Possible recurrence? -- Jumping back in

I've been gone for a while--almost six years since my husband's prostatectomy. As much as I appreciate you, your support and advice, I think you can understand when I say that I really hate to be back. I hope you can answer some quick questions (if there is such a thing).

Quick background: For the last six years, my husband has been getting ultra-sensitive PSA tests every six months. They have all been <. Two weeks ago, he got a result of =.05 (I think that's what it was. The important part is that it was =, not <.

My husband meets today with his GP about these results. Originally I wasn't going to go, but now I am. (Long story)

I've read a few other posts about recurrence after surgery, etc. Saw some things about different results and different labs. Even saw something about spinach?!? I've been away from this board and this subject for so long that I need a complete refresher. But for now:

--What are the important topics to discuss with the GP?

--Is there a non-cancerous explanation for the = result?

--Should the next test be three months after the last PSA test? Or some other interval?

Thanks for your advice!

Hi Melaine. Any unexpected rise in PSA should be confirmed with a retest after some period -- testing errors do occur.

Whenever you have a result with a "<" sign, i.e., below the test's lower limit of detection, there is peace of mind. However, you don't know exactly how much lower your actual value is. So you don't know if your husband's past <0.05's represented an actual value of, say, 0.049 or 0.001. In other words, if we assume the 0.05 is correct, has his PSA been just under that all this time, or has it slowly (or rapidly) risen from a much lower place? A rise from 0.049 to 0.050, for example, can be a tiny physiological fluctuation of no import or well within the test's limits of accuracy.

In any case, even with a rising PSA, there is time to monitor it, determine the rate of rise, have consultations and advanced imaging, and, if necessary, formulate an action plan and an action PSA level for salvage radiation. Today's advanced scans can help find the location of lesions, but they need higher PSA values.

Your husband's doc will probably want to retest in perhaps 1-3 months. If his next PSA is above 0.5, you might want to transfer monitoring to a uro.

Keep us posted.

Djin

Melaine,
I'm in a similar situation. My PSA didn't move for 7 years then started creeping. My Dr. said they see that often and sometimes it's actually benign tissue that has formed PSA. Now that I've hit 0.11 he's not so optimistic and say's" Not clearly recurrence, but moving up a bit faster than benign glands would.Meeting with radiation oncology reasonable but most would wait until 0.2 to treat so no rush."
So I met with the Oncologist this week and he thinks it's too early to radiate and wants to sit down with my surgeon and another Dr. to discuss another possible experimental treatment. Of course mine as well as your husbands could level off or come down but he thought at this point mine would probably increase rather than decreasing. I hope this helps. Best of luck!

I have also read different numbers as to when to start. It may vary per individual as to how long it took the PSA to start moving and how long did it take to double. There may be other factors as well as age, clinical PSA etc. My guys are saying 0.2. in my case. If you read in the Walsh book, he says something like if ones PSA goes up years after surgery and stays over 0.1, it could possibly never cause any problems.
I would think the contrary at 0.2 or more.

The slight increase in the retest, while not definitive, does suggest thet PSA is indeed rising and will be another data point for your docs to chart his P.SA values and determine the doubling rate.

Djin

Although it is certainly true that some men have a PSA that increases a and then stabilizes, I believe that is more common relatively soon after RP rather than six years later, I suspect that with the recent PSA vales of <0.05, 0.05, and 0.06, your doc will want to keep a close eye on it. I would consider changing from a family doc to a uro for monitoring purposes. From reading posts, my impression is that non-specialists tend to be too cavalier regarding prostate issues.

When PSA recurrence does occur, the longer the time after RP that it begings and the slower the rate of rise, the better the chances of a good outcome

Djin

Caveat Emptor...advice given is sketchy...even tho the posters claim NOT to be doctors...this does NOT mean that the claim does NOT have its affect on the effect of that claim...and ya know something...tho some of these posters...willy nilly make such claims un-effected...they know perfectly well that what I am claiming is true...hence ego's are stricken( evil cousin of stroked) umm a stroke...interesting...stricken with a stroke...maybe blood brothers?? PS...it really is not that complicated...follow the words as posted and think...if you(generically) do not want to think...because words are in truth...difficult to understand...especially quantum speak...which playfully reveals solutions to problems unknown but none the less are very much in play be sure to Caveat Emptor