PSA Truth Needed

What was your Gleason score? Staging? How long since you completed treatment? Those things would be helpful to give a reasonable response.

Rising PSA is worrisome, and not what you want. Likely you should retest in a month or so to confirm the rise. Scans at your PSA level aren't likely to show anything useful.

The real question is why is it rising. Bunch of reasons. In general recurrence post RT is considered nidar+2 so you're still well below the clinical point of concern. At this point, I am not sure what you'd do. I likely just keep monitoring.

However, a consult with an RO, or URO might good to get a second opinion.

Andrew

My Gleason scores were 6, 7, 9 and 9 as I mentioned in my earlier posting. My doctor is my Radiation Oncologist, he does specialize in prostate cancer along with other cancers. I mentioned also that my cancer was found three years ago. I completed radiation in December of 2014. I finished Lupron in May of 2015. My staging as I understand it is T2b. Dr. Alan Partin told me I had a 100% chance of having microscopic cells outside the prostate. The scan did not show anything outside when I was first diagnosed. I continue to read many postings that say 0.2 is BCR and should be treated. I am thinking it is sign my cancer is returning.

RestOfMine....I'm posting some more info here for others to see from your previous post 8/21/14.

Dx Jun '14
PSA 4.4 pre-tx
DRE positive, hard spot
DOB October 1942
Bone Scan June 2014 - no outside cancer found


I'm a 3rd stringer here. So any advice I give would is inexperienced. My FWIW's.....

If it were me...i'd get in touch with JH to find out, if you don't know already, if they radiated my lymph nodes or not. (my guess is that they almost certainly did, but I'd want to be 100 percent sure on that.

I'd also get in touch with a medical oncologist that specializes in prostate cancer. Even if you're not recurring....as your current doctor suggests, I'd let the next opinion I get come from a medical oncologist whose specialty is PCa. And I would get one, if it were me. I'd let him make the call as to what, if any, scans he wanted. He's the doctor.

You will receive some great information here....and I believe you're doing what I would be doing in your shoes...which is coming here to get a "bigger" picture from those "whose been there". But I wouldn't let whatever I read here deter me from getting my "actionable" next step and/or opinion from an MO.

Your RO may even have a recommendation for you. Don't be afraid of insulting him.

You may or may not need more treatment at this time...but the doctors are who I would rely on to make that call....

but that's me...

Acceptable levels of PSA are different for surgery and radiation. After surgery the levels should be very low known as undetectable, <0.10. Why? Because all of the prostate gland was removed and can no longer emit any PSA.

After radiation, there is normally a little more PSA since the prostate gland is still there and continues to emit a small amount of PSA. So, generally a stable level under 2.0 can be acceptable. If the level continues to increase past that point, then it would be a signal that PCa is growing somewhere and would need treatment.

So, for now relax and as TA says, get off the ultra sensitive test. And don't compare yourself to the ones that had surgery. The trigger points are different.

Once again, I think you are confusing risk factors associated with surgery from those associated with radiation. I don't know of any special risk for radiation of an apex tumor. For surgery, apex tumors can be troublesome because the capsule is indistinct there and the surgeon may have to cut wide and deep to get it all, sometimes impairing urinary function in the process.

Hey restofmine - I can relate to your thoughts about PSA. This was on my mind pretty much the whole last year as I watched my testosterone recover quickly post ADT, and my PSA slowly climb too.

One word for you - relax. Easy to say, tough to do.

The guys have already pointed out the low numbers post-surgery are a different category than what you get post RT. The smart docs figured out that a climb after RT is normal, and not to call recurrence unless it exceeds nadir+2. That's for a good reason, due in part to your remaining prostate tissue generating some low level of PSA.

My PSA climbed initially at a worrisome rate, but every quarter it was rising at a slowing rate. The curve was leveling off, not steepening as would be expected with recurrence. Finally, in July, it actually repeated the May value of 0.8. That's a little higher than I hoped for, but level is level. I'm fully expecting the October value to be unchanged, and it could stay there for a very long time.

ADT suppresses testosterone, and your recovery of T can be very slow indeed. Have you had your testosterone checked? I did each quarter when I had the PSA done. Your PSA rise to its "normal" post-RT level can lag the T recovery by quite a few months. Watch the trend. I can drag you through some deep mathematical weeds about it, but suffice to say just watch the trend, see if it's steepening upward, or leveling off.

You can find lots of studies about post-treatment PSA, but for those of us that had ADT along with primary RT? It's a big question mark. Few have even looked at it in any detail, and most studies just shrug their figurative shoulders about what is to be expected. The unpredictable T recovery, and your PSA related to it, are largely unexplored medical territory.

Again, relax. It's a marathon run at a snail's pace, as someone here has said. Stay with your docs, continue follow up, watch the trend. Meanwhile, go live life! ;-)