PSA Rising - Help Please

Hi Guys,

Sadly had blood drawn today, results 0.04. Have been <0.03 since surgery 2.5 years ago.
Obviously will need to have it done again, in the near future to see if trend is starting. What is the usually waiting time for a retest, and should I be worried at this stage, or do these bumps in PSA often happen ?
Is it common for the psa to go up and down at this ultra-sensitive levels ?
Any advice appreciated.

Cheers Kev.

Post Edited (NotHard) : 6/6/2011 8:26:47 PM (GMT-6)

I agree with Piano - you are still in the Zero Club ( PSA <0.10) - enjoy.

The rise (if its truly a rise and not a test blip) from .03 to .04 in that length of time is probably nothing to be concerned about. If it continues to rise in a pattern, then that might be something else. At this point, you are strongly in the "zero" club, and I would be enjoying a number that low. Good luck in the future.

david in sc

Thanks David, I appreciate your opinion, and I am hoping you are right, with the blip theory. Cheers Kev

142- Thanks for the reply, certainly helps with the re assurance.

Hi Kev,

Can feel your anxiety,  so this is just what we would do in this situation  (same surgeon as you know)... In year 2 (2008)  I asked Stricker this question at a consult,  as there is a wonderful person here called "Swim" (a vet) who I had spoken to by email from first PSA when it went from 0.01 to 0.02 (and then for the last years like you went to 0.03). It was at the time CJ's went to 0.03 from a previous 0.02.

Swim had suggested that according to each individual some fluctuation from 0.02 to 0.04 may be a result of that gland which I can't pronounce, as well as lab variations - and that it is hard to tell but 0.02-0.04 could be a result of this (I hope I am para[phrasing her correctly but that was my understanding at the time). We saw Stricker after the 0.03 came back, and he  labelled us "worry warts" (which I allowed him to just that once!) but he did take it seriously. He gave us his protocol (at the time that is - you'd have to check what it is now),  and agreed to have the discussion again in person in the future,  if we were to reach 0.04.

So what would we do if we were in your shoes now? Well... Maybe first, we would get the PSA repeated, just so you are sure it wasn't a callibration issue - Then we would probably email his main nurse who you would know (which will get passed onto Stricker before she replies to any questions). Then we would probably wait for her reply, and re-test again in 3-6 months. That's stressful, and he would probably say wait 6 months,  but since it could be a normal  fluctuation, or could be a rise - that way you could perhaps monitor it). That way he will know you are onto it, and that you have concerns - even if he doesn't in your case.

That way also, if you come down to the big chill (Sydney) in the next 3-6 months, you should be able to get into see him on a Thursday when he sees post ops. Remember his commitment to follow-up - this is the time you need either reassurance or a plan from him - We would insist on it, but that's just us (and I believe if doctors say they will follow-up for life, they then have to follow through - even if it is all OK in the end).

Just a few ideas Kev. I am no expert as you well know. Let us know how you go,  and try to take a deep breath. There are several guys here with 0.04 and 0.05 readings from time-to-time. Anyway, I am sure this does not make it any easier, but good luck and let us know what you decided. Lana & CJ

Hi Lana,

I was hoping you would chyme in, because I remember CJ, having similar probs and the fact we are seeing the same surgeon, is somewhat comforting. Yes I have already emailed Jane, and waiting for her response. I was also labeled a worry wart, by Phillip, so he must see this sort of thing all the time. I have no doubt he will tell me not to worry, and wait and see what happens next test.
I am hoping "ralfinaz" is correct with his theory regarding time of the day that psa is taken, because this time was the first time I broke my schedule.!! I always have blood drawn, first thing in the morning before breaky, but this time went after lunch. [Never knew time of day mattered].
I am feeling more confident now, with all the reply's I am getting, and I am probably worrying about nothing, but worrying is something I can do real well.
Thanks for all of your idea's and information, and I will see what Phillip has to say, and keep you posted. I am hoping BillyMac, also chymes in, because I know his knowledge on PSA testing, is worth listening to.
Cheers Lana & CJ..........Rgds Kev

I don't think the time of day makes any difference in the PSA test. The vials probably sit for hours before the lab tech does anything. Same thing with fasting, having food or not, doesn't do anything with the PSA test.

My only concern would be your Gleason score. Mine was a 9, (5+4). My PSA stayed low for 3 years and then started doubling every six months. So I just finished RT. I get my PSA checked at the end of June.

Kev,
The hard copy of the PSA tests here in the US has the name of the assay used for the test. I looked up assays used in Australia and came up with names like:

ADVIA Centaur and Centaur XP

DPC's IMMULITE and IMMULITE 2000

Dxl-800

The difference in your last PSA result could be related to the use of a different PSA assay.

As far as fasting for a PSA test, there is no need. I usually get the PSA test at the same time as other tests that require fasting. I always try to get these tests done in the morning.

There is an association of PSA and testosterone levels based on circadian rhythms. These rhythms are off-phase with testosterone levels higher in the am and PSA at the lowest level. The reverse is true later in the day.

Some sources:

1: Mermall H, Sothern RB, Kanabrocki EL, Quadri SF, Bremner FW, Nemchausky BA,
Scheving LE. Temporal (circadian) and functional relationship between
prostate-specific antigen and testosterone in healthy men. Urology. 1995
Jul;46(1):45-53. PubMed PMID: 7541585.

RESULTS:
Mean PSA correlated positively (P < 0.001) and testosterone correlated negatively (P = 0.014) with age and inversely with each other (P < 0.001). The mean circadian range of change (ROC) from lowest to highest values for PSA was 0.37 +/- 0.07 ng/mL (28 +/- 9%), and for testosterone it was 202 +/- 23 ng/dL (53 +/- 7%). The mean ROC over 6 weeks was 0.32 +/- 0.04 ng/mL. A significant circadian rhythm was found for PSA (P = 0.011, amplitude = 5.4 +/- 1.8%, acrophase = 5:02 AM; 95% limits, 2:40 to 7:24 PM) and testosterone (P < 0.001, amplitude = 9.4 +/- 1.8%, acrophase = 8:38 AM; 95% limits, 7:12 to 10:04 AM).


2. Relationship between diurnal rhythm of serum testosterone and two prostatic markers (PSA and PAP) in untreated prostate cancer
Susumu Akimoto, M.D., Motoyuki Masai, M.D., Jun Shimazaki, M.D.
Received 6 July 1993; accepted 14 September 1993.

Results. Serum levels of PSA and PAP showed circadian rhythm in 4 and 5 patients, respectively. about half of the remaining patients, the highest or nearly highest peaks of serum levels of PSA or PAP were ob served in the afternoon rather than the morning. In 3 patients, circadian rhythms were not observed in serum levels of PAP, but the fluctuation patterns were the same as those of testosterone and showed synchronous movement. In 7 patients, serum testosterone levels were followed by the same fluctuation pattern for either PSA or PAP after some time delay. Little change in serum levels of PSA was seen throughout the thirty-two-hour period despite large fluctuations of testosterone and PAP levels in 5 patients.

RalphV

Tks Bill, Feeling much more confident now, was a bit of a shock when I first got it, and I guess panic sets in. Good idea, I will ring lab and check it out.

Cheers Mate

Tks Sheldon, yeah its a bit of a blow, when you are going along quite nicely, like I was and then suddenly hit a speed bump. Oh well I just have to wait and see, what the next one presents. Tks for you thoughts....Cheers Mate

kev,

We are in almost exactly the same situation. I had surgery 4/14/09. My PSA has been slowly creeping up form <.01 to .03. I was prepared to start RT as sort of a delayed adjuvant action. I didn't do RT earlier because of my incontinence.

I saw a post on here about a study by a doctor at Cleveland Clinic about RT. As it turned out, he was actually a developer of the MSK monograms. After looking over my chart and discussing things with me, he turned to a computer and plugged my numbers into his nomogram.

He said, I think your slight increase is benign prostate tissue left behind. Based on being 2 years from surgery and having a PSA <.06, you have a 60 % chance of a cure. Come back in 3 months and we'll take another look.

Obviously as a Gleasin 9, it may me feel a lot better. Of course I would have liked him to say 90%, but at least he had a scientifically based answer, and had a plan if action that sounded logical to me.

Good luck to you. Here's to hoping that doctor missed a few pieces.

Goodlife

Hi Kev,

I can imagine the anxiety you are feeling with the number going up to 0.04. We had the horrible feeling in the gut when Paul's numbers went from 0.02 to 0.03 soon after his surgery. Then we realized the blood tests were at completely different times of the day.

The time of day issue is an important one I think and there is natural variability in the psa in the blood through the day, even without a prostate. The same collection centre typically has the same pick up times for the blood and for some blood tests the time between collection and testing does make a small difference. The blood is picked up and processed within two hours of the morning collection time at Lab 2.

So Paul does his test at the same time (first thing in the morning) at the same lab, and as far as possible with the same collection centre on a weekday. Just so the variables that we can control are controlled.

Hope this helps,

An

NB: Paul's op was also with Dr Stricker and just looking at CJ's results, your results and my husband's it seems to me that Dr Stricker does a pretty careful nerve sparing op and maybe leaves a little tissue behind when he is confident that it is benign. All three ops seem to have a low but detectable level of PSA on the ultrasensitive.