Gleason 8, T1c, EPE-,LN-,m- and SV- Why has the uPSA increased after18 months of the RRP?

I have found my Gleason 8 disease very early but at moment I feel nervous and afraid because my uPSA became detectable after 18 months from RRP.

I have read about agressive CP and I am discovering that the same prostated cancer can evolve differently in each pacient. Therefore, I think it is totally unpredictable.

Which of these possibilities can be my case?

1- Benign tissue has increased during this 18mo after RRP, than the uPSA has been detectable.

2- Usually, the agressive CP (Gleason 8-10) has sprayed as micrometastasis before the diagnosed of the cancer . So, the uPSA can be the evolution of the micrometastasis than it's mean "systemic diseases".

3- Problems with the UPSA devises: imprecision in the test or variations in the test performing.
I do not believe it because the test was repeated more than once time. Therefore, there is a tendency to uPSA increasing.

I would like to know the opinions of my "CP colleagues". Please see my CP informations bellow.

Excuse me for my poor English, my native language is Portuguese.

M1961,

Unless you misplaced the decimal point, those are not the kinds of uPSA readings we normally see - Most uPSA tests do not detect anything below 0.01 ng/ml. Readings like 0.005 ng/ml are available on some very specialized tests but they are seldom done for a very good reason that you just discovered - they cause concern for no reason.

There are many non-prostatic sources of PSA (e.g., breast tissue) that puts out the kinds of amounts you are detecting. Those extra-prostatic sources fluctuate in their PSA output. The readings you are detecting tell you nothing useful.

I recommend you talk to your urologist about switching to a less sensitive uPSA test. If it gets above 0.03 ng/ml, let's talk some more. In the meantime, I hope you can put it aside and enjoy what you should consider to be undetectable levels.

- Allen

M-
Your .005 psa is too small to draw any conclusions. There are many tissues and glands in the body other than the prostate that secrete small amounts of psa, and it's likely that they could be contributing to your negligible amount. You have nothing to concern yourself with for now. If it increases by 10x, to .05, then you might need to consider additional treatment. I would be thrilled to have your number.

jFL1957

You would like to have my PSA number, right? It is a litle diferent but I have thought that my PSA tendency is almost the same.
Your PCa is least agressive (Gleason 3+4) than mine (Gleason 4+4).
Probably, the SRT has cured you because it was realized early and you had very good pathology report .

Mensagem Editada (M1961) : 4/21/2016 3:26:08 PM (GMT-6)

JFL1957

Ok! You are right, I shouldn't be thinking about PSA recurrence.
Allen said the same, " I should consider to be undetectable levels".

I was considering my operation a success because the pathologist report had been perfect. This apparent PSA increasing after 18 months was an unfortunate surprise to me.

Now I feel anxious because I was being naive to think that my PSA would be zero forever despite having a high risk of PCa.

My uro said "it's too early to talk about PSA recurrence". The uPSA test has been used to discover the early PSA increasing and to analyze the PSA velocity. If will be necessary to anticipate any treatment he can do immediately. The problem is the anxiety generated for the uPSA control.

Regarding your situation, I have read some researches that said: even with positive margins , Gleason 7 (3 + 4) or less have much higher cure chance after RT if you compare with Gleason 8 with negative margins. (Searching in Google : "The Natural History of metastic Progression In Men with PSA Recurrence After RP")

Therefore our prognostics are similar. You have had a less aggressive Gleason but the post surgery pathology is slightly worse than mine and, I have had a more aggressive Gleason but my pathology report is little better.

Your Gleason is similar Gleason 6. It doesn't spread fast, so you have great chances of your PCa is fully located in the prostatic bed.

Mensagem Editada (M1961) : 4/22/2016 9:25:45 PM (GMT-6)

Gleason 8 is considered as high grade cancer. Same happened in my fathers case PSA got increased to 5 afte 6 months of surgery. In your case no need to worry. Consult an oncologist and you should possibly go for PSMA PET scan.this will say exact location from where PSA is rising. Sometimes ceels at prostate fossa or bed also secretes PSA . Hve a scan first. There are many treatment options available. Good luck.

No problem Jannett. I should think that PSA 0.005 is nothing worth Worrying but It can be the beginning of something else.
OK! I must take out these negative thoughts of the mind and enjoy the moments.

Mensagem Editada (M1961) : 4/23/2016 3:48:34 PM (GMT-6)

Usually,I have only manifested in difficult situations when I need help.But I would like to share my relief (reduction of anxiety) with everyone, see below:
I owe my PSA updating for everyone on this site since March of the last year when it was 0.005 ng / ml. Unbelievable! After 15 months of anxiety, my PSA has returned to undetectable (<0.003 ng / ml).
I hope these PSA fluctuations are benign prostatic cells that have remained after RP
During these months my thoughts were totally negative. I was very anxious and I just wanted to know the value of my "PSA doubling time".
Here, I have read that UPSA is important for hight risk patients to know the PSA tendency and to interfere as soon as possible (between 0.03 and 0.1 ng/ml). But, this causes a lot of anxiety because the UPSA functional sensibility is 0.03 only, so values ​​below are inaccurate numbers (errors over 20%).

Thank you Ed C for your words. I've been following your posts and other Gleason 8 colleagues with similar clinical stage.
I hope the PSA fluctuation is benign tissues that have been left behind. But if it is true, why was PSA detected only 18 months after RP?
I have thought that benign tissues should appear on the first PSA test after surgery. These tissues grow very slowly, how could they evolve in a few months enough to be detected by UPSA?

Hi Allen!
In my last oncologist appointment (3 months ago),he suggested a PSA vacation during 6 months. But I decided to wait the PSA stabilization because it had decreased for 0.005 after 9 months in 0.01. Next Thursday, I will show him the undectable result so I will accept the vacation suggestion.
By the way, why did you write about "non-prostatic benign sources"? Don't you think this kind of flotation could be benign prostatic tissue?

Thank you Allen, but I believe that his comment was based on studies related to PSA close to 0.03 ng / ml and without the use of UPSA with analytical sensitivity of 3 decimal places. Right?