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After 6 years PSA shows small rise from .01 to .02 to.03

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Posted 12/2/2018 12:59 AM (GMT 0)
How can you have some healthy prostate tissue after prostate removal?
Posted 12/2/2018 5:10 AM (GMT 0)
Thanks to Andrew, Robert, oldbeek, and Going for brachy for the replies. It's nice to have some conversation with guys who understand some of the emotions you go through with prostate cancer.

To answer Going for brachy's question it is not guaranteed that every cell of the prostate will be removed during surgery. My urologist has said that if any benign tissue was left behind it can grow and will secrete PSA. When I last saw him a year ago with a reading of .04 he seemed unconcerned and said he felt it was much more likely that the PSA resulted from some minor benign tissue growth than any cancerous cells. I don't know if this new reading of .05 will change his mind or not. I'll find out when I see him on Monday.

In answer to Robert, as best as I can understand the report there was one positive margin and I did not get a Gleason score for that margin in specific. I was interested in your comment about your doctor thinking no one would do anything before a PSA of .1 My urologist told me when I was at .02 that as an example if I showed jumps to .04 and then .07 in a year span he would recommend doing something such as radiation. So he agrees with you about getting test results with more specificity than .1 and in certain cases would act aggressively on the results.

oldbeek, hang in there. I'll make sure to post what I hear from my doctor. If you guys wouldn't mine posting I'd like to hear how things go for you as you get further into this.
Posted 12/2/2018 12:06 PM (GMT 0)
bucky24, At the moment, your PSA is rising very slowly. Perhaps, you should have PSA test every three or six months to see the trend. In my case, you may have noticed that my PSA increased from undetectable in Jan 18 to 4.48 in Nov 18 with a PSADT less than 2 months.
Posted 12/3/2018 4:59 PM (GMT 0)
Going for brachy, I expect the result of my meeting later today with my doctor will be that he'll want more frequent testing before recommending any new procedures. My guess is that if the PSA scores continue to grow this slowly he'll recommend continued surveillance. If my doubling time is indeed three years I'll be well into my eighties before metastasis. We'll see what he says today.

Your PSADT is a different animal than mine. Glad your doctor is being proactive. Hope things go well for you.
Posted 12/3/2018 7:10 PM (GMT 0)
Dear Bucky
I was operated 12 years ago, and had my first `bounce` to 0.14 about three years afterwards, then back to undetectable, some more bouncy stuff during the years (see my signature) and recently I seem to have stabilized at around 0.1 My doctor says tha it seems to be healthy tissue left behind, and that there is a high probability that I will never need radiation, although it cannot be ruled out. I am still on a 6m checkup schedule.
I am a rare case in many respects ( I was diagnozed at 42) and a reminder that rising PSA is not always cancer.
Best of luck with your psa rise, lets hope your numbers bounce back like mine!
Posted 12/3/2018 7:21 PM (GMT 0)
bucky24,

Your case is very similar to mine, so will be so interested in your post after appt.

Can sure see the advantage of a wait-and-see for a while longer.

Also, would give us more time to insure we are not just having some type of benign growth that "tops out" at some point. Dr. Myers spoke about patients having this occur (forgot exact timepoint in this 10 min video).

https://askdrmyers.wordpress.com/2012/12/19/when-recurrent-pca-isnt-cancer/

This is going to be such a difficult decision, assuming upward trends and doubling time remain non-threatening. I don't want to wait too long as to let the situation get out of control, but don't want to jump gun with overtreatment either.

Robert
Posted 12/3/2018 9:52 PM (GMT 0)
Thanks for the kind words, pattersson. Especially glad that your PSA has stabilized.

Robert, you and I have extremely similar numbers, so hopefully this will be of use to you. Today my doctor had no concern about the increase to .05. He reiterated that he thinks it is growth in a little benign tissue. He said that given the length of time since my RP (10 years and three months) and the very slow linear growth in my PSA that he is confident it is not cancerous. He told me to come back in a year for my annual test. I asked him if he might be a little more concerned if next year's test bumps to .06. He said he would not. As long as the growth remains slow and linear it will be an indication that the tissue is benign. He said cancerous tissue normally doesn't react the way mine has. He said he has a number of patients in situations similar to mine. Now if my PSA growth starts accelerating then he might have to reconsider, but he doesn't think that will happen.

I don't know where you live, but just in case you're interested my doctor is David Duchene at the Kansas University Hospital in Kansas City. He did my surgery in 2008 and has been the doctor for all of my follow up tests.
Posted 12/3/2018 10:48 PM (GMT 0)
It seems as if groups come through at a time. So add me to this one. For the most part, I've been mostly mum on the topic of SRT for myself. But it's beginning to bother me some. The last thing I want to do is to pass up a chance for cure. The consults I've had thus far...…

1) John's Hopkins RO....."Your chance for cure as it sits are in the low 70 percentile range. Adding ADT to that gives you another 10 percent tacked on. I suggest we begin the process this afternoon."

This consult was when my last PSA was at .05. The next PSA was .028....which he never saw. I believe he would say the same thing now as he did then.

2) RO at Proton Therapy Center here in Knoxville, TN......"I do not believe you need SRT today to be cured. But, I do suspect you will need it at some point". This was after my .028 reading.

3) Urologist......"Don't worry about it. You're fine". October, 2018
Posted 12/3/2018 10:58 PM (GMT 0)
Reason is telling me to do it. Inconvenience and fear of SE's keeps me from doing it. The way I see it is....There's a high probability of cancer being in my body. So, waiting is not in my best interest. That' my common sense side.

My common sense side jibes with JH. But....man, what a hassle. Plus...it can weigh on a man's mind. My next PSA test is in Jan. I'm already getting anxious. This stuff takes up a lot of my brain space. (But so would continuing SE's from Radiation). I'm also gun shy about treatment. My surgery went off the rails.

I do not put alot of stock in these studies. But, rightly or wrongly, I use them to rationalize what I want to believe. And, again, what I want to believe is that it's cool to wait. But that's not what my common sense is telling me to do. (Nor is John's Hopkins)
Posted 12/4/2018 12:33 AM (GMT 0)
Island Time & others - my post RP PSA fluctuated in the hundredths a bit (see sig). It's been undetectable for a couple of years now, perhaps discouraged by diet. Appears to be working and makes sense to me that it could. It's not for everybody but if you're interested. I'm likely just buying time, but I'll take it.

Wilderness
Posted 12/4/2018 3:25 AM (GMT 0)

island time said...
Reason is telling me to do it. Inconvenience and fear of SE's keeps me from doing it. The way I see it is....There's a high probability of cancer being in my body. So, waiting is not in my best interest. That' my common sense side.

My common sense side jibes with JH. But....man, what a hassle. Plus...it can weigh on a man's mind. My next PSA test is in Jan. I'm already getting anxious. This stuff takes up a lot of my brain space. (But so would continuing SE's from Radiation). I'm also gun shy about treatment. My surgery went off the rails.

I do not put alot of stock in these studies. But, rightly or wrongly, I use them to rationalize what I want to believe. And, again, what I want to believe is that it's cool to wait. But that's not what my common sense is telling me to do. (Nor is John's Hopkins)

Come on Island, it went backwards 3 months ago. Keep calm. I am nervous also but am going to wait to see a trend. Same as you waiting for the next uPSA test. Just had some blood work for an operation and wanted to ask them to throw in a uPSA while they were drawing blood. Did you watch theDr Meyers video?
Posted 12/4/2018 3:38 AM (GMT 0)

bucky24 said...
so hopefully this will be of use to you.

Yes, it is, definitely. Thanks.

I feel like this may not be cancerous in origin for both of us. In your case, your PSA does not seem for sure trending up, compared to other guys here who go non-linear just before they go for SRT. I hope you level off and go stable. Or go back down, as you have before, and stay down. It's happened to others here--hope it does for you too. Your docs, seem mostly encouraging.

In my case, going off TRT IM last year for six months and seeing PSA drop by 50% just did not seem to be compatible with real recurrence. Had my last shot Nov 30 so will now stay off the TRT for three months. That's how long it took last year for my PSA to drop and stay down -- until I restarted TRT that is. Of course, I could really have recurrence and the TRT is just adding noise (confounding) to my PSA trend. Will repost when I know something.

Thing is though, if benign sources can contribute much to PSA at the levels we are seeing, you'd think there would be more in the literature about it because it would be something researchers would have to filter for, or account for, in all those studies we see that track PSA as a sign of recurrence. So I wonder.

And thanks for the KU ref. It's close enough to me to use if needed. Btw, my father-in-law, a radiologist, went there for med school. He's deceased now. Died of PCa w. advanced mets (sigh). Same end for my uncle. So sad to have happen to anyone. Yes, its a slow growing disease, but still must be fought hard at times, and still so dependent on wild guesswork...

Robert
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