PSA now 0.03

Hello everyone! Here's an update on my husband's rising PSA now 0.08
From 01/19/2020 to 4/13/2020 PSA 0.03
6/14/2020 PSA 0.04
9/16/2020 PSA 0.05
11/01/2020 PSA 0.06
1/10/2021 PSA 0.08
Per his urologist: "PSA is slowly creeping up. The doubling time is approximately 12 months which is the threshold to consider resuming ADT."
Any thoughts/opinions to just continue to monitor PSA vs starting ADT even though PSA numbers are still relatively low? His urologist will be retiring Feb 1st, so husband will be discussing a plan with a new urologist.
Thank you!

Husband had his PSA checked every 6 months for a few years. The results were always < 0.01 In January, his PSA registered 0.03, same lab. Today, he received the same results of 0.03. Again, same lab. His urologist is thinking that his cancer might be coming back and will be monitoring his PSA every month now to check the trend. Husband is beside himself. He was always a worrier, now 10 fold! Thoughts? Thanks!

I believe his treatments in 2011 and 2012 have failed. The only good news is they have more options today than they did in 2011.

Djin read the signature. RT 2012, 4 months post RALP.

Forgot to update his treatment on signature. In January/Feb 2012 he received 33 sessions of RT. I believe it was 60 Gy plus a boast. Thank you all!

Doxa said...
.....Husband is beside himself. He was always a worrier, now 10 fold! Thoughts? Thanks!

Do monitor the trend. PSA is still microscopic, so no reason to go crazy. Try, as best you can, not to fuel his unproductive worry. Good luck!

Doxa,
Your husband's long time between treatment and what may now be the start of recurrence can be a good sign. Not as good as no recurrence. But it may mean a slow rise to a point where further treatment is needed and also a good chance that further treatment will work effectively to slow any future advance for many years.

Your husband's experience thus far is somewhat like mine. I may not be typical. But my PSA reappeared in 2014, which was 12 years after surgery 4 years after SRT. It then took two more years to rise from .02 to 0.2 and another two years after that before I need to start intermittent ADT in 2018. I've now been on break from ADT for 10 months and will probably start the next round of treatment in May or so. My oncologist says my history of long periods of very low PSA after surgery and after SRT suggest a likelihood of ADT also being successful for a long time.

I know this isn't the news you or your husband want. But it is also not like going over the waterfall in a barrel. I'm now in my 18th year with this disease and expect to have quite a few more.
Jim

PeterDisAbelard. said...
As IslandTime said, the longer between treatment and recurrence the better the prognosis tends to be. Aggressive cancer comes back aggressively. It's been, what, six - seven years since his last Lupron shot? Technically, a PSA of 0.03 doesn't count as a recurrence, but it does make it likely that he will eventually reach the threshold. But hopefully it will take a long, long time. He should let his doctor worry about it for him.

Given that his doc retested the unexpected reading and has switched to monthly tested, I believe there is no intention of waiting for his cancer to get anywhere near 0.2 before starting a new round of treatment. Given a history of mPCa, evidence of a clearly rising PSA after years of being undetectable will motivate treatment and perhaps a bone scan.

Djin

mattam, that's possible, of course, but I don't see the logic of waiting too long (assuming his PSA continues to rise) when it was known from the outset that the cancer was metastatic. Perhaps I'm in the minority. Question: after your RP and RT, when you PSA was climbing, what was the thinking as to the location(s) of the recurrence, and how was the decision for ADT reached when it was? In other words, why 64, as apposed to, say, 30 or 100?

As poor as bone scans are, the majority of men with a G8-10 diagnosis get bones scans with PSAs even below 10 (I did). I didn't mean the bone scan or treatment would happen immediately. The new generations of scans, e.g. 68Ga-PSMA can have success at very low PSA levels, although when below 1.0, the higher, the better.

I hope we can follow the OP's husband and see what the thinking/advise is of any consultants. We learn too!

Djin

Doxa - In my opinion, after surgery (RALP) followed by radiation (RT), small amounts of PSA or small changes are not indicative of any action to be taken other than say, "darn, something may or may not be brewing". Your husband had two PSA's of 0.03 which tends to confirm the low values so there you sit with a couple of small numbers that are the same after a month or so.

At this point, a 3 month PSA testing protocol would be more than adequate to keep an eye on his PSA. Testing every month could be like watching paint dry with the extra anxiety of too many tests that will tell him little that you can do anything about. Why do I say this? There is really nothing much that can be done until his PSA gets significantly higher which can be easily monitored with 3 month tests. It would be prudent to let the PSA get high enough where the highly sensitive PET scans might be able to see a source of the PSA which might guide future treatment schemes. There is no reason that I have seen that would start therapy at 0.03 once surgery and radiation have both been done but that is not to say that there are not other theories out there.

I think your husband should be guided by an experienced prostate oncologist now since you can't have surgery or radiation twice in the conventional sense so that expertise may not be needed again. The treatments after this point tend to be forever so no reason to waste years of feeling fine prematurely until it is actually time to do something.

"In addition, anyone in the delay group was treated if metastasis was ascertained OR the PSA doubling time was <= 6 months."

Yep, which falls in line with the views of my all MOs (I'm currently seeing my third one).

I think the point is that many patients (and possibly some doctors) feel more comfortable when they have the sense that they are Doing something, when in reality it may sometimes be better to do nothing until the time is right. It is for sure a controversial area of PCa treatment.

I agree with Jim. There is a view that oligometastatic PCa is not only treatable, but, in some cases, even curable. I would not jump to a conclusion that after MAXRP all treatment is perforce palliative. However HT can play its role at some point in limiting the formation of additional lesions. Bone accounts for a large majority of mets, and can often be irradiated, as some lymph nodes can be, depending on the location.

I don't know if the OP's tissue from his 2011 RP is still banked, but genomic studies could make other systemic treatments attractive.

Djin

Hello Doxa - Looks like a long run and your husband is still <0.10. I am thinking keeping an eye on it for a while would not hurt as it may or may not increase at the same rate and some people stabilize at some point and just have a small PSA.

I might suggest that he start seeing a MO (Medical Oncologist) who is knowledgeable about prostate cancer as the surgery and radiation options are done for now and a MO specializes in the other treatments. There may be a reason to let his PSA get to higher levels such that a high powered scan might be able to find the source of increasing PSA and guide possible treatments. There may also be a reason to beat the PSA down now but this should based on the oncologist’s recommendations.

Just my thoughts after I read the story and some of these have been stated before.