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Rising PSA after RP

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Posted Today 1:41 PM (GMT 0)
Hi again. Just got my test results back and they have me worried again. This time went from 0.03 a year ago to 0.05 today. Previously tests were bouncing on the 0.020 to 0.029 range. I had my prostate removed in 2015, Gleason 6, with 1 open margin less than 1 mm. I know based on previous conversations that my doctor will want me to get radiation treatment. Any thoughts on this? I am worried about side effects and possibly the radiation causing other types of cancer down the road. I am 61 years old. Also, what are the chances it has spread outside the prostate bed?
Thanks to all.
Tom

Post Edited (TomC1962) : 11/29/2023 11:32:48 AM (GMT-8)

Posted Today 2:22 PM (GMT 0)
Sounds like a PSMA scan is in order.
Posted Today 3:12 PM (GMT 0)
Tom, that is a very low psa reading, and you say that you have had higher scores. My recommendation is to enjoy the holidays and immerse yourself in activities that bring you joy. My best guess is that you have many years of a good life left to live. Do not let worrying take you away from that.
Michael
Posted Today 3:59 PM (GMT 0)
I agree with Michael. Your spa going up .02, from .03 to .05 in one year is the first thing that leads me to believe you have little to be concerned with. The second thing is, this is after 8 years post surgery.

I decided to proceed with SRT with my PSA at .08. But that was 3 years post surgery, and more important it was after a full year of PSA tests every 3 months, with each subsequent test going higher than the previous one.

Yes, monitor it. Maybe test every 6 months instead of a year, or maybe every 3 months. If you detect a multi test trend, then yeah, speak to an RO. But until then, enjoy every minute of life.
Posted Today 4:21 PM (GMT 0)
Exactly what Pratoman said. Test every 3 to 6 months, and watch for a trend. Otherwise, just live.
Posted Today 6:30 PM (GMT 0)
Thank you guys. The main thing that worries me is if the radiation can cause other types of cancer.
Also, does anyone have any statistics as far as at this level, 0.05, is it possible that it has traveled or is it more than likely still most likely in the bed where the prostate was?
Michael, this is the highest reading I have had. You mentioned in your post that I said I have had higher readings.
But all along its been bouncing in the 0.20-0.29 range. 1 Year ago he changed labs and it was 0.30. Yesterday was my all time high of 0.50 (same lab this year as last year)
I go to my doc a week from today.
Thanks,
Tom
Posted Today 6:44 PM (GMT 0)
Tom, I think you may have your decimal points a little mixed up hence the confusion about whether you are lower or higher than you were previously. Did you mean that previous tests were bouncing between .02 and .029 rather than .2 and .29? Big difference...

Since, it's been a year since your last PSA test I would test again in 2-3 months before pulling the trigger on anything. And, BTW, if you do have to have radiation the chances of a secondary cancer down the road are increased from where you are now but only very slightly...not enough to change a medically necessary decision now IMHO.

Jim
Posted Today 7:07 PM (GMT 0)
Hi Jim,
Sorry Jim and All. I did mess up the numbers on my first post.
Here is my history. The first 4 after surgery were all <.03
Then switched to ultra-sensitive test and my numbers bounced up and down from 0.020 to 0.029.
Last year he switched labs and it came back at 0.03. (This lab seems to only use 2 digits after decimal.)
Yesterday was 0.05
Thanks,
Tom

Post Edited (TomC1962) : 11/29/2023 11:31:45 AM (GMT-8)

Posted Today 9:32 PM (GMT 0)
"Thank you guys. The main thing that worries me is if the radiation can cause other types of cancer."

there is always something to fear with cancer. i had a lot of radiation 14 years ago and i am cancer free. we used to say that G6 cancer doesn't kill you. has that changed?
Posted Today 9:42 PM (GMT 0)
That is what I heard about Gleason 6 too. But if it is growing, I guess I have to stop it????
My head is Jello from reading too much. I just don't want to wait too long, have the numbers continue to increase, and have it spread. I used to worry when I saw it go from 0.028 to 0.029. So for me, going from 0.03 to 0.05 in 1 year from one test to the next is a huge jump.
Posted 11/30/2023 1:43 AM (GMT 0)
I am not positive but I believe 0.05 is considered undetectable at some places. Newer radiation techniques make it unlikely to develop new cancers. You may be a long way from having to worry about that. Like others said ( and it's easy for us) enjoy the holidays.
Posted 11/30/2023 2:02 AM (GMT 0)
The standard medical line is:
Radiation therapy elevates risk for future cancers.
The risk is low, but one you should discuss with your doctor.

2-3% was the number provided by my radiation oncologist, lowest probability of the side effects possible with RT.
Posted 11/30/2023 2:10 AM (GMT 0)
Than you everyone again. I appreciate the advice and encouragement more than I can say.
Tom
Posted 11/30/2023 3:34 PM (GMT 0)
Hey Tom!
I'm similar in that although I was a G7, one margin was less than 1mm from edge. My PSA started changing at 7 years with a doubling time of about 15 months. Mine is a little weird in that it has fluctuated some, up then down, same lab. I was getting ready to do the PSMA scan then it went down and the Dr. told me that it's sometimes not accurate below 0.3 (as I recall). Now it's moving upward again so I may consider doing it after the first of the year if it keeps going upward. I'm somewhat optimistic that mine may be benign tissue due to the fluctuating. My Dr. jokingly said (after me being maybe overly concerned) something like at the rate mine is moving, I'd probably be between 500-600 years old before mine would metastasize. I often think about in the Walsh book he says ( I'm paraphrasing ) that even though our PSA may climb some after surgery, it may not ever give us any problems. The 'may not' part is still unsettling with me. I guess pre surgery PSA, Gleason, Stage, how long before PSA started to move and doubling time should all be factored in.
Posted 11/30/2023 5:11 PM (GMT 0)
Thanks for your story Kwoo. I am like you....I read into stuff to much. Like the "may not". LOL
But I know its there and I want it gone. I know many subscribe to the wait and see, but for me,
waiting is maybe a week, then I run out of patience. That's not good to rush it I know.
My Gleason was 6 and confirmed 6 after surgery. Do you, or anyone reading, know the answer to
this....IF the numbers I am getting are indeed prostate cancer cells, would it still be considered a Gleason 6,
or does that no longer apply after surgery?
Tom
Posted 11/30/2023 8:23 PM (GMT 0)
Good question! I'd be curious to know as well.
Posted 12/3/2023 2:05 AM (GMT 0)
Those spikes are worrisome when they happen. So, I can relate to that.

The “not patient” part is me to a tee Tom. Here’s how much…

…on one of my spikes I did not wait 3 or 4 months to see what my future held. I went directly to a different lab within a week. That result came back much lower.

I understand the reasoning behind “stay with with same lab.” And I do. Labcorp. However…because I went to another lab, got a “normal” (for me) reading…that test kept me from ruminating about it for “weeks on end”. It was out of my mind. And Labcorp confirmed the lower result at my next regularly scheduled blood draw.

I’ll go against conventional wisdom if it means a shot at peace of mind.

But, then again, I can be a real wus too.

Good luck and enjoy the Holidays Tom. 😊
Posted 12/3/2023 2:58 AM (GMT 0)
Thanks Island. I see my doc on Wednesday and plan on getting a retest while there. I get my blood draw at the same office. They use Sonora Quest and LabCorp. All of my tests for the first 7 years were labcorp. But last year he switched me to Sonora because of my insurance. But I am going to pay out of pocket to use labcorp. Labcorp I think was a more sensitive test as they went 3 digits behind the decimal. (Not to mention gave me better results! lol) Sonora just gives me 2. I know those 3rd digits are meaningless but I don’t like the rounding off.
Thanks again
Tom
Posted 12/3/2023 11:04 AM (GMT 0)
Tom, this may have changed in recent years, but the historical interpretation is that G6 does not metastasize. Increases in PSA post surgery for 'true' G6 occur because a fragment of prostate tissue is left behind, and it has started to grow. The important two concepts are "true G6" (which is confirmed in your case) and "grow, not metastasize".

A PSMA scan is probably in your future to evaluate what is going on down there. After that, a few shots of photons in the area will likely take care of business if warranted. Your PSA is still quite low, and the key question is doubling time. Is it more than 12 months? That's pretty long.
Posted 12/3/2023 2:28 PM (GMT 0)
Thanks Halbert.
As far as doubling time, would mine be that it doubled since my surgery 8 years ago, or the ”almost double” 0.03 to 0.05 in this past year?
Tom
Posted 12/3/2023 4:06 PM (GMT 0)
Tom, your current doubling time is the 'latest', and it's more than 12 months. That is still pretty low risk.
Posted 12/3/2023 4:36 PM (GMT 0)

halbert said...
Tom, your current doubling time is the 'latest', and it's more than 12 months. That is still pretty low risk.


Correct, but please note (Tom) that doubling times based on two data points are fraught with a great deal of uncertainty.
Posted 12/3/2023 4:58 PM (GMT 0)
I don’t know anyone that thinks 0.05 is worrisome other than me and my urologist! Thanks again to all! I appreciate the thoughts and wisdom.
Posted 12/3/2023 5:23 PM (GMT 0)

Sr Sailor said...
Correct, but please note (Tom) that doubling times based on two data points are fraught with a great deal of uncertainty.

Doubling times based on really small numbers is a waste of math skills as well since ±0.01 makes a huge difference.

PSA does not just come from cancer so having a small value is not indicative of much by itself. Cancer PSA will grow faster than normal PSA so it gets detected as a trend over a longer period of time.
Posted 12/3/2023 5:46 PM (GMT 0)
That is great to hear. Thank you!
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