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Recurrence or Benign? PSA up, down , up .What The??

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Posted 5/14/2022 11:24 PM (GMT 0)
Basically undetectable PSA for 7 years then went up with a doubling time around 12-15 months. PSA was slowly creeping up til 0.2 finally came. Was then discussing radiation options with Dr's. It was checked again in a month to make sure and it then came down to 0.18. So I asked the Dr if the PSA comes down with a recurrence and they said no. The next 3 month test it came down 0.15 and the next 6 months still 0.15. I'm feeling pretty good now that it's benign tissue. Until........

Checked it again this week (after 6 months) and it's 0.3!!! Now I'm scratching my head a bit. My surgeon, who I stay in contact with said I could do a PSMA pet scan but it's still not likely to be anything worrisome. It make me wonder how high PSA can go while still being benign tissue. Can't find any answers on that. Anybody?
Posted 5/14/2022 11:50 PM (GMT 0)
Sorry to read that, but benign tissue after surgery?
A scan is in your near future, it seems to me.
Posted 5/15/2022 12:17 AM (GMT 0)
It's disturbing to hear that a Urologic Surgeon would say not anything to worry about if post surgery PSA is .3. ESPECIALLY in view of a slowly rising PSA over the years

Maybe I am missing something, but it makes no sense, correct me if i am wrong.
Its not the first time i have seen a member here have this experience. It makes me wonder if surgeons are just prone to letting their ego's get involved and thus dont want to admit failure not only to patients, but to themselves.

That aside, get the scan. And consult a Medical Oncologist, the surgeons work was done after surgery.
Posted 5/15/2022 1:00 AM (GMT 0)
Thanks for the kind input. But what do you guys think about dropping from 0.2 to 0.18 and 0.15 then back to 0.3? I would think a recurrence would mean cells are multiplying and it would keep going up instead of down (and then back up).
Posted 5/15/2022 1:02 AM (GMT 0)
Pratoman maybe he's considering being undetectable for 7 years, then slow doubling time, then the dip. I don't know.
Posted 5/15/2022 1:23 AM (GMT 0)
It's an unexpected rise, so it merits retest after some interval--say, 30 days. I would do that before a scan. Also, was this last reading 0.3 or 0.30 on the lab report? It makes a difference. At this point I would not want to monitor my PSA with a single-decimal PSA test. The right-most digit on any lab test is the most uncertain and open to rounding up, inherent testing limits, sample prep., less-than-perfect equipment calibration, other lab/on-off errors, and your body's physiological fluctuations.

Djin
Posted 5/15/2022 1:34 AM (GMT 0)
It was actually 0.302. It's also worth mentioning that the tests have been at 2 different places but they both showed the dips(one 0.18, the other 0.15) and each showed a rise, (0.2 and 0.3.)
I also just noticed that the free PSA is <0.02.
Posted 5/15/2022 1:38 AM (GMT 0)

kwoo64 said...
It was actually 0.302. It's also worth mentioning that the tests have been at 2 different places but they both showed the dips(one 0.18, the other 0.15) and each showed a rise, (0.2 and 0.3.)

It can take quite a few data points when there is fluctuation. I would test at the same place with the same test at some regular, small interval to get a better idea of the current trend. PSA can stabilize, too.

Djin
Posted 5/15/2022 3:02 AM (GMT 0)

kwoo64 said...
Thanks for the kind input. But what do you guys think about dropping from 0.2 to 0.18 and 0.15 then back to 0.3? I would think a recurrence would mean cells are multiplying and it would keep going up instead of down (and then back up).

PSA doesn't always move is a straight line. if you chart your PSAs in a line graph you will see the uptrend. your doctors are too much!
Posted 5/15/2022 3:04 AM (GMT 0)
"Basically undetectable PSA for 7 years with a doubling time around 12-15 months."

that means you were never undetectable, and they knew it!
Posted 5/15/2022 11:33 AM (GMT 0)
F8,to clarify, I was undetectable for 7 years. I was referring to the doubling time post that.

Undetectable PSA since at <0.03 until 8-2018 0.04,
1-2019 0.05, 4-2019 0.06, 7-2019 0.07, 1-2020 0.09
7- 2020 0.11, 9-2020 0.15,12-2020 .2,1-2021 0.18 3-2021 0.15, 9-2021 0.15, May 2022 0.3
Posted 5/15/2022 3:14 PM (GMT 0)

kwoo64 said...
F8,to clarify, I was undetectable for 7 years. I was referring to the doubling time post that.

Undetectable PSA since at <0.03 until 8-2018 0.04,
1-2019 0.05, 4-2019 0.06, 7-2019 0.07, 1-2020 0.09
7- 2020 0.11, 9-2020 0.15,12-2020 .2,1-2021 0.18 3-2021 0.15, 9-2021 0.15, May 2022 0.3

why was your PSA allowed to rise to .3 with no treatment?
Posted 5/15/2022 4:06 PM (GMT 0)
Well we were discussing radiation when it got to 0.2, then after it dropped 3 times, we thought it was benign tissue forming PSA.
Posted 5/15/2022 4:56 PM (GMT 0)

kwoo64 said...
Well we were discussing radiation when it got to 0.02, then after it dropped 3 times, we thought it was benign tissue forming PSA.

what about the rises in the past two years that brought you to .3? unfortunately, someone dropped the ball
Posted 5/15/2022 5:17 PM (GMT 0)
Again, being that most attribute 0.2 as recurrence time, we were waiting for that number to then discuss radiation. Any before could simply be benign tissue forming PSA, and could still be that. There is a video online somewhere where Dr. Snuffy Myers says he has seen PSA's hit 0.2 then start to plateau and level out. He attributed that to benign tissue.
Posted 5/15/2022 6:40 PM (GMT 0)

kwoo64 said...
Again, being that most attribute 0.02 as recurrence time, we were waiting for that number to then discuss radiation. Any before could simply be benign tissue forming PSA, and could still be that. There is a video online somewhere where Dr. Snuffy Myers says he has seen PSA's hit 0.02 then start to plateau and level out. He attributed that to benign tissue

you are at .3 and it's been a steady rise over several years

in my mind all questions should have been resolved well before .2 when SRT had the best chance of working. that's all i'm going to say on the matter. i wish you the best!
Posted 5/15/2022 6:43 PM (GMT 0)
I think you meant to type 0.2 (and rising) rather than 0.02. Also, when the working definition of BCR was being iscussed and established, Johns Hopkins doctors proposed 0.4 for the very reason that some men go up and then plateau. Note that RT between 0.2 and 0.5 is still called early salvage therapy.

Djin
Posted 5/15/2022 8:06 PM (GMT 0)
Thanks F8. I wasn't aware salvage radiation was an option before 0.2. I was ready and willing at 0.2, then on having the recheck ,the PSA went down.
Thanks again.
Posted 5/15/2022 8:07 PM (GMT 0)
Thanks Djin. Correction noted.
Posted 5/15/2022 9:24 PM (GMT 0)
I don’t believe unstable PSA is a favorable prognostication. But that came from a very small study I read years ago.
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