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Rising PSA post surgery and radiation .

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Posted 1/4/2020 12:14 PM (GMT 0)
Had rising PSA after post radiation and prostatectomy. Radiation Onc says wait and see. I'm scared. Not sure weather to see another Cancer specialist or stay. Any suggestions ? Thank you.

Age 52 Diagnosed 8/18 PSA 11 Prostatectomy 11/18 Gleason score 7 (3/4) Positive margins but prostate not ruptured.. Post surgery PSA .08 3 months later. Two MRIs revealed no change in lymph nodes. Bone scans negative. PSA rise to .11 8/18 prior to radiation. Radiation started 9/18. 37 sessions. Completed 12/18 . First post PSA test 2/19 was .08. Second PSA test was .05 on 7/19. Radiation oncologist said great results,' You're almost cured. " Recent test on 12/19 revealed rise of PSA to .09. Oncologist says take wait and see PSA results in 6 months. I was told it was such a small amount we have time. I don't want hormone therapy but will accept if I have to.
Posted 1/4/2020 1:32 PM (GMT 0)
Listen to your doctors. All you can do is wait for a clear trend. If your PSA does turn out to be increasing, treatment initiation would depend on several factors - with PSA doubling time probably the most important. I would stick with guidance from my MO going forward. At this point you are a long ways from needing ADT.

Good luck!
Posted 1/4/2020 1:32 PM (GMT 0)
Bagman,

Welcome to our club. Well, that's discouraging...but it could be a bounce. Your RO is being conservative, and it IS a small change. You could ask for another PSA in 3 months to see if it's a bounce or a real trend.
Posted 1/4/2020 1:33 PM (GMT 0)
PS, welcome to the forum!
Posted 1/4/2020 4:20 PM (GMT 0)
Bagman - Hang in there, not much you can do now other than observe your PSA for a while after surgery & radiation. It could just bounce around for a while at these low levels. It will have to rise quite a bit before any high powered scans can be utilized that might show where the PCa is lurking so you have a fair bit of time before making any decisions regarding next treatments.
Posted 1/4/2020 4:31 PM (GMT 0)
Bagman, agree with the others, you are likely a very long way off from needing additional treatement, if you ever do. As mattam said, doubling time is something you will want to keep an eye on. Here's a link to the Memorial Sloan Kettering Doubling Time Calculator, if you want to track it yourself (you should, be in charge of your own care, with strong guidance from your Doctors.

https://www.mskcc.org/nomograms/prostate/psa_doubling_time

If it really takes off, with say a doubling time, less than 6 months (you will need at least 3 PSA tests to know), then you will probably act sooner rather than later. I am guessing that won't happen though with a G (3+4).
Posted 1/4/2020 4:55 PM (GMT 0)
Welcome to HW - sorry you need to be here.

Sounds like you've got a good doctor there. It can take a couple of years for RT to be fully effective so the wait see approach is the right one. It's annoying and can be stressful - so much is riding on that.

Even if the current treatments have failed, you don't need to start ADT until your PSA is much higher. Also post RT you really need to be looking at the trend over 3 or 4 tests. Things can bounce around a bit before settling into a stable pattern.

Hang in there, and ask all the questions you have, we're here most days.
Andrew
Posted 1/4/2020 5:08 PM (GMT 0)
Yep, just wait for the well established trend, if it ever shows up. More than a few RT guys see some initial increase in PSA, followed by a steady decline for a year or so, the see one or more bumps along the way, during a steady decrease in trend( lower highs, lower lows, but the highs sometimes exceed the previous lows). Also keep in mind that dying PC cells(or at least some think so) can dump a load of PSA into the blood stream. Though I don't know if this would be as noticeable if the bulk of the tumor has already been removed by surgery, but theoretically it could still influence the PSA results, at least for a while. Also keep in mind that your G3+4=7 does not put you in the high risk category, so you have that on your side. You will just have to see how that future trend does.
Posted 1/4/2020 5:10 PM (GMT 0)
Your doctor is giving you good advice, you have minor PSA bouncing, and an excellent prognosis. Staying away from nasty ADT is recommended. Do hang in there, and try hard not to worry, which causes inflammation, resulting in higher PSA.

Take note of my bouncing uPSA. Good luck!
Posted 1/6/2020 3:19 AM (GMT 0)
Bagman,

Hang in there... I am 13 years past dx and have had both RRP and SRT... Post SRT started very low and I thought I was done. Since then it has been slowly raising only to stabilize/bounce in the 0.20 to 0.30 range. I am used to it and actually don't worry about it much. A long way from a 2.0 trigger level at which point hormones would be considered. Technology is also rapidly advancing, so even that could change. I figure I will just plain outlive PCa now and don't let it affect my lifestyle or outlook.

pasayten
Posted 1/6/2020 4:03 PM (GMT 0)

pasayten said...
..... I figure I will just plain outlive PCa now and don't let it affect my lifestyle or outlook.
pasayten

A superb way of living with PCa pasayten, and my wish and prayer for so many folks who obsess about controlling a disease that defies logic.

BTW, outliving PCa, and dying of something else, is what most urologists and radiologists call either success, or a 'cure'. ;-)
Posted 1/6/2020 5:40 PM (GMT 0)
Thank you all for the support and advice. It's been rough since diagnosis. Ups and downs are frustrating. My Dr. is old school and not very talkative. Got more support from you folks. Thanks again .....
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