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rise in PSA post-radical prostatectomy

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Posted 11/27/2015 9:58 PM (GMT 0)
Feeling alarmed. I had a radical prostatectomy (Da Vinci) in December 2012 - 3+4 Gleason, confined (no positive margins etc). Post- op PSA .04 and settled at 0.03 or lower. Great! Went to annual testing from October 2014. Oct 2015 showed a reading of 0.05. Am somewhat freaked out by this result, even though the level is still pretty low. Would be very grateful for any responses. Thanks!
Posted 11/27/2015 10:23 PM (GMT 0)
Welcome to HW, sorry you're one of us.

First, I vote for a retest. It's not much of a rise and there are any number of reasons for it. A retest to confirm the finding might be wise.

You really don't need to worry until you see a rise over a number of tests. One test could just be a lab error or a bit of prostate tissue that got left behind. A rising pattern is more of a concern.

What you have now is an unexpected result so you need to find out why. Have you discussed this with your doctor yet? I'd start there and maybe ask for a retest in the next few weeks.

Hang in there,
Andrew
Posted 11/27/2015 10:30 PM (GMT 0)
Good advice!
Posted 11/27/2015 10:53 PM (GMT 0)
A couple of questions...

1. Have all your post surgery tests been done by the same lab?
2. What does your doctor say?

There have been a number of discussions about various labs getting widely divergent results, particularly at this low end using the ultrasensitive test. The way around that is to choose one lab, one test site, and stick with it.

Then there is the basic question....what does a shift of 0.01 actually mean, if anything? My personal opinion is that it doesn't mean much, until it's shown as the first step of a confirmed steady rise.

I agree with the suggestion to do a retest in a month.
Posted 11/28/2015 12:47 AM (GMT 0)
Thank you for responses. I don't want to over-react, but I feel a bit like I have re-entered a long dark tunnel. Hate this PSA tyranny!

I'm assuming it's the same lab - the blood sampling was taken at the same pathologist, where the testing isn't actually performed. I do know that it was assayed using the same equipment (which is specified on the results).

I haven't spoken with my doctor as yet - he didn't bring it up when I first received the results: the PSA was done as a full blood analysis (fasting). He talked about other things (high blood sugar in particular). I did contact my urologist (who's good): his office suggested having a further PSA done in 6 months and to make an appointment to see him then.
Posted 11/28/2015 12:49 AM (GMT 0)
.01 rise in 1 year...the percentage of 100% that that rise is would be the percentage of concern I would have on this issue/.
Posted 11/28/2015 12:56 AM (GMT 0)
I wouldn't wait six months. Given that you've posted your concern here, I am going to assume that you find the result a bit, er, 'unsettling.'

Given that, I'd call the Uro and see about a test sooner just for your peace of mind if nothing else.

Medically a six month wait might not make any difference, but the wait could be annoying.
Andrew
Posted 11/28/2015 12:59 AM (GMT 0)
Actually the rise is from Oct 2014 <0.03 to Oct 2015 0.05.
Posted 11/28/2015 2:30 AM (GMT 0)
That may or may not be the start of a trend. One thing to remember is that you're an intermediate risk so there is time to do another test. Also if there is still PC around, likely it's still in the prostate bed which means a little radiation will zap that in to non-existence.

It could also just be a bit of prostate tissue that was left behind that is doing something.

Yeah, it's not nice to think of the bad possibilities, but it could also be nothing to worry about.

You've got something to check out more.
Hang in there,
Andrew
Posted 11/29/2015 5:45 AM (GMT 0)
Thanks for your input, Andrew.
Posted 11/29/2015 2:58 PM (GMT 0)
I would go for a retest and go from there. I had a rise after 6 years. It is good you are staying on top of your medical issues and being deligient. However, no need to over react.
Posted 11/29/2015 3:40 PM (GMT 0)
I agree : don't over react but get re tested. It is disturbing to have to deal with PSA anxiety. The bane of our existence!
Bob
Posted 11/29/2015 5:36 PM (GMT 0)
The ultra-sensitive PSA test will drive you crazy with worry...0.02, 0.04, 0.06, 0.03 these are meaningless variations caused mostly by the testing process itself......No ACTION is likely to take place until it reaches 0.1 so why worry about it?
Posted Yesterday 10:05 PM (GMT 0)
I agree with Fairwind..... Always being concerned and on top of things, which your are. But 0.05 ish is a wait and see situation... The tolerance factor of the test definitely comes into play here....
Posted Today 12:14 AM (GMT 0)
I also agree with Fairwind.....maybe an issue..... maybe not but at these low numbers only time and more data points will tell.
Posted Today 1:09 AM (GMT 0)
Four years after Robotic removal my PSA went from .02, .02, .17, 1.17, Sept 8th 2015 had 39 radiation treatments, had a PSA in 30 days, thought should have waited 3 months, PSA after 30 days went to 1.89, now will do another PSA in Jan......
Pre op was 4.8
T2cN1Mo
3+4=7 no margins
Bone, MRI and CAT scans were all clear, all nodes were normal, this was just before radiation treatments.
Hopefully was in prostate bed.
Posted Today 9:02 PM (GMT 0)
With no adverse pathology, the critical prognostic indicator of biochemical recurrence is your PSA velocity. You won't be able to know that until you've had another PSA test. (I think a 3-month schedule is prudent, given the rise.) If you have another increase in PSA, and especially if the PSA velocity is greater than 0.05 ng/ml/year, it may be time for salvage radiation. If your PSA is stable, you can be comfortable just watching it.

If you should have another rise, you may be eligible to get in on a clinical trial of Decipher™ Genomic Classifier test which is very good at identifying patients who will not progress to metastases (but is not as good in identifying those who will). It costs $4000 if you have to pay for it, but may be covered if you get it as part of the clinical trial. Check the list to see if any of the locations are near to you:

/clinicaltrials.gov/ct2/show/NCT02080689

- Allen
Posted 12/2/2015 1:10 AM (GMT 0)
I just went through something similar. Had RP March 2014 with a 3+4. Contained. First 5 post-surgery PSAs came in at <.04 and then this past September the reading was .08. Doctor explained all the possibles and felt with my stats that it could be an anomaly and scheduled another test for 6 weeks. The anxiety level during those 6 weeks was off the charts. The result came back as <.02 . (I also had another doctor run a test independently from my Uro and the results also confirmed that the .08 was not a trend.)

I don't think the anxiety ever completely goes away but I also learned a lot in those 6 weeks gaining information about the disease as well as the "what ifs". And I found this site. I agree that you will eventually want to retest but I also think it's good to verbalize your anxiety with your medical team. When I told both my General and my Uro what I had been going through during those 6 weeks, they both said the same thing, "Why didn't you call me."

Best wishes. .
Posted 12/25/2015 9:55 PM (GMT 0)
I am in your situation and have watched psa go from 0.01 to .087 in 1 year. See my profile. The key thing is to see if a trend develops. I suggest psa tests every 2 months. Build up a data set. Good luck
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