Slowly Rising Post-Prostatectomy PSA (.O4 to .31 over 13 years) Went Down Again

I made the posting that follows a couple of weeks ago. I just got my latest PSA test result--.29, down from .31 six months ago. My urologist says changes like this, in this range, after a prostatectomy are "more consistent with microscopic benign prostate tissue" and suggests that annual PSA checks should be sufficient to confirm this. Any comments?

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I had a radical prostatectomy in 2001. My pre-surgery PSA was 11, my Gleason score was 7-8, and there was cancer in the seminal vesicles, but none in the margins or lymph nodes. I've had no post-op treatment of any kind. My post-op PSA went to less than .04, but has gradually crept up over the 13 years since my surgery and is now .31. The increase has been roughly linear. I was at .15 in 2008, and experienced a .03 decrease in 2011. I am not one to pursue aggressive measures to stomp out a condition that may or may not be indicative of a recurrence. And in fact, in a discussion with my urologist two years ago, I was told that based on the very slow progression of my PSA, I may just be harboring some residual condition that's not going anywhere, and that he could see no reason for further treatment unless I were to experience a sudden and significant PSA spike. I am 71 years old, in excellent physical condition, and have no other health issues. What would you recommend?

Such a long doubling time sounds like you have little to worry about but I'm no doc!
Bob

Owing to your age, observation is a reasonable option. However, there are also risks attached to that option.

I think it is highly unlikely that benign prostatic tissue left behind is causing your PSA to rise so continuously. The theory of benign tissue causing PSA increases has been called into question:

Does Benign Prostatic Tissue Contribute to Measurable PSA Levels After Radical Prostatectomy?

If benign tissue were emitting PSA, there would be no reason for PSA from it to increase over time. Your PSADT is no longer slow. A PSADT of less than 3 years is associated with clinical progression. Yours is 2.2 years - not fast, but certainly not at a "safe" level, and it is accelerating. Your Gleason 8 with stage pT3b are additional adverse features that are prognostic for spread of the cancer. Based on this, and your good health, salvage radiation is a reasonable option. Salvage radiation at the lowest possible PSA has the best outcomes.

You can use the following nomogram to compute your progression-free probability if you have salvage radiation:

nomograms.mskcc.org/Prostate/SalvageRadiationTherapy.aspx

- Allen

You missed the 2011 PSA:
.12 in 2011
.31 in 2014
= 26 month PSADT

I'm not assuming anything - just reading what he wrote: "I was at .15 in 2008, and experienced a .03 decrease in 2011."
.15-.03=.12