Prostatectomy + 8 Years -- PSA Creep

It looks like eight years after my prostatectomy my PSA is now detectable. In the last year and a half, my PSA has worked its way up from <.03 to .05 to .08. I think we're looking at a trend. I just got kicked off Androgel and was told to see my oncologist, who I understand is no longer with the Clinic. Crap.

I know a lot of guys are in much worse shape, but it looks like I'm headed for radiation. Would anyone here who's been down this road care to fill me in on what to expect? Also, if anybody know who the hotshot radiation doc is at Cleveland Clinic I'm all ears.

I too will be 63 in 3 months, I like that, too young for MEDICARE, too old for women too care, i think that’s about right...

Hang in there boys.

Trifecta here, and rising PSA. Living healthy, keeping an eye on it, accepting that the treatments failed and I will eventually be back on chemo. :shrug:

I'm in a very similar situation. After 7 years mine went from <0.03 to .04 and recently to .05. Testing again soon. Best of luck!

Bobbiesan, I wish I had a good answer for you, but right now things are up in the air.

The doc who prescribed Androgel is not my regular urologist. He’s a guy who specializes in testosterone replacement. I went to him specifically for that purpose. He ordered my most recent PSA test and then told me to see my regular urologist about all this. Then he said my regular guy (a great doc) is no longer at the Clinic, so I guess I’m doctor shopping right now. I’m seeing my PCP on Tuesday for a checkup, so he may refer me to someone.

All this talk about salvage treatment is just My supposition. I have no idea what the treatment plan will be; this is my first rodeo. Maybe they’ll want to see what my numbers do now that I’m off testosterone, but somehow I doubt I’ll get that lucky. I’ll report back when I know more. I’m sorry to see that others are in my boat.

Jazzman1 said...
Thanks for the good information, Protoman. It's nice to hear from you.

The ADT part of your story set me back a bit. I hadn't even contemplated that with a 3+4 cancer. Can these things come back with a higher Gleason score? It sounds like you're doing well after your treatment, which is good to hear.

Thanks for your input too, mspt98. We're at that awkward age alright...

Jazz, justto clarify, the ADT was my choice (sick mind, I know 😂). My RO told me that as long as the PSA is below 1 he would be comfortable if I didn’t want the ADT. I asked him to quantify the advantage, he said 5-10%. Another to- RO at Cleveland Clinic (in Florida) Told me he would think ADT wouldn’t be necessary given my (3+4). So you may not want ADT. ESPECIALLY, WITH THE 8 YEARS BETWEEN SURGERY AND .08.

But let’s not jump ahead of ourselves. This could still stabilize.

Samster: Yes, all my PSA tests have been at Cleveland Clinic.

Pratoman: I could be talked out of ADT, but I like you’re idea about this thing stabilizing even better. I’ll drink a glass of Scotch to that.

Ed: wishing you luck on your journey too.

Everyone, thanks for your support. This has always been a great place for support and information. Some things never change.

Thanks, Jim. It'll be ironic if I go from T supplementation to T suppression, but you do what you've gotta do. Before Androgel my testosterone level was pretty much in the basement, so maybe Casodex won't be necessary, but we'll have to see what an oncologist has to say.

By the way, I pointedly asked if Angdrogel was appropriate and safe for someone with a history of prostate cancer. I asked if it amounted to playing with fire. The urologist assured me that a number of studies showed that it was perfectly safe. Maybe this PSA rise had nothing to do with the testosterone, but I guess I'll never know.

Thanks, Paxton. I'm familiar with Dr. Morgantaler's work. Reading about his studies was what prompted me to see a local urologist about TRT. The guy I saw was pretty confident that Androgel wouldn't present a problem for me. I may be able to talk my way back into the Androgel club, but right now it's not my highest priority.

From what I've seen of the research, there are a number of relatively small studies indicating that TRT may be appropriate for low-risk PCa patients, but no really large studies. Apparently the universe of PCa patients on TRT is relatively small so it's unlikely that we'll ever see any large group studies.

It's interesting to hear from someone who was seen by the man himself. If this cancer situation doesn't get out of hand and I start feeling crummy again, I may end up trying to get back on TRT. We'll see.

Hey Jazz,
Dr. Stephenson at clinic did robotic in September 2010. Followed by adjunct radiation. Stayed undetectable for about four years. Stephenson said he would not do anything till the magic number of 10. No advantage to earlier intervention. So he waited till the number was 19. Then he shipped me off to Oncology telling me he was going to recommend Lupron with six chemo treatments. After chemo we started Zytiga with Lupron, Prednisone and Prolia. Gilligan is medical onc. I can certainly say he is good.
The best radiation onc. is Tendulkar. Just checked find a doctor and he is still there.

Last time I saw him he had just returned from a symposium in New Orleans, and was extolling the virtues of the Crescent City. Maybe there was an opening at Tulane or LSU? Is envy a bad thing?

Jazzman:

Almost four years after after my RP my PSA started creeping up as well. Although I probably should have started salvage treatment earlier, my URO recommended I wait until the Axumin scan came along to try and find where my recurrence was. By the time my PSA reached .338 a couple of years or so later, my treatment center finally offered the Axumin scan in a clinical trial and my MO signed me up. Unfortunately, the results of the scan were negative. My PSA was just too low.

At that point, it was time to move on to salvage treatment and my MO recommended either 6 months of Lupron or prostate bed radiation, more than likely due to my slow PSADT. However, I chose to consult with two other MO's and two RO's, one of which was a co-author of the RTOG 9601 study comparing 2 years of Casodex with salvage radiation and salvage radiation alone. I told him I wanted whole pelvic radiation because of my positive lymph node and that I wanted to avoid Lupron if at all possible. In my case, he recommended 4 months of Casodex and Avodart together with whole pelvic radiation. I went back to my MO and told him this is what I wanted to do. My MO really wanted me to have at least 6 months of Lupron, which I wanted to avoid, so I agreed to 6 months of Casodex, two months before, during and after my SRT.

The Casodex was a breeze, a few brief hot flashes here and there and some slight breast soreness. My PSA dropped by 75% in the first month. The whole pelvic radiation was also very easy. No side effects except fatigue the last week or so, which subsided about a week after the treatments ended. After a year I am now experiencing some changes in my bowel movements, which are not as firm as they used to be, but not too bothersome.

Since I completed my SRT, my quarterly PSA's have been consistently less than .008, which I am hoping will stay the same indefinitely. Time will tell. I remain very optimistic.

Fortunately, there are many options for salvage. Best of luck in selecting and completing a successful treatment.

Rick

Going to see a medical oncologist and a radiation oncologist on Tuesday and Wednesday. We'll see what they have to say. From what I can gather the treatment choices are likely to be radiation and/or Lupron. I'm not crazy about either one, but you do what you've gotta do.