Another disappointing PSA

After 7 years post-proton treatment, my PSA continues to increase incrementally. I really had hope that this year I'd return to my nadir reached in 2017, or at least drop a little. In the prior past 2 years my urologist felt I was fighting prostatitis and believes that either that has caused the increases, or that my remaining healthy prostate is just generating a small amount of PSA. Unfortunately, up again for the third consecutive year. By the old ASTRO definition, I'd be declared BF now.

Seeing my urologist today. It'll be interesting to see what he has to say about this 3rd increase. My guess is he'll prescribe an antibiotic and have me retest in 4-6 weeks. I'd like a mp-MRI or PET to see what's going on, if anything, but don't know if Medicare will approve that now, or even if it's appropriate at this stage. My RO doesn't do any testing for recurrence until the Phoenix definition of BF is met which for me would be PSA of 2.75.

Wow! That's informative follow-up, Stephen. I hope you're around when I get a PSA rise.

I met with my urologist today. He said the PSA increase was small and nothing to be concerned about. He said he thought I was doing very well and after 7 years post-treatment with a PSA of 1.2 I should be feeling good about it. I still have a 25-30 gram prostate that will continue to grow a little as long as my testosterone is good and will generate some PSA. And my long history of prostatitis probably accounts for some of the increase.
He didn’t seem convinced by my references to many articles and papers that after primary treatment with radiation the PSA should reach a nadir in about 1-2 years followed by stable PSA, and that I am the classic case of a recurrence in the works. He does allow for the possibility that I could have some small amount of residual cancer but that it would be so small and is never likely to be a major concern or require treatment. I would likely die of something else first. Probably from worry.
When I suggested maybe I should just quit having PSA tests because they’re so stressful and he thinks I'm doing okay, he said fine, I see no problem with that. I don’t think you could do it he said because the worry of not knowing would be more stressful than having periodic tests. He suggested every 2 years.

50% chance your Proton treatment failed to kill all the cancer in your prostate.

Your Friend said...
Wow! That's informative follow-up, Stephen. I hope you're around when I get a PSA rise

I will do my best to be around!

Better yet hopefully you will not have to deal with a BCR.

HR, I get your concern but I know a lot of radiation guys who did not reach nadir in 1-2 years and are doing just fine. For me it took six years. Still, your PSA levels are relatively low and I agree with most of what your urologist told you.

However, the idea of stopping PSA testing or doing it every two years is nuts in my opinion. Rather you worry a little bit and get information than - god forbid - it does turn out to be bad news. If it was me I would re-test in 3 months and then every 6 months until I saw a trend or stability. Waiting two years is WAY too long IMHO.

Jim

You're right. I was frustrated in the Uro's office when I said I may not have another PSA or wait 2 years. He knows me well and knows that I couldnt stick my head in the sand. I have to know what it is. At least annually.

hrpufnstuf said...
You're right. I was frustrated in the Uro's office when I said I may not have another PSA or wait 2 years. He knows me well and knows that I couldnt stick my head in the sand. I have to know what it is. At least annually.

I don't get the URO's position on not testing more frequently. Even if he believes it is increasing slow, any increase is somewhat concerning and there is nothing wrong with switching to quarterly PSA checks to get a more accurate sense of doubling time. One thing I did when I was nervous about a rise in last PSA test, was contact PCP and schedule an annual physical. The physical includes a full blood work including PSA. Obviously, that isn't a move I can repeat frequently, but it worked once.