Disappointing uPSA Report

After three great (and declining) uPSA reports in a row following my RALP about a year ago (I was down to 0.008 in February), my doctor gave me permission to go back on my testosterone shots. The shots were resumed in March, and I kept the dose to something very small. My testosterone is naturally very low (double digits) and without treatment I feel like garbage but muddle through. Yesterday I had my usual PSA test and it popped to 0.022. Not what I wanted to see. I've stopped the shots until the doctor weighs in.

I'm afraid that this event, combined with my high risk Decipher results, are going to introduce me to SRT. Meeting with the doctor is in about a week. Anyway, would appreciate any thoughts, experiences and advice here.

Thanks for the reply Robert.

As a follow-up, I had a meeting today with my PCP and also heard from the surgeon. I'm happy to report that both stated that there is no immediate concern. The surgeon said my PSA number was still very low and it was too soon to consider it an indication of a reoccurrence. And my PCP pretty much forbid me from going off of the testosterone, so I was really happy to give myself a shot when I got home. Without TRT, my T-level drops to double digits and everything suffers -- in addition to very low energy and mood problems, my lipid numbers rise substantially and glucose tolerance takes a hit (my A1C numbers rise to almost pre-diabetic levels). The PCP emphasized the importance of "quality" over "quantity" and raised a valid point -- even IF the T-shots somehow reduce my lifespan by some amount of time, it's a worthy tradeoff. It's better to have 20 awesome years at this stage of life rather than 25 years of feeling like crap, hating life, and destroying my body's hormones and everything connected to it. It was a needed attitude adjustment.

A bit confused. How were you T3a post surgery with no ECE or SVI?

Duck2 said...
A bit confused. How were you T3a post surgery with no ECE or SVI?

BNI was officially noted by pathology; however, according to my surgeon it was a false reading. The reason is that several months earlier I had a TURP procedure and, consequently, there was no bladder neck left -- it was all prostate tissue. In his opinion, my PCa was most likely contained, as the only margin noted was the "bladder neck".

azrr - Stay the course as your doctors have suggested, your PSA is virtually nothing. This is where the high sensitivity testing causes anxiety long before it is warranted in my opinion.

Never studied it but my guess would be that TRT may or may not materially affect the speed at which recurrence occurs but it would not change the outcome. If there is cancer left somewhere, it will proceed on its own schedule and let you know someday.

Salvage radiation timing is difficult as earlier is generally better but there are diminishing returns at some point so no doctor is going to endorse treatment at microscopic PSA levels with decent pathology. I went the ART route but that was due to more issues to wrestle with and the odds clearly favored it for my situation (in my interpretation of lots of conflicting studies).

BTW - Decipher is not 100% indicative of anything. Just another good piece of information that has to be weighed in context with the other information. Keep it all in perspective

On a related note -- does anyone know if sexual activity prior to a PSA test matters anymore once the prostate is removed? Curious about this, since uPSA is an extremely sensitive test that measures virtually down into the noise.

Pratoman said...


My understanding (i always start with that, because I'm not an expert or a doctor) is that it has no bearing on PSA after your prostate is removed

Thanks, Pratoman. And for those who may be interested -- I heard back from my surgeon today and he said that once the prostate is removed, sexual activity has no bearing at all on PSA numbers. There's very little information about this readily available online, probably because it's an odd question.