Psa bump 14 years after prostatectomy

Good morning - Your data as presented does not indicate anything, good or bad, and you have 14 years under your belt. It is premature to worry much and your next couple of scheduled PSA tests should help tell a story. The small number results may continue to bounce around and show a general increase over time which might be consistent with prostate tissue or very low grade PCa which you just monitor.

Dalota said...
Should I just switch to the standard test which will show undetectable until or if it ever reaches .01. This will help stop needless worry and given my history I probably shouldn’t take action until it hits .02 anyway, the standard definition of Bcr.

I would say it depends on two factors. First, your comfort level. You might have more peace of mind with the standard test. Or you could have it with the 3-decimal Labcorp test, where most of the "normal" fluctuation will likely be in the third decimal place rather than the second if your PSA is actually stable. Having 3 decimal places also makes it somewhat easier to track the rate of rise, if there is one.

The other factor is a discussion with your doc the PSA level at which you'd want to start investigating and a number where you may want to take action or start planning for action. If this is, say, 0.15, you'd still want to monitor with an ultrasensitive test (but better a 3-decimal one). if your first action would be PSMA imaging, then you need to wait for a higher PSA. In my case, since I was a G9 (4+5), I may want (or be counseled) to zap the prostate fossa preemptively before my PSA reaches 0.2. On the other hand, you may want to first know where any recurrence is located.

There is an advantage to staying with your current test: if your next PSA reading is 0.07 (as opposed to 0.06 or 0.05), I think you'd want to know, rather than getting back a result of <0.1 on a standard test, which would mean you'll have lost information and be in the dark as to any trend.

I may be in the minority, but I like knowing (as accurately as possible) what my PSA is. If mine is slowly rising (at it appears to be), I'd rather know it than take the ostrich approach.But to each his own

In general, any unexpected rise in PSA warrants a re-test to rule out lab error.

If you are pleased with your current uro, it means you trust them. I personally have great trust in my uro/surgeon and give his opinion much weight. You should ask for advice and make an informed decision.

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For what it's worth, the uros in my doc's practice also use an in-office (Labcorp) test has an undetectable of <0.05 for almost all their patients who have had a RP. So 0.05 is the threshold PSA value at which they first appear "on radar" as it were and merit closer watching. Since that is where you are, I personally wouldn't switch to the standard (<0.1) test, which is really intended for men who still have their prostates (or the very first post-surgery PSA test).

BTW, I think you meant to type 0.1 and 0.2 in your last post (rather than 0.01 and 0.02).

Djin

Dalota said...
Thanks for the reply DJin. I will probably just stick with the same test and retest this week. Not sure however why you would say that it appears to be slowly rising. My psa was .04 in 2015, .05 in 2016, less than .05 in 17 through 21. .03 in 2022 .06 two weeks ago. Don’t these just look like fluctuations?

Sorry if I was unclear. I changed "If it's slowly rising" to "If mine is slowly rising" to make it clear I was talking about my own PSA in that sentence

Your values could certainly be fluctuations around a stable PSA. However, if your next value comes back 0.07, you might be suspect of a slow rise. It often takes quite a few data points to establish a trend. As I mentioned, there is uncertainly about the right-most digit of any lab test. When you repeat a test many times with the same blood sample, the results usually vary a bit due entirely to the nature of the assay method itself. You have to couple that with the fluctuations in one's PSA over time that occur even when the PSA is not trending upward.

BTW, unless your doc wants it sooner, you can wait longer to retest -- even 1-3 months. One advantage being that if you PSA is indeed rising, it could conceivably come back higher than the last result.

Post Edited (DjinTonic) : 3/11/2024 7:30:15 AM (GMT-8)

Thanks Mumbo for the thoughtful reply. Yes I have been doing annual testing and I frequently delay my physical which includes the psa test by a month or two because of fear of the psa test. I’ve been doing that since I went to annual testing more than 10 years ago. My good friend who’s the chief of urology at nyu said it’s nothing to worry about and to retest in 6 months. He’s convinced it’s noise given that it’s 14 years out and I’ve had psa readings as high as .05 in the past - 6 years ago in fact. My path report was also 3/4 and all contained within the prostate with clear margins. Dr Tewari performed the robotic surgery.

Thanks Mattam. Yes. The labs have been different over time. I had two tests that were .04 and .05 back in 2015 and 2016. Then it switched to a lab that went to less than .05. Last year, my test was .03 and this year I went to Quest diagnostics and it was .06. So who knows other than this is the highest number I’ve had in 14 years so hence the anxiety. Btw, I will be 66 in June. Diagnosed with pc at age 51.

Post Edited (Dalota) : 3/11/2024 9:56:24 AM (GMT-8)

Thanks again. No, if I make up my mind to test again in 6 months or 12 months, I will not be anxious until a few weeks before. I recognize I’m lucky compared to many on this forum but I’m still petrified that my PCa could coming roaring back one day. These thoughts only happen near the time of my psa test. And when I get a less than sign, my worries essentially go away for another year. Last year I wasn’t worried with the .03 because I’ve had higher readings than that 6 and 7 years ago.

In threads like this I post mine.

You get used to it lol

Good luck 😊

Dalota, if you have anxiety, I suggest you test more often, like quarterly for a year. Frequent repetition often reduces anxiety as the item becomes routine. Hopefully you will see the PSA is stable and much less to worry about, thus lessening the anxiety. Also if you are concerned about it roaring back, then more frequent testing would certainly catch it much earlier.

Well, you have a lot of comments and theories, even one by a doctor!

Now it is up to you to weigh your personal feelings against the options and select a course of action. No right answer, just a right answer for you. Simple, right?

My pathological report assigned me a localized primary Gleason 5. First psa was 0.08. My surgeon said, typically, "nothing should be done unless it reaches 0.2". I did not believe him and I was more or less in panic. But next psa tests gave smaller values. Along the years, I have learnt it just fluctuates below 0.1. This is my particular experience with my particular laboratory. Now, I am still half way of your 12 years after surgery. In summary, I would be calm if I am in your situation 6 years from now.

I don’t think you’re jumping the gun. You officially hit the definition of bcr 9 years after your surgery on 12/20 at .2.

kwoo64 said...
I'm in a similar situation although mine started moving after 7 years surgery, doubling time was around 15 months. Mine has flucuated a few times but the last few check its been climbing. At first with the flucuating I thought benign tissue, and it could be, but I'm now at 0.504 and I'm waiting for a call to schedule PSMA scan. Am I jumping the gun here? Being a pT3a is also a concern.

"Being a pT3a is also a concern." Yes. Was there advice to plan SRT when your PSA began to rise above 0.2 given your were upgrade to G(4+3) and extraprostatic extension was found at your surgery?