue with. Fortunately, for me, the hospital in my town is one affiliated with the Mayo Clinic. Does this seem like a good plan? Thank you!

Jump to this post

Eight years is a good run, but...

Just my thoughts as a layman who has traveled this path too.

It may be time to add a medical oncologist to your team.

It may also be time to throw the BS penalty flag on your urologist and find a new one. With your PSA, it seems inexcusable that he has not suggested imaging to locate where the recurrence is.
https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-second-psma-targeted-pet-imaging-drug-men-prostate-cancer
These scans, or the Aximun and C11 Choline scan can provide critical clinical data to inform any treatment decision such as where is the recurrence, prostate bed only, lymph nodes, how many, where, is there any bone or organ involved...any clinical data from imaging would be critical in a treatment decision.

Another piece of the clinical data may be your doubling and velocity times - https://www.mskcc.org/nomograms/prostate/psa_doubling_time

A general guideline is:

>12 months - monitor
6-12 months- consider treatment
< 6 months - treat.

There are other clinical factors involved, your age, life expectancy, health snd and morbidity factors along with your personal regarding quality versus quantity of life.

So, your Urologist handing you off as you described would constitute grounds for my firing him for failing to actively diagnose you using current NCCN guidelines - https://www.nccn.org/patients/guidelines/content/PDF/prostate-advanced-patient.pdf

Bring a medical oncologist on board.

Image - https://www.urologytimes.com/view/psma-pet-imaging-modalities-added-to-nccn-guidelines-for-prostate-cancer

Kevin

REPLY
1 reply
james1951 | @james1951 | Apr 15, 2022
In reply to @bettwils16 "I just joined, not sure I'm writing this in the appropriate place. I had a Robotic..." + (show)
@bettwils16

I just joined, not sure I'm writing this in the appropriate place. I had a Robotic Prostatectomy 8 yrs ago. PSA started going up slowly last three years, .19, .20, 1.6. My surgeon told me because I'm stable, he is transferring my care to his APRN, that I won't be seeing him anymore. He will review my PSA and any issues with the APRN prior to my visit. I feel uncomfortable with this arrangement and I think I'm at a point where I need to find a Medical Oncologist to continue with. Fortunately, for me, the hospital in my town is one affiliated with the Mayo Clinic. Does this seem like a good plan? Thank you!

Jump to this post

U should consider MRI with contrast .
A visit to Radiation Oncologist is fine.
Any positive surgical margins?
What is doubling time?
All questions to ask. Hormone and salvage radiation a possibility.

REPLY
bettwils16 | @bettwils16 | Apr 15, 2022

I just joined, not sure I'm writing this in the appropriate place. I had a Robotic Prostatectomy 8 yrs ago. PSA started going up slowly last three years, .19, .20, 1.6. My surgeon told me because I'm stable, he is transferring my care to his APRN, that I won't be seeing him anymore. He will review my PSA and any issues with the APRN prior to my visit. I feel uncomfortable with this arrangement and I think I'm at a point where I need to find a Medical Oncologist to continue with. Fortunately, for me, the hospital in my town is one affiliated with the Mayo Clinic. Does this seem like a good plan? Thank you!

REPLY
2 replies
james1951 | @james1951 | Apr 14, 2022

PSA seems to be very stable just continue to do regular PSA checks possibly residual prostate tissue?

REPLY
james1951 | @james1951 | Apr 6, 2022
In reply to @jrp "I just got my results of rising PSA. I had a Radical Prostatectomy in June 2019...." + (show)
@jrp

I just got my results of rising PSA. I had a Radical Prostatectomy in June 2019. My PSAs were .001, then .009, again.009, and now have jumped to .77. We are obviously upset Doctor says we can take another test in 10 weeks followed by a pet scan. I am hoping my medications to be a cause of this rise as I just stated Hydrochlorothiazide 25mg and Oxybutynin Chloride Er for symptoms. Thoughts?

Jump to this post

To me that doesn’t seem to make sense retest and see what that is.

REPLY
jrp | @jrp | Mar 28, 2022
In reply to @jrp "I just got my results of rising PSA. I had a Radical Prostatectomy in June 2019...." + (show)
@jrp

I just got my results of rising PSA. I had a Radical Prostatectomy in June 2019. My PSAs were .001, then .009, again.009, and now have jumped to .77. We are obviously upset Doctor says we can take another test in 10 weeks followed by a pet scan. I am hoping my medications to be a cause of this rise as I just stated Hydrochlorothiazide 25mg and Oxybutynin Chloride Er for symptoms. Thoughts?

Jump to this post

I might add that I had 39 rp right after surgery. I found that I had radiation cystitis afterward and as I was on eliquis for Afib i ended up getting a watchman device in my heart to stop the bladder bleeding. It kind of worked as ThE bleeding has stopped. Right after the prostatectomy the nurse was irrigating my Foley bag on The wrong side and it ended up blowing up inside my bladder. It took a long time to get this settled out and it made it so I had a very hard time holding my urine during radiation. This whole thing has been a crazy mess for me.

REPLY
natem | @natem | Mar 27, 2022

Mine went up from several years being <.1 to .2, then .3 and I'm receiving radiation treatment. I had an inconclusive psma pet scan. saw a little something (Type 3 inconclusive) on a lymph node so they're including that. I'm also taking a hormone called Orgovyx for 6 months. I'm 61, was 54 at rp. Best wishes.

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