Sudden PSA spike

Jissmax, welcome to the forum.
First, I’d suggest you go to your profile page and create a signature, with your pSa history and surgical pathology, so that as this thread grows, and you post elsewhere, others who want to respond will know what your history is. Without searching your posts.

To your question... I, like you, am G7(3+4), but pt2B. I finished salvage Radiation in November and ADT is winding down, I am 3 weeks away from my 6 month course of Lupron. I started at .08 PSA

Yes. .2 Is the standard for BCR. However that is the old standard, and the trend is more important. many urologist/radiation oncologists are recommending earlier treatment, as soon as one sees a clear trend above .03 as the standard for BCR. At .22 you might want to ask about an Auxumin Scan, or see about getting a PSMA PET scan which would be under a clinical trial. There is a chance it might find where the cancer is. I think the chance is about 40-50%. Someone will correct me if I am mistaken about that.
Stick around you’ll get lots of others responding soon/

Jlssmnx, welcome to you!

Some info about biochemical recurrence (BCR):

* Big picture regarding primary PC treatment methods, 20–40% of patients undergoing radical prostatectomy (RP) and 30–50% of patients undergoing radiation therapy (RT) will experience biochemical recurrence within 10 years

* The American Urological Association (AUA) has responsibility for defining BCR after RP; similarly, ASTRO has responsibility for defining BCR after RT. (ASTRO=American Society for Radiation Oncology)

* Some years ago, an AUA panel evaluated 53 different definitions of post-RP BCR observed int he literature and recommended adoption of this single definition:
.....** The presence of a PSA greater than 0.2 ng/mL measured at least 6-13 weeks after RP, followed by a confirmatory test showing a persistent PSA greater than 0.2 ng/mL


Please note that your original post was off by 10X (you wrote 0.02, but the AUA threshold above is 0.2), and also did not include the confirmatory and persistent test result greater than 0.2 ng/mL. I'll emphasize the word "persistent" because PSA tests are notoriously imprecise. Their is an important rule of thumb to NOT take action based on just one unexpected PSA test result. When there is an unexpected result, retest.

Ultra-sensitive PSA assays have recently improved detection levels down to 0.01 ng/mL or smaller, and may possibly lead to better treatment outcomes through earlier adoption of salvage radiation therapy following RP.

However, false positives occurring because of trace amounts of PSA produced by residual benign prostatic tissue, along with uncertainty about whether ultra-low levels of PSA will be followed by continued PSA increases, have led practitioners to continue to rely on the AUA definition for determining when clinically-relevant biochemical recurrence has occurred after RP. Your up-and-down test results are another mixed-message...PSA from cancer-only goes only one direction.

One other helpful, albeit minor, clarification...you wrote "PT3A diagnosis" but the "p" prefix indicates that this was your post-RP pathology, not your clinical classification at the time of diagnosis based on biopsy plus other possible imaging steps.

Your post-surgery pT3a pathology implies "local progression"...PC into the fatty tissue around the prostate, but not to the seminal vesicles or elsewhere, which would make outlooks worse. In the big picture, even with your current local progression, overall PC survival is still very high (98% at 10 years), but a substantial number of men with pT3a do experience BCR and need 2nd-line therapies...which means that you do, indeed, need to monitor PSA carefully and regularly.

My most important comment: if your most recent PSA result was "unexpected" based on the previous results (you used the word "sudden" in the title)...retest.

Post Edited (Blackjack) : 2/1/2019 10:32:21 AM (GMT-7)

Paxton said...
If 30-50% truly did suffer BCR, why would anyone recommend RT? Are your figures for high(er) risk groups?

Big picture, the overall cancer control outcomes for RT and RP are about the same (as the data shows).

Obviously, obviously, no two cases are the same and there are in fact a wide range of PC cases, so one-size-does-not-fit-all. Surgery is not the best for every case, and RT is similarly not the best for all cases...it simply "depends."

Of course, both methods are equally effective in terms of cancer control on one particular set of cases...the favorable-risk cases that never needed an aggressive treatment anyhow...