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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?

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

Tom | @tom86 | Jun 9, 2022
In reply to @mngreen "Yes. Apparently, the 0.5 is around when there are (unfortunately) enough PCa cells that are in..." + (show)
@mngreen

Yes. Apparently, the 0.5 is around when there are (unfortunately) enough PCa cells that are in sufficient clusters to be more readily detectable.

My RO feels that despite this, it's possible that at lower levels there has been clustering - particularly when the PCa is persistent (where PSA never dropped to a post radical prostatectomy level of < 0.01, which unfortunately reflects my own circumstance), as opposed to PCa recurrence.

This makes me simultaneously hopeful and fearful, which is really a weird place to be - kind of like feeling both overheated and cold at the same time. With any luck, the persistence is not related to metastasis but rather locally left-behind cells from the non-focal EPE and seminal vesical invasion. The RO tells me that he feels it "extremely unlikely" that the PCa has metastisized. The RO team here is very experienced, so I find some hope in that too.

This is quite the journey, isn't it.

In shared experience and support ... I am deeply grateful for communities like this and I hope I can be around long enough to pay all the support forward to the unfortunate many more who will find themselves with a ticket on the same boat.

- michael

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Hi Michael,
Agreed. Sharing experience and information is so important. It sounds as though you are being treated by a facility considered to be in the 'center of excellence' catagory. Also so important.
My husband has found support groups through the center and they meet through ANCAN fairly often. Excellent shared experience from individuals with the same thing you are experiencing. Both informative and comforting.
It is quite the journey. Staying on top of it and realizing they come up with new ongoing treatments and information all the time is encouraging as well.
Dee

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mngreen | @mngreen | Jun 10, 2022

I know that while we still have a prostate, a urinary tract infection (among other things) can cause a rise in psa.

My question is, can a UTI spike psa *after* a radical prostatectomy? I'd think, "probably not", but I can see that it might.

Anyone out there know *definitively *?

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bettwils16 | @bettwils16 | Jul 24, 2022

8 yrs post Robotic Prostatectomy , clean margins

Hi, PSA rising slowly last few yrs. Highest .20 down to .14 during 2022. Now .24 four months after .14. Going for a repeat as M.D ruling out error. I've been in the hands of my Urologist for these 8 yrs. Researching for a Medical Oncologist. Any suggestions if PSA is accurate? My medical center has an affiliation with MSK in N.Y. Thanks fir any suggestions

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1 reply
Moderator
Colleen Young, Connect Director | @colleenyoung | Jul 25, 2022
In reply to @bettwils16 "8 yrs post Robotic Prostatectomy , clean margins Hi, PSA rising slowly last few yrs. Highest..." + (show)
@bettwils16

8 yrs post Robotic Prostatectomy , clean margins

Hi, PSA rising slowly last few yrs. Highest .20 down to .14 during 2022. Now .24 four months after .14. Going for a repeat as M.D ruling out error. I've been in the hands of my Urologist for these 8 yrs. Researching for a Medical Oncologist. Any suggestions if PSA is accurate? My medical center has an affiliation with MSK in N.Y. Thanks fir any suggestions

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Hi @bettwils16, this is a question that several have asked and had answered in the Prostate Cancer group. For that reason I moved your message to this existing discussion:
- Rising PSA years after radical prostatectomy https://connect.mayoclinic.org/discussion/rising-psa-2years-after-radical-prostatectomy/

I did this so you can read the previous posts and connect with others to ask questions.

PSA tests can have fluctuations, so I’m encouraged that your urologist is sending you to be retested to see if the .24 is an anomaly.

You mention that you are looking for a new medical oncologist. Might Mayo Clinic be an option for you?

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1 reply
bettwils16 | @bettwils16 | Jul 26, 2022
In reply to @colleenyoung "Hi @bettwils16, this is a question that several have asked and had answered in the Prostate..." + (show)
@colleenyoung

Hi @bettwils16, this is a question that several have asked and had answered in the Prostate Cancer group. For that reason I moved your message to this existing discussion:
- Rising PSA years after radical prostatectomy https://connect.mayoclinic.org/discussion/rising-psa-2years-after-radical-prostatectomy/

I did this so you can read the previous posts and connect with others to ask questions.

PSA tests can have fluctuations, so I’m encouraged that your urologist is sending you to be retested to see if the .24 is an anomaly.

You mention that you are looking for a new medical oncologist. Might Mayo Clinic be an option for you?

Jump to this post

Absolutely. Where do we even start? Some of the comments say it's hard to get an appointment or they have to wait quite a while. Thank you for contacting us.

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2 replies
Moderator
Colleen Young, Connect Director | @colleenyoung | Jul 26, 2022
In reply to @bettwils16 "Absolutely. Where do we even start? Some of the comments say it's hard to get an..." + (show)
@bettwils16

Absolutely. Where do we even start? Some of the comments say it's hard to get an appointment or they have to wait quite a while. Thank you for contacting us.

Jump to this post

I 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.

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budisnothome | @budisnothome | Jul 26, 2022
In reply to @bettwils16 "Absolutely. Where do we even start? Some of the comments say it's hard to get an..." + (show)
@bettwils16

Absolutely. Where do we even start? Some of the comments say it's hard to get an appointment or they have to wait quite a while. Thank you for contacting us.

Jump to this post

My radiation oncologist is Dr. Choo. Wonderful team. 507.284.9428. Mayo Rochester

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1 reply
bettwils16 | @bettwils16 | Jul 26, 2022
In reply to @budisnothome "My radiation oncologist is Dr. Choo. Wonderful team. 507.284.9428. Mayo Rochester" + (show)
@budisnothome

My radiation oncologist is Dr. Choo. Wonderful team. 507.284.9428. Mayo Rochester

Jump to this post

Thank you!

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kujhawk1978 | @kujhawk1978 | Jul 26, 2022

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.htmlhttps://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.htmlhttps://www.urotoday.com/conference-highlights/eau-2021/eau-2021-prostate-cancer/130825-eau-2021-gaps-in-the-evidence-adjuvant-versus-early-salvage-radiotherapy.htmlhttps://www.urotoday.com/conference-highlights/asco-2022/asco-2022-prostate-cancer/137633-asco-2022-salvage-treatment-for-biochemical-recurrence-after-radical-prostatectomy.htmlhttps://www.urotoday.com/conference-highlights/apccc-2022/136843-apccc-2022-who-needs-systemic-treatment-with-salvage-rt.htmlhttps://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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web265 | @web265 | Jul 27, 2022

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.

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