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PSA of 1.5 of concern 7 years post-brachytherapy?

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Posted 7/25/2015 9:53 PM (GMT 0)
Well, my DH was just turned down for life insurance since he supposedly had a recent PSA result of 1.5. (We still need to verify that since we were unaware of it.) They also said that he had not been following up with a oncologist, but we were told after 18 months of PSA results of <1 that there was no need for continued followup.

Anyone else run into this regarding applying for life insurance and is a PSA of 1.5 truly something of concern? He'll be following up with his doctor on Monday, but we're curious in the meantime.

Thanks.
Posted 7/25/2015 11:27 PM (GMT 0)
MW: if you could post a signature with previous PSA readings that would be helpful. I say this because the 1.5 reading could be a bump that is sometimes associated with RT behavior and nothing to be alarmed about.

If this is a bump, I believe your RO could come up with strong, clinically-backed evidence to share with your insurer.
Posted 7/25/2015 11:47 PM (GMT 0)
Unfortunately, I lost the signature info in my profile somewhere along the line in the last few years ... I think his original PSA was around 4 or so. Immediately after the brachytherapy it was much lower, but took about 6 months to get to <1. Once we were told not to worry about further testing, we really didn't pay attention to it anymore after the 18 month point. No doctors along the way brought up any concerns.

In the meantime, we've moved, changed doctors, changed insurance plans, etc. Part of me feels that the insurance company is just playing it safe since most of the records are old and they probably don't have any more access to them than we do at this point.

ETA: Just found this from an old post of mine from 2007:

"His PSA was high two years ago, but after a round of Cipro it came down a bit. This time the antibiotics didn't lower it from 4.4.

"There were 12 samples taken in the biopsy (left x6; right x6). All was benign tissue on the left. On the right it states: Adenocarcinoma, Gleason grade 6 (3+3), involving 3 of 7 cores (95%, 90%, 30%, discontinuously)."
Posted 7/26/2015 1:33 AM (GMT 0)
What is more important than the PSA number is the PSA velocity, it's doubling time..Standard procedure is to have 3 month check-ups for 2 years, then 6 month check-ups for 3 more years then annual check-ups forever....How old is your husband today?
Posted 7/26/2015 1:48 AM (GMT 0)
I am thinking recurrence is nadir +2 .
Do you know what his nadir was after treatment?
It does not look like you are that near recurrence.
Posted 7/26/2015 11:23 AM (GMT 0)
I think his nadir was just a little below 1, but neither of us is recalling exactly. Hopefully his current doctor has some of his old records and we can get a bit more info tomorrow.

He's 66 years old. He did follow up closely for several years, but only had general checkups for the last 3-4 years and no one mentioned anything of concern.
Posted 7/26/2015 1:09 PM (GMT 0)
MW: If possible get his PSA readings during routine physicals the last few years.
Posted 7/26/2015 3:31 PM (GMT 0)
Perhaps the underwriter isn't distinguishing between surgery where his PSA should be zero and brachy where it should be something else (but not zero).
Posted 7/26/2015 5:19 PM (GMT 0)
Michael_T, I hope that's the case! We'll be trying to round up all of his records first thing tomorrow.
Posted 7/26/2015 5:36 PM (GMT 0)
Hello, Michael's Wife. Re the insurance, once a nadir is reached post-brachytherapy and over 5 years have passed getting insurance should not be an issue. I suspect, however, that the insurance issue may be that the company fears that he is having a recurrence - as the 1.5 is high for a nadir. Do they have any inkling of what his earlier post-brachy numbers were?

Beyond that, and I hate to say it, I think you guys should be a little concerned right now. After this much time it is unlikely that this is a radiation bounce. Also, given that his nadir was below one and has now risen to 1.5 this is headed in the wrong direction. The advice you received re the 18 month mark may not have been clear; perhaps they meant no specific follow up with the doctor was needed but he ABSOLUTELY should have had his PSA read each and every year.

At this point, the insurance issue aside, I would recommend another PSA reading within 3 months. If it drops back down then you can go back to annual readings. If it settles in around 1.5, I think I would check again in another 3 months. It it continues to rise, I think you should consider discussing this with an expert like Dr. Dattoli in Sarasota.

Good luck and please keep us posted.

Jim
Posted 7/26/2015 6:52 PM (GMT 0)
Thank you all for your thoughtful replies. Now I remember how great the support from this forum was back when my husband was first diagnosed and how much we appreciated all the advice we received.

I had assumed that my husband was having his PSA monitored at least annually with his regular medical exams but now I'm not so sure. He was definitely surprised when the insurance company said he had a recent test result of 1.5. At this point we're not even sure that is correct, but we will definitely be making sure we do everything necessary to follow up.

His brother had very aggressive prostate cancer (treated with surgery, radiation, and hormone therapy) and his father had it as well (untreated, but he died of other causes in his 70s), so we're more than a little concerned.
Posted 7/28/2015 12:05 AM (GMT 0)
Well, so the plot thickens ... Between moving, changing doctors, transferring records, etc., it seems that there are no recent PSA test results at all (which, of course, raises the question of what the insurance company could actually be basing its denial upon ...). In any event, we are picking up historical records tomorrow that will at least show the trend between 2008 and 2013. Also, he is scheduled for new blood work to be done on Wednesday. Fingers crossed for no surprises ... I had sooooo hoped all of this was behind us. (And lesson learned that we need to keep better track of this from now on.)
Posted 7/28/2015 12:11 AM (GMT 0)
MW: best of luck and my vote is for undetectable!
Posted 7/28/2015 1:51 AM (GMT 0)
Thank you! Same here!!
Posted 7/28/2015 10:53 PM (GMT 0)
Just a quick update. We still haven't figured where the insurance company got the info re: a "recent" PSA result of 1.5. That said, DH has definitely been remiss in follow up. The only records we have found are for the following:

1.00 on 2/25/09
1.43 on 7/2/09
1.12 on 3/2/11

I find it hard to believe the physician who did his annual physical after we moved didn't include PSA in the order for his blood work, but it seems that is the case.

Onward and upward (hopefully downward!) with tomorrow's blood work.
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