3 yrs of Bliss Comes to an End - Advise Needed

Three years of bliss comes to an end - I've been no higher than 0.05 psa since my RP in March 2011. So life has been pretty good. Unfortunately, things appear to have have changed.

My six month test just wighted in at 1.1 - six months ago I was 0.04. Almost triple in six months. Bad deal. My UR offered me a bone scan now (though he said he didn't expect it would show anything) or wait three months and re-test psa, then proceed to scan if still elevated.

I of course wanted a re-test to ensure the validity of the 1.1 value. If it's real it's highly unlikely to go down on its own. My UR then said I should wait 30 days and then re-test. Waiting seem pointless, the re-test is only (in my mind) to ensure the Lab didn't screw up which is at least possible. So why proceed to a scan prior to re-test anyway?

I think I should have insisted on a re-test straight away - Isn't that the obvious call? My psa doubling time is terrible. A delay doesn't seem like an advantage. Right? But what's 30 days? My UR pushes my off to a Med Onc at psa 0.2 (or evidence of mets) so my days with him are drawing nigh either way. T3 sucks.

Any thoughts/advice

These are the good old days

pT3a, one positive apex margin focally,-SVI,+EPE,+PNI,+LVI, N0, M0
open RP 3/17/2011, 50 yrs old
ART 6/2011
PSA had been bumpy but no higher than 0.05 since RP - until today when my six month test came back at 1.1

I would retest immediately. what was your gleason score? good luck. hope it was a fluke.

ed

K2,
If your psa was .04 and it tripled it should be around .12. Regardless, there is no reason to not get a retest shortly after a course of antibiotics. Then, if the psa is the same or higher a bone scan and high resolution MRI might be in order. I' m certainly no doctor but at your age that's what I would do.
I noted that you had srt so I don't know if more radiation is an option if a lymph node is enlarged. With primary radiation therapy I realize that 81gys is about max and srt like you had is normally given at 70gys. Perhaps 1 of our experts will chime in and let us know if additional radiation can be given.
Bill

I had been undetectable for 18 months straight after surgery then this past January, I went to 0.1. I had a retest 2 weeks later and it didn't change. Then I had another retest 6 weeks later and it went back to undetectable.

I would say wait for 4 weeks like your uro said. You don't show what your original PSA was before treatment. Mine was 18.5, I have 2 positive margins and my staging is like you, pT3a.

So all things considered, our stats are similar.

I hope you have my luck and drop back to undetectable.

Bill from Florida

Thanks for the comments...and you are correct Rob2, my Psa was 0.11 - I also included my G-score below. Big Mac's experience is interesting, what can temporarily spike psa in the absence of a prostate? At what psa level do they normally start hunting for mets?

HT is sometimes given intermittently to mitigates some of the side effect like libido decline, osteoporosis, heart, ect. Are there long term PCa survival advantages to intermittent HT? Still an open debate?

K2

pT3a - G7 (3+4)
1 positive apex margin focally,-SVI,+EPE,+PNI,+LVI, N0, M0
open RP 3/17/2011 at 50 yrs old
ART 6/2011
PSA had been bumpy but no higher than 0.05 since RP - until today when my six month test came back at 0.11

I would want an immediate re-test. I once had a test that went from 0.04 to 0.4 in three months. That seemed crazy. My uro did an immediate retest. It came back as 0.1 -- still a doubling, but not three doublings. I then stayed at 0.1 for three more years before having a further uptick that finally resulted in SRT. Good luck.

Jim