HealingWell
Search Close Search
☰

PSA rise - 3rd data point

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 11/13/2021 3:29 AM (GMT 0)
Hi all, I posted a while back but here again as just got my uPSA result and it was .049. Tested previously last January with result .03 and in July .045 so with these three data points feel that I’m looking at early recurrence. Long story but prior to January my primary care was only doing PSA not uPSA so I don’t know when PSA rose above .01. I had radical prostatectomy in May 2017 so will be 5 years this May. I was 3+4 at the time of surgery with no positive margins, seminal vesicles negative. PSA pre surgery never reached 10, I believe the highest it got was 6. My urologist suggested now that I could either talk to a RO now or wait another 3-6 months and see if there is further increase. We talked about PSMA scans but not sure at what PSA levels those are helpful? Insurance coverage could be an issue as well. So I am seeking advice in terms of whether SRT is something I should consider at this stage or do I have time to wait? Will a scan be useful at this PSA level? My general thinking is I would want to act if I reach .1 but would really value thoughts on this. Also, what is the likelihood of spread outside the prostate bed in my case? I had my surgery at the NIH and hope to talk to them this week, though I believe they don’t take patients back until PSA hits .1. I would like to think there is some possibility that my PSA won’t continue to rise but with 3 data points I fear that is unlikely. Thanks for any advice or thoughts I might consider.
Posted 11/13/2021 12:59 PM (GMT 0)
Hi James. Note that official biochemical recurrence (BCR) has not been changed from a PSA level of 0.2. Many men with BCR do not go on to clinical recurrence and for them SRT is overtreatment. Of course the problem is one doesn't know which category one is in, so many men choose to treat BCR. Check with your doc and do your own research, but I think you are well below the optimal PSA levels for a PSMA scan (optimal being the sweet spot between low enough to get a treatment edge but high enough to pick up small lesions).

A Decipher Prostate test could help you decide if and when to begin SRT. It examines your cancer's RNA in the tissue removed at your RP and gives you a score in the low, intermediate, or high risk category as to the theoretical/statistical chances of metastases in the first 5 years post-op. As you point out, RT at 0.1 is still considered very early SRT.

A change in PSA from 0.045 to 0.049 is well within what I would call expected fluctuation. Was that 0.03 result a different (2-decimal test) or was that result actually 0.030? You want to compare results from the same test method. Your PSA could be or become stable.

Talking to an RO now doesn't mean you have to start SRT now. You'd have another opinion and you can get a plan in place. If you want to do that, I would get the Decipher result first: it's a valuable piece of information and appears to be figuring into SRT decisions more now. You might want another PSA in 3 months as well. IMO it takes a fair number of data points to establish a trend given the fluctuation in a 3-decimal PSA test. Also, the more data points, the more accurate the calculation of your PSA velocity (rate of rise).

Djin
Posted 11/14/2021 2:16 AM (GMT 0)
Thanks very much Djin, this is helpful and to some degree reassuring advice. I had not heard about the Decipher test but will certainly discuss with my urologist. I also plan to make an appointment with a RO in the coming weeks, and reconnect with NIH as well. I will repost with any updates. Thanks again.
Posted 11/14/2021 3:30 AM (GMT 0)
Keep us posted, please. We learn too!

Djin

Post Edited (DjinTonic) : 11/13/2021 8:38:30 PM (GMT-7)

✚ New Topic ✚ Reply