Returning customer. PSA is back.

Well, 8 years and six months. That is how far I got without a return of psa. So long zero club, and so long that feeling that maybe I beat this thing. 2 readings of .097. I am not sure what to do, if I even decide to do anything.

Agree with Mattam, re your age factor.
I do think you need to see a trend before taking action. It’s possible that it just stays around that .1 n8mber that you are close to.
If it DOES start trending up, don’t wait too long though. Maybe even see an RO now, so you have things in place and can act quickly when the time comes.

Don’t wait and see. That is what the cancer likes. On Monday you should see an excellent radiation oncologist that does a lot of PCa salvage work. Your urologist/surgeon is done as that failed.

lowandslow said...

...got another within 4 days of the first. Both the same. .097...I lost my son in law in a car accident and daughter severely injured, and this was kind of put on the back burner with 7+ years of negative results. My last ultra sensitive test was July 2018 and it was undetectable at below .006.

Yes, those two readings are enough to justify locating a good RO and having an initial visit to talk things over. BUT, here's the thing: I had my surgery a year after yours and have been monitoring this board and another very regularly, reading most posts that pertain to cases like yours and mine, i.e., pretty good path with reasonably long recurrence times, and I do not remember very many cases where a guy's uPSA went practically zero for seven years then jumped to about .1 in just about sixteen months.

Besides recurrence, there are some other things that might be going on. First might be a faulty lab or machine. Did you get the two readings at the same lab? Did you by chance ingest any vitamin B7 (biotin) that is known to jack with the test substrate, making it look like a rising uPSA though it's a false reading? Many multi vit pills have it -- look at the label.

Also, on the other board I visit, there have been posts about the effect of stress on PCa and, by extension, uPSA tests. Do you mind me asking when the accident occurred and how your daughter is faring (very well, I hope)? Would you say your stress level will be coming down a bit over the next month or two? Reason I ask is I have been monitoring my rising uPSA closely for about the two years since it became uPSA detectable. It has not moved up that much in two years but instead is gyrating some around a very gently rising trend line. I am trying to correlate with A1C levels, OTC use, stress levels, etc., but cannot figure it out and no one can provide advice. Docs say I'm very likely to die of something else. But you are much younger, of course.

If in your situation, there is no way I would allow them, right now, to strap me to a table and radiate me and perhaps shoot me up with ADT, both possibly permanently life altering. I would go to LabCorp myself and get two more uPSA tests, one about three weeks from now, and another three weeks after and let that guide me. Sure, let your doc(s) do another at their lab, too, if you/they want, but what I'm getting at here is "trust, but verify...".

We have seen cases on this board where uPSAs stabilized or even went down--no explanation really, cause nobody knows what's going on in these cases. The nuclear scans are not much help in this range. Benign leftover prostate tissue can shrink and grow, but no way to tell for sure on that either. One of Dr. Myers' videos says that even the best surgeons can leave some benign tissue left in spots when the prostate is ripped out.

Bottom line, you seem to have enough time to make a considered decision based on more facts. A month or two more delay will probably not hurt you. But, yes, start getting RO contacts lined up and be prepared to move on that if you see a verified trend line moving up. It's just hard to believe with your path: no margins, organ confined, only 7% involvement, and uPSA below .006 for seven years? Really??? I really hope for you that this is not recurrence but rather something else.

Robert

You have had a good run. My readings were up a little from yours. You can see that my after surgery readings vacillated and eventually reached .06 at the eight year mark. Both my surgeon and then RO feel that .03 should be the trigger point of starting SRT. They let me go to .06. No I did not get strapped down to the table. SRT was a nothing burger for me. It has been over 4 years since the treatments were completed. All of my post SRT readings have been <.006. Praise God, I would suggest you find the best RO and start the conversation. You are young- lots of living to still happen.

Lowandslow,
I agree with the others here who say it is time for you to see an RO. If you decide to go ahead with SRT there will still be a month or two between an initial consult and start of treatment, which gives you time for another PSA test before making a final go/no-go decision.

There are some parallels and some differences between your PCa experience so far and mine. Even though I had a more adverse pathology report than yours after surgery - 70 percent in one lobe, some presence in the other lobe, and SVI - I went a long time after surgery with essentially undetectable PSA. I had ultrasensitive tests that showed PSA hovering around 0.02 to 0.04 for 4 or 5 years and then a jump to 0.1 where it stayed for a couple of more years.

My experience both after initial surgery and later after SVT is that my PSA has stayed very low to undetectable and then had a sudden acceleration. Though my post-surgery PSA hovered at 0.1 for a couple of years. when it hit 0.2 it jumped again to 0.4 in only a few months. Likewise after SRT my PSA stayed completely undetectable at 0.00 for 4 years, then became minimally detectable for a couple of years more at 0.02 or so. But when it started moving again it accelerated quickly - see the dates and numbers in my signature.

Based on my own experience PSA can move very slowly and then have a sudden increase.
Jim

I can’t say I agree or disagree with what others have said, only that it seems lining up your optionality is probably prudent, but taking a BIT of time to really assess, re-asses before deciding is where I think I know I would land in this situation.

I know I always have this sinking feeling when getting my uPSA done, every six months still and still <.02 (whatever the lowest is for this test).

I hope yours is maybe just falls signal or testing protocol, as much as I hope I don’t have tests that tend this way.

Well I had the two tests that showed .097. I have since had four more, all at an undetectable level of <.006. I've used the same lab and same protocol every time since my surgery in 2011. Maybe a new labtech, a bad batch of reagent, who knows? I will continue testing every 30 days (or less) and see what happens I guess.
I didn't go the RO route yet for the simple fact that my daughter has had a rough time with her husband's death, and im dealing with both of my parents having dementia. (I'm not an only child but i am the only one close to my parents geographically so I get all of those trials.)
Luckily my testing site is on the way to my daughter's new apartment, and i can stop and pick up a lab order from my urologist any time i want without an appt. . I simply don't have time to have a recurrance right now. Lol.
Someone mentioned Purgatory's issues. I instantly thought of him when I thought of SRT. Did he pass? Quit posting? Is he still around?
Thanks for the replies!

I'm sorry to hear you lost your son-in-law, and that your daughter is having such a hard time. I can't imagine her pain.

lowandslow - Nice results, good job staying after it. More low and slow to look forward to.

Four recent tests at <.006 beats two old tests at .097. Others have posted here about wild swings in numbers that turn out to be lab error. I had one of those but it was do to Dr. Assistant reading them wrong and not the lab.

PCa can act in a similar fashion to bankruptcy — barely perceptible for a long time, then a cascade. Agree with other posters, time for a consult with an RO. Many SRT veterans here on this Board for great info.

Thanks for the replies. I am attributing the positive results to lab errors. A bad week for a tech or some poor calibrations. But I will continue getting psa tests every 2 weeks for the next year just to be sure.