PSA is rising

Howard, welcome to the forum. I haven't had that experience (yet), but many guys here have, and no doubt they will chime in shortly. Here's hoping the last two readings were just a fluke. But stay on top of it.

Howard,

I think you meant that your last 3 PSAs were:<0.05, 0.05 and 0.07 - is that correct? And you had no adverse pathology - pT2 and negative margins. They will probably want to see another rise, or evidence that it is rising faster than 0.05 per year. Even if that turns out to be true, you may want to have them use the prostate tissue for a Decipher test. It's pretty good at ruling out cancer that's not likely to metastasize in the next 5 years. It isn't quite as good at predicting those that will.

about 30% of primary prostate treatments fail.

- Allen

Hi Howard,

Hang in there, and thanks for your post regarding my journey. I have a friend in his 70s who went through the radiation and he's doing just fine. He actually opted for radiation over surgery. I think he went in 5 days a week, an hour a day, for eight consecutive weeks.

Here's hoping that your upcoming treatments will kick PCa's butt for good.

Howard, looks like you might have something remaining. I don't know what your gleason score is, but if it's G7 (3-4) you've probably got time for another test before you start making any calls. If it's anything higher, I'd recommend setting up the RO appointments now. Our post RP psa's are similar, but my pathology has more adverse factors, i.e. positive margins (apical and lateral) and high volume, 50%. I've just finished 30 of 35 radiation treatments with the Varian Arc machine. No issues so far. After the 1st 5-10 it gets easier to gauge the water intake without busting the bladder. Next Friday I ring the bell! The worst part of the whole SRT treatment is the preliminary MRI with coil. Not a pleasant experience. If you get that far, be sure to get adequately numbed up beforehand.

I found two things useful with my radiation: a trunk full of bottled water in 16oz bottles in my car, and to make sure to have my wife with me when I was watching TV.

My radiation oncologist wanted my bladder to be full-ish during my radiation so I was supposed to drink water before each session. With the water bottles in the car I could sip at stoplights on my way to the treatment center. I was also careful to have exactly as many bottles of water as there were treatment sessions planned. That way, as I got near the end of my treatment I could count the bottles in the trunk and see how close I was getting to the end.

As for watching TV with my wife, the fatigue that almost everyone gets with radiation would make me fall asleep during whodunits. When the show was over my wife would wake me up and tell me who the villains were and how they were caught.

Aside from that, and a little problem with hemorrhoid flareups, the radiation was a bit of a grind but was at no time acutely horrible. You'll do fine.

Hi Howard,
I had SRT, though not until 7+ years after my surgery, though the standard guidance then was to not do SRT until PSA exceeded .2. Based on today's guidance I'd probably have been off the visit the radiation oncologist about 3 years after surgery, which is more in line with where you are now. Unlike PDA's comment above, I had no fatigue from the radiation, though at the time I was working long hours at a deadline-driven job, so maybe I just had no frame of reference to tell the difference between fatigue and normal. You didn't mention if you are still working. But in my case I was able to work throughout my treatment, though I worked at home (which was nearer the hospital for my daily treatments). My job at the time involved long hours at a desk and computer. So aside from adding a daily early morning trip to the hospital, I was also able to work more than full-time hours. Though had I been a brick mason, a farmer, or someone who had those kind of physical demands, maybe the radiation would have begun to wear me down. Best of luck.
Jim

It is detectable because the test was able to detect it. When it is undetectable, you will see a "less than sign: <" in front of the number, as you did until July.

"Detectable" is different from "biochemically recurrent." Biochemical recurrence was quite arbitrarily defined in the last century as a confirmed reading ≥0.2 ng/ml. It was set at that level because the lowest PSA that could be detected back then was 0.1, so anything above that was considered to be meaningful. Now that ultrasensitive PSA tests can detect much smaller amounts, it may be time to re-visit that definition if clinical trials prove it is warranted to do so.

There is a lot of controversy, and no really solid data, about what is the best time (i.e., at what PSA level) to have salvage radiation. No one wants radiation unless he really has to have it. On the other hand, one wants to have it before it is too late to be curative.

I wrote about the best study I've seen that is applicable to men in your situation:

Low detectable PSA after prostatectomy – watch or treat?

If your insurance covers it, the Decipher test may be a good decision tool for you.

- Allen

Allen
Thanks, the article was very informative. Looks like I am headed for radiation.

Gleason pattern 4 can migrate, unfortunately.

Hi Howard

Seems your pattern is similar to mine. My surgeon was happy with the surgery, but my 1st PSA came back as .06, rather than undetectable. The rise kept going and I soon hit .13 My insurance made me have lots of expensive scan before (which picked up nothing - to no medic's surprise). Then had hormones for 2 years, with radiation (33*2gy) 3 months into the hormone therapy. Lots of niggling SEs from both Hormone and Radio, and still suffer fatigue 4 months out of hormone therapy. Better than the alternative tho, and everyone is different.

Good Luck

Ritter/Carbone is a great choice! I've followed his work on hypofractionated salvage radiation, and I really think he is onto something there.

- Allen

Met with Dr. Ritter at UW Madison regarding my rising PSA. He recommended having one more test in April to determine if it continues to rise. If so, then radiation in late May. If it does not rise then we monitor it closely. He is fairly sure that it is in the prostate bed. He says that radiation works best when the cancer burden is low.