Any documented cases of post RP uPSA rising and then plateauing indefinitely at a low level?

Often the subjective consensus is that these rising low uPSA values are no risk or low risk but this view is just state and never backed by any hard data or research.

I have had several friends with low risk clean margin post RP pathology like mine with low rising uPSA values that have been forced to undergo SRT after a few years.

I would like to learn of any other outcome experience.

60 years old
Decipher score 0.22 low risk
11/15 RP UCSF Dr Carroll
3+4 Gleason7 30% 4
10% tumor 1.2 cc

12/27/19 12/20/19 12/13/19
0.011 0.010 0.012
7/19 4/19 11/18 9/18
<0.006 0.008 0.009 0.007
7/18 4/18 2/18 1/18 11/17
0.007 <0.006 <0.006 0.008 <0.006

nice decipher score btw.

my decipher score is 0.22 which should reduce metastatic risk correct?

thx for the answer, I am just surprised that I cannot find any examples anywhere of guys plateauing at low uPSA levels like 0.03?

I understand that there is a selection bias as those guys are likely not to be active on these forums.

But it seems that someone here might have a friend that is an example of plateauing

my friends with low uPSA in person and online have all continued to rise

decent pathologies typically 3+4 and negative margins also but ended up at SRT when their uPSAs crept near 0.05

My medical history is

I am 60 years old

My uPSA was first detectable at 17 months (with b7 vitamin supplements being used)

These b7 vitamin supplements were subsequently eliminated with uPSA being detected again at 26 months post-op RP

Radical Prostatectomy 11/19/2015 with Gleason 3+4 at age 56

uPSA test result history

12/27/19 12/20/19 12/13/19 12/6/19 12/4/19 7/15/19
0.011 0.010 0.012 0.011 0.011 <0.006

4/3/19 11/29/18 11/16/18 9/21/18 7/16/18 4/30/18
0.008 0.007 0.009 0.007 0.007 <0.006

2/24/18 1/8/18 11/14/17 10/11/17 9/16/17 9/15/17
<0.006 0.008 <0.006 <0.006 0.009 0.010

6/5/17 3/3/17 12/1/16 8/29/16 5/4/16 1/14/15
<0.006 <0.015 <0.015 <0.015 <0.015 <0.02

12/27/19 12/20/19 12/13/19 12/6/19 12/4/19 7/15/19
0.011 0.010 0.012 0.011 0.011 <0.006

4/3/19 11/29/18 11/16/18 9/21/18 7/16/18 4/30/18
0.008 0.007 0.009 0.007 0.007 <0.006

2/24/18 1/8/18 11/14/17 10/11/17 9/16/17 9/15/17
<0.006 0.008 <0.006 <0.006 0.009 0.010

6/5/17 3/3/17 12/1/16 8/29/16 5/4/16 1/14/16
<0.006 <0.015 <0.015 <0.015 <0.015 <0.02


my medical history is as follows

Genomic Health Decipher test score 0.22 below-average risk, 0 to 1 scale

Genomic Health Decipher test predicts metastasis risk and longevity for 5, 7 and 10 years out.

11/19/2015 Radical Prostatectomy UCSF Dr Peter Carroll da Vinci robotic surgery

Synoptic Comment for Prostate Tumors
- Type of tumor: Small acinar adenocarcinoma.
- location of tumor: Single tumor. Left posterolateral midgland and base (1.2 cc; slides B10-12).
- Estimated volume of tumor: 1.2 cc.
- Gleason score: 3+4=7; primary pattern 3, secondary pattern 4.
- Estimated volume > Gleason pattern 3: 10%.
- Involvement of capsule: Tumor invades capsule: left posterior midgland (slides B10, B11).
- Extraprostatic extension: None.
- Margin status for tumor: No tumor at ink, but tumor into capsule is less than 0.1 mm from ink; slide B11.
- Margin status for benign prostate glands: No benign glands present at inked excision margins.
- High-grade prostatic intraepithelial neoplasia (HGPIN): Present, extensive.
- Tumor involvement of seminal vesicle: No tumor.
- Perineural infiltration: Present.
- Lymphovascular invasion: None.
- Lymph node status: Negative; total number of nodes examined: 1.
- AJCC/UICC stage: pT2aN0.

Johns Hopkins (Epstein) pathology 10/13/2015
Gleason Score: 3+4=7
Left Base
2 cores (60% + 20%) (30% Gleason pattern 4)

Kaiser pathology, 9/1/2015
STAGE: T1c
Gleason Score: 3+4=7
NUMBER CORES INVOLVED/TOTAL NUMBER CORES: 2 / 14
TOTAL CARCINOMA LENGTH: 10 mm
PSA 3.2 6/10/2014
PSA 4.8 6/8/2015
PSA 4.4 8/10/2015 (free PSA 7%)
PSA 5.0 9/28/2015 (free PSA 8%)

A) PROSTATE, RIGHT APEX, NEEDLE BIOPSY
-- ATYPICAL SMALL ACINAR PROLIFERATION
-- TOTAL SPECIMEN LENGTH, 44 MM

B) PROSTATE, RIGHT MID, NEEDLE BIOPSY
-- FOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA
-- TOTAL SPECIMEN LENGTH, 30 MM

C) PROSTATE, RIGHT BASE, NEEDLE BIOPSY
-- FOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA
-- TOTAL SPECIMEN LENGTH, 23 MM

D) PROSTATE, LEFT APEX, NEEDLE BIOPSY
-- BENIGN PROSTATIC GLANDS AND STROMA, 43 MM

E) PROSTATE, LEFT MID, NEEDLE BIOPSY
-- BENIGN PROSTATIC GLANDS AND STROMA, 22 MM

F) PROSTATE, LEFT BASE
ADENOCARCINOMA, GLEASON GRADE 3+4 = 7
ADENOCARCINOMA INVOLVES 2 OF 2 CORES AND 10 MM OF 30 MM

The first involved core from the left base contains 3 mm of Gleason grade 3+3=6 adenocarcinoma and the adenocarcinoma is located 6 mm from the presumed peripheral edge (see note).
The total core length is 17 mm.

The second involved core from the left base contains 7 mm of adenocarcinoma. Greater than 6 mm of the adenocarcinoma is Gleason grade 3 and less than 1 mm is Gleason grade 4. The Gleason grade 4
adenocarcinoma is located approximately 2 mm from the presumed peripheral edge (see note).
The total core length is 13 mm.

Thx, I will edit and amend it. Your comments are correct.

I changed my signature but it displays the old crap. oh well it will show up later I hope

jronne said...
Thx, I will edit and amend it. Your comments are correct.
I changed my signature but it displays the old crap. oh well it will show up later I hope

See if you get an error message when you hit Save. There are limits to the number of characters and perhaps the number of lines too.

Djin

logged in and out, still hosed
353 chars is my signature
60 years old
Decipher score 0.22 low risk
11/15 RP UCSF Dr. Carroll
pT2a pN0, invasion into capsule, EPE-, LVI-, PNI+
3+4 Gleason7 30% 4
10% tumor 1.2 cc
12/27/19 12/20/19 12/13/19
0.011 0.010 0.012
7/19 4/19 11/18 9/18
<0.006 0.008 0.009 0.007
7/18 4/18 2/18 1/18 11/17
0.007 <0.006 <0.006 0.008 <0.006

correct just trying to figure out if the more than doubling of uPSA in less than 5 months was real, UCSF is fine with this, the test is noisy but for 12/19 I am a solid 0.011, going to back off of the testing and hope it goes down, they feel the guy that gets prostate cancer in their mid-50s needs to be more vigilant and proactive with regards to SRT as my friend of the same age got SRT at Stanford with a uPSA of 0.45 after 3 consecutive rises spaced by 3 months

jronne said...
I would like to learn of any other outcome experience.

Five years after my RALP, I became uPSA detectable in early 2017, slowly rising from mid .020's to ~.050 in December 2018. I decided to stop the T-cyp injections my uro had me on, and I have stayed off the juice since.

In the list below, the Dec 2018 blood draw was done just before I quit. The remainder shows a pretty steady level:

12-18 0.052
01-19 0.041
02-19 0.036
03-19 0.035
04-19 0.035
05-19 0.039
06-19 0.044
07-19 0.038
08-19 0.035
09-19 0.045
10-19 0.035
11-19 0.041
12-19 0.041
01-20 0.041

I have an endocrinologist appt. coming up and may possibly be able to approach my continuing low-T/very high estradiol problem via meds, like an aromatase inhibitor. Kinda like "back door" TRT, I guess. I will closely monitor my uPSA until I have figured something out or have just learned to live with it. Then back off on my uPSAs frequency to just every few months or so. You said you will be backing off the frequent monitoring, too. Probably good for both of us to do so.

But the thing is, my trend may not continue. It could accelerate in the future, stay same or even go down. Dr. Myers had a video out there years ago that said he had seen a number of men level off at .1, but he didn't say what characterized those that did so.

No telling what yours will do. But here are some rough calcs based on the some of the values you gave us:

(1) your uPSA rose .004 in 17 months (.007 07/18 to .011 12/19) which is a yearly rate of (.004 / 17) x 12 = .0028

(2) In 40 years, when you are age 100, your uPSA will be (.011 + .113) = ~.12

I rounded here and there, and chose just some of your numbers, but you see what I'm getting at. If your rate increases or decreases, you can redo the calcs, but that's all we have right now.

Bottom line, from what we see now, you are likely to die of something else before advanced PCa. Nobody is going to be able to guess what your uPSA future will be. It's fruitless to try. If the continuing anxiety from dealing with this is keeping you awake nights, there is no shame in talking it through with a professional or getting on some anti-anxiety meds for a while.

We are all trying to help, and hope best for you, but we cannot predict the future any more than you can.

Robert

DjinTonic it is me jronne that has been testing these low numbers with UCSFs approval, they do think it adds some value but not much, it does not hurt as the testing errors tend to average out

so while two nearby uPSA readings of 0.012 and 0.008 in time might be possible it is not probable

basic statistical analysis

the other unknowable is that prostate cancer, especially in small volumes, might exhibit sporadic activity which likely accounts for my 7/14/19 uPSA value of < 0.006

still waiting for the medical science to catch up with the lowered sensitivities of the new uPSA tests

there is information and data here, it just needs to be processed and categorized, it has some noise and margins of error which all data has to a certain degree

at Stanford they now use the new uPSA test to establish the first rise in uPSA levels

their protocol is 3 consecutive rises at 3 month intervals as a trigger for considering SRT

this can occur for uPSA levels as low as 0.035

DjinTonic my close friend went thru early SRT at Stanford in 8/19 with a uPSA of 0.045

will get some more info from him this weekend

I am also curious as to what constitutes a substantial uPSA rise (absolute number, percentage or both ?)

will also email his doctor Dr. Hilary Bagshaw there requesting if she has a standard document that details some of this

My psa has been at 0.03 or so for the last 18 months. The last couple of readings were done at 6 month intervals. I see my urologist next week and I'm curious as well to find out what this means. ie a 'permanent' 0.03 or is it a pause ?

jronne
I've had ultrasensitive PSA tests for most of the 18 years I've had PCa, though all of these tests have been to 2 not 3 decimals. I do believe uPSA testing to two decimals is very important for monitoring trends in post-prostatectomy patients. FWIW my tests at Dana-Farber are to two decimals and my MO cautions against projecting doubling times into the future based on the movement of numbers measured even at the 0.0X level.

As for plateauing, I've had a couple of lengthy pauses over the years but no permanent plateaus. After prostatectomy in 2002 my numbers stayed at 0.02 for a couple of years - with one dip to 0.01, which to my thinking was just the noise fluctuations that live at the bottom of any signal (sorry, I was once a Navy radioman). In 2005 - 3 years after surgery -- PSA hit 0.1 and then plateaued there for 4 years until 2009 before jumping quickly to 0.2 and then 0.4 over less than a year.

After SRT in 2010 PSA remained undetectable at 0.00 for nearly 4 years - though if tested to a third decimal a slow increase would probably have been observable. But even so, it would have had no practical relevance because any decisions about further treatment at that level would have been way premature. When PSA reached 0.2 in 2016 I transferred my care to an MO and we continued to monitor until a sudden up-tick in doubling time and a PSA that had reached 6.6 signaled time to start ADT.

Over my PCa history I have had long periods of stable or very slowly advancing PCa followed by sudden increases in DT - both after prostatectomy and after SRT. I can't say how typical this is. But in my own case, DT has been non-linear--more like what the late Stephen Jay Gould called punctuated equilibrium in terms of evolutionary biology.
Jim

jronne said...
jasperx10
what was the date of your RP?
what is you psa history? dates and values?
my uPSA test measures down to 0.006 from LabCorp and is $20
your last tests have odd numbers 0.03,0.02,0.03,0.03 not 0.031, 0.022, etc ...

RP was in Dec 2017
Last 2 psa readings were 6 months apart. Before that they were 3 monthly, except for the 1st. I can't remember when that was done, but I think it was about 6-8 weeks after the op.

I agree, the last few readings are odd being exactly 0.02 or 0.03, but earlier readings showed a few more decimal points and lower so I figure that's just the way it is. I better check on my visit next week .... I'm curious now.