Have I relapsed?

It’s been 3 months since my last PSA and normally I wouldn’t be thinking about this until a month or so before the next scheduled test in February, 2023. But for some reason it has been on my mind the past few days and I have been looking for any information that might give me hope that my consecutive increases for the past few years have some benign explanation. Unfortunately I have not found much to explain my recent increases, but did identify some positives and negatives.
Positives (if I can call them that)
1. Nadir between .60 and 1.00. Not the top tier of <.60 but in 2nd place
2. Time to Nadir 2 years. Less than 2 years is not as good. The longer the better.
3. Two bounces; one at 18 months; another at three years. Bounces are predictive of better outcomes.
4. PSA at 5 years <1.00. Studies show this to be predictive of better outcomes.
5. PSADT is 5.4 years based on last 3 PSA readings.
Negatives:
1. Three consecutive PSA increases.
My urologist believes the increases can be explained by my having a normal size prostate producing PSA, plus other causes as he stated in my last exam in February. Here are his notes:
<i>CT scan from 2 weeks ago demonstrates a moderately sized prostate measuring about 20-25 g, certainly capable of producing some measurable PSA.
Additional risk factors include his previous prostatitis, perhaps ongoing cellular changes secondary to prostatitis. Additional sources of PSA detection include his vigorous exercise, rowing machine, recumbent bicycle, etc.
I reviewed his CT scans, laboratory values, physician notes. Majority of our 45-minute visit was spent in face-to-face consultation, reassurance that I am very satisfied with his current status and I do not anticipate any problems with prostate issues in the future. I told him that it is my opinion that he will never be affected by recurrent prostate cancer and he will not die from prostate cancer. All questions and concerns were addressed.</i>

As to my Uro’s opinion, with all due respect, he’s not an RO and may not understand the physiology of prostate tissue after RT. One article I read said that it used to be thought that the prostate after RT would produce PSA just like a prostate that had not been irradiated, but that opinion has changed. That makes good sense to me since lots of men have nadirs <.50 after RT. I do have a long history of prostatitis and know that could affect my PSA but I would expect if that were the case the increases wouldn’t be so small. As to the exercising, I am very careful not to do any exercising for 2 weeks before the test that involves pressure on the prostate.


I consult with my RO after each PSA test and his opinion is that nothing needs to be done until PSA is 2.0 over nadir which would be 2.75 in my case. He does not seem too concerned with my increases, but it’s difficult to know what he’s really thinking. I don’t have the same relationship with him as I do my urologist. My guess is he doesn’t want to speculate and strictly follows the Phoenix definition of BCF and doesn’t recommend any intervention until then. He did say that he has some patients who did not reach a nadir until 7, 8, 9 years after treatment, especially his intermediate cases.

I sometimes feel like both of these docs think I will probably continue to increase until I have BCF but since they don’t know for sure at this time and it might take several years at this rate, why upset me with negative speculation, so they take the high road.

My thinking now is I will meet with my urologist again in February next year and discuss with him having some scans and biopsy. I would opt for mpMRI at Duke like I had in 2014, followed by a guided biopsy. Perhaps a PET scan. I’ll have to see what Medicare will pay since I may not have met the Phoenix definition of BCF. My RO said insurance wouldn’t pay but that may be because he wouldn’t push it whereas my urologist would if I asked. I can’t see waiting for 5 years to get an official BCF.

I’m interested in what you guys think. Have I relapsed? Are the doctors stringing me along?

Stuf, My PSA too has been bouncy and I get your concern. However; my RO and team remain unconcerned and very happy with my progress. Make sure your testing is with the same laboratory and if it weighs on you too much get additional PSA testing. My RO has me on a once/year schedule. Any imaging at this point is not likely to show anything. Keep us posted. Terry

hrpufnstuf said...

I’m interested in what you guys think. Have I relapsed? Are the doctors stringing me along?

No (in all likelihood from the data you presented) and No.

@Stuf…My last PSA was Aug. of 2021 with a .4 and the RO now has me checking once/year so I have one coming up this August. Prior three years I was checking every 6 months. Feb. of 2021 it was .8; Aug of 2020 it was .6; Feb. 2020 .3. The first couple years following treatment PSA’s were checked every three or four months. I’m careful to use the same lab (Quest) and typical pre-testing protocol. I’ve found Quest Labs results are typically a littler lower than our local hospital so it is important to stick with the same lab when splitting hairs.

I’ve been very happy with my Cleveland Clinic treatment team and I’m comfortable following their advice. On my first bounce they said bounce’s are typically good and to reduce my anxiety they moved testing from three months to six months to reduce my stress. But, I do continue watching it closely.