PSA rise after 4.5 years post-op undetectable results

I got my most recent PSA results of .06, after being undetectable (<.01) for 4 and a half years post Da Vinci. My uro had me retest yesterday in case it was a bad test (11 days after the first test) and it came back at .05. It didn't drop much, but at least it didn't go any higher. It had been a full year since I had my last annual test in April 2015, so the mystery is, when did the it begin to go up during the past year? I'm scheduled to do another PSA test in early July which should give us some idea what the deal is. My surgeon/urologist, Benjamin Lee at Tulane Med Ctr. is leaving Tulane to take a new position as Head of the Urology Division at the University of Arizona. My new uro/oncologist will be Dr. Oliver Sartor.

Any feedback is appreciated.

NolaVette

There has been many discussions on this very subject over the years…mores in recent years. i not sure how to search archives so that you an stay abreast with the various arguments on this point. But i think if you do this it will help you in choosing where you will ultimately stand.

Nola,
Sorry to read of the increase. But it's still extremely low and considered undetectable below 0.10 ( unless that's changed?).
To be diligent, I think your scheduled retests make sense. But I wouldn't worry about it.

By the way, I posted a 0.06 recently too after being <0.05 since my surgery. I'm not allowing any anxiety over the change but will be watching future tests as well.

Good luck Nola. Hope the next one is back the other way.

Nola, hang on to the good news that you didn't see another increase, this may be another one of those things that we see quite often, where PSA pops a bit, then stabilizes, maybe a result of some healthy tissue left behind .
So easy to say put it out of your mind till July, not so easy to do, but try t focus on the fact that it was stable from a few weeks ago to now.

That's the trouble with ultra sensitive test. Under the regular testing both the 0.06 and the 0.05 plus all the prior tests would translate to " <0.1 undetectable" and no worries

Under the new 0.06 went to 0.05 so not a lot of movement but a significant % of a negligible number, but then again it went down. So does going down 16.7% mean all is well or is being =0.05 any worse than <0.1, Impossible to compare the two.

Easy to make a mathematical argument but not so easy when it is your future we are discussing.

So what does it mean it next one is 0.04. At least it would be going down but is it a trend?

And what does it mean if next one is 0.06. Did it go up from the prior 0.05 or is it just level from the two times prior also 0.06.

As long as July test is not 0.07 or higher a good thing. Even here I can guarantee we would all discount the 0.01 decrease from 0.06 to 0.05 as "insignificant" but worry like hell if the 0.01 were in the opposite direction to 0.07 even though they are both only a 0.01 change in direction.

I recall Halbert talking to us about sampling error at last week's GFMPH.

Maybe Tulane just changed their method of reporting and the prior series of <0.1's were all in the 0.05 and 0.06 range so no material change at all, just a new lower limit on how they report.

Probably best to have a discussion with huge knuckles Oliver Sartor as Kbota calls him to set a threshold and what to do if that threshold is ever met.

The only basis you have right now is that as long as it remains <0.1 you do not know if it has changed materially at all.

enough of a worry though that more frequent testing is warranted but hard to interpret the results, or even to predict in advance what any score <=0.06 even means.

Probably need to agree in advance with Dr. Sartor, and with you and Sue how often to test given the next reading in July, but nothing can be done about it until then.

When I was trying to qualify for Provenge with two consecutive PSA increases I had the same issue in reverse. Chicago Prostate Center on July 10 2014 came in at <0.04. My next test two weeks later in FL was =0.03 but in effect a wasted test other than to set a discrete baseline since no one can say for sure whether it was the increase I was looking for, or the same.

As appealing as it is to hear undetectable, you almost have to ignore the series of <0.1's and just start with a new baseline of 0.06 and a recent decrease to 0.05 and measure all future tests to 2 decimals of precision.

For the moment all you know is most recently your PSA is decreasing which is a good thing.

Congratulations on getting Sartor as your doctor - one of the best!

Unfortunately, with your stage T3a, and a confirmed uPSA≥0.03, you probably will want to stop further progression with early salvage radiation. We have 3 major trials now that have shown an advantage to early treatment over waiting. As much as we hope it will go away, we have to deal with what's there. It's not going to go away and it's important to cut it off before it metastasizes. Especially important at your relatively young age. Since you are doing well in terms of SEs after your surgery, there's every hope that you will do well with the salvage radiation. It also bodes well that you caught it so early after its long dormancy. I'm sure Sartor will show you how good your odds are of curing it with SRT on a nomogram.

Here's an article about early salvage, if you're interested:

When should the patient and doctor consider salvage radiation therapy?

- Allen

Thanks for the feedback guys....I guess all I can do is wait till July to take the next PSA test and see what Dr. Sartor has to say.

Oh man, I'm sorry to read about the PSA increase. Not what you wanted to hear, I'm sure.

I've got no advice for you except to hang in there and try not to let this make you crazy. Maybe the next test will bring better news.

Best,

Jonathan

4.5 years later with that slight of an increase means to me that there is a miniscule amount of cancer in the prostate bed. I know you have an aversion to radiation but you are the odd man out here. most of us want to be cured. also, i'm not one to blow smoke up someone's tailpipe -- I really believe what I said .

ed

I said IF. IF it is BCR. IF.

ed

i had a similar situation and suggest you do psa tests at the same lab but do it every 2 months so that you get more data points. If you are a proactive sort, schedule a meeting with a radiation oncologist to discuss and get his perspective on when he thinks you should start radiation, if psa progresses. Meaning at what psa level would he start, and what type of treatment . By doing your homework now, you can save a lot of time when and if you have to pull the trigger

Well folks, today was the day. I had my urologist visit this morning with Dr. Sartor at Tulane and my PSA has ticked up to .1 from the previous .05 three months ago. They've decided that it would be best to go with the IMRT radiation and a single Lupron injection which they say will be for a single six month period. They're using the newest guidelines for this sort of PSA increase by pulling the trigger at .1 instead of the customary .3. Tall Allen....thanks much for the link to the very informative article you gave me back in April.

https://prostatecancerinfolink.net/2015/01/04/when-should-the-patient-and-doctor-consider-salvage-radiation-therapy/

I now have a huge amount of info to absorb concerning radiation treatment and hormone therapy. These were terms that I would usually skim past because I assumed I'd be in the "Zero Club" forever since I had gone a solid 4 years with a PSA of <0.01. I guess I'll need to get busy updating my signature with the new info.

Good luck