Slow, but continued uPSA increase

Mumbo said...
Djin - My Invitae genetic testing checked 21 factors in 2019. There was something about saving specimen for future testing since the field was rapidly evolving. I don’t recall the details. Same conclusion statement.

On the one hand, you hope something is found. On the other hand, being negative is good too. Not exactly sure how I felt at the time, glad I did it was about it.

Yes, they saw to check back every so many years for that reason. I don't think they have to keep the specimen, since your entire DNA has been sequenced and you have plenty more spit and blood. AFAIK, the only thing that changes when you do more/fewer genetic panels is the genes they look at.

I, too, wonder about finding something vs. nothing. On the one hand you don't want a gene variant that leads to aggressive, resistant mPCa; on the other it would be nice to have a targeted treatment if your mPCa was caused by that gene. I plan on discussing this with my uro at my next visit/PSA check.

I did recently come across a study that found evidence that combining a specific gene treatment with a standard ADT treatment has proven beneficial even in men with mPCa who did not have that gene variant (I didn't read the paper, so I don't know if there is a proposed mechanism, but the idea is certainly promising).

Post Edited (DjinTonic) : 10/26/2023 5:40:28 PM (GMT-8)

Mumbo said...
Why did grandpa die? “He had a heart problem” sounds better that “he was an overweight, wife beating drunk” and is easier to digest.

You forgot the 3 packs of Camels he smoked a day.

So my boyfriend has surgery in 2012. Been a journey. Our mentality at this point is doing nothing until it reaches bones. He does not want ADT if he can avoid it. It's been a slow creep. Hopefully it takes it's sweet old time. I think you can never truly be out of the woods with this beast.

George PSA Tracking Surgery RALP Dec 2012
Undetectable until….
Date PSA
March 28, 2019 .03
Sept 30, 2019 .03
May 28, 2020 .05
Nov 12, 2020 .07
May 11 2021 .13
June/July/Aug 2021 Radiation IMRT + IGRT
Aug 16, 2021 .05
Sept 16, 2021 .04
Nov 30, 2021 <.1 Labcorp (not ultra-sensitive)
March 1, 2022 <.1 Labcorp (not ultra-sensitive)
June 27, 2022 .075 Labcorp
Sept 6, 2022 .106 Labcorp
Oct 4, 2022 .098 Labcorp
Jan 10, 2023 .144 Labcorp
Jan 31, 2023 .09 Qwest
March 17, 2023 .2 Labcorp (not ultra-sensitive)
April 13, 2023 .193 Labcorp
May 30, 2023 .15 Veterans Affairs (VA)
Aug 22, 2023 .23 Labcorp

Yesterday, at my 3-month visit & PSA blood draw, my uro and I were thinking that if I climb to 0.1, we'll schedule a consult (only) with an R.O. specializing in PCa and at 0.2 we'd consider a PSMA scan. However, in discussing a likely location for recurrence, my doc thought it would be pelvis and doubted it would be distant mets--thinking that with my pathology, they wouldn't have taken this long to rear their head. And he said my PSA could very well plateau--we don't know enough about the residual glands/tissues that continue to produce small amounts of PSA post RP.

Three months ago my PSA was 0.065. I just got back yesterday's test result: 0.068. So...essentially stable for now. Of course it will take several more data points to confirm whether I'm in a plateau, but, frankly, I was surprised, since recently I was showing a slow, linear climb.

At least good new heading for Thanksgiving!

0.023
0.038
0.036
0.049
0.054
0.065 3 months ago
0.068 yesterday

Djin

Djin - You knew this was going to happen. The test is just playing with you. 0.02, 0.04, 0.04, 0.05. 0.05, 0.07, 0.07 makes more sense to me. Next time a couple 0.08's or another 0.07? Three of kind beats 2 pair so I am going with another 0.07.

If you are going to have PSA values, these are the good ones to have.

Has to be truly frustrating in many ways, "a riddle wrapped in an enigma" as attributed to Winston Churchill.

"One more data point" has doomed many theories and proved assumptions to be faulty.

The full quote attributed to Churchill for context: "I cannot forecast to you the action of Russia. It is a riddle, wrapped in a mystery, inside an enigma; but perhaps there is a key. That key is Russian national interest."

Better than Yogi Berra quotes...

Yesterday's (3-month) uPSA was 0.079, still inching up (0.049, 0.054, 0.065, 0.068, 0.079) from my nadir of 0.007. I'm 6.5 yrs post-RP. My uro believes this is not metastatic disease, given I was a G9 (4+5) with confirmed prostate-confined disease, a relatively low pre-treatment PSA, a low tumor burden, a Decipher score that is low-risk for mets, and a history of fluctuating PSA (both pre- and post-treatment). Aggressive PCa that was left behind would have made itself known long before now.

However, at yesterday's visit (before we had today's uPSA result) my doc said we certainly don't have to wait for a PSA of 0.2-0.5 to do PSMA imaging--rather we could go ahead and zap the prostate fossa if I get to, say, 0.150. I messaged him today that if in 3 months I'm up to around 0.085 or 0.090, I'll let him decide if we should continue to wait or (at least) do an RO consult for another opinion about if/when to zap.

I think, as does my uro, that whatever is going on, it's going on locally. If the cat is out of the bag (i.e., I now have distant micromets) then irradiating the fossa won't be very helpful anyway. (I haven't completely given up hope that my PSA could plateau or slow down its rate of increase). I do not think my situation is identical to that of a PSA that climbs to 0.1 or 0.2 within a year or two of surgery.

Djin

Thanks for weighing in, Halbert! I much appreciate it. It seems like I'm asking myself When should I start to worry and If I do start worrying, what do I do about it? In other words, hurry up and do nothing

I found "Dr. D’Amico on the use of radiotherapy after radical prostatectomy" (2023). However, it seems to be aimed at men whose PSA increases relatively soon after RP, which is not my case (the ART vs. SRT question). I'm not sure how much applies to a PSA rise after, say, 5 years post-treatment (just to pick a number).
_________________
"At our own institution, we've adopted the policy of starting salvage therapy in men with a single high-risk factor before the PSA gets to 0.2 ng/mL, and certainly not 0.25 ng/mL. And so I think that that's an important point to take home: with one risk factor, do salvage by 0.25 ng/mL and with 2 risk factors, do adjuvant and don't wait for the PSA to rise." [Emphasis mine]
_____________________

I'm a single-factor guy, but I think my uro may have a point in perhaps doing SRT as early as 0.15.

Post Edited (DjinTonic) : 2/21/2024 6:44:00 PM (GMT-8)

Exactly, Mumbo--and I was going to make the same point (and I have done so for others in the past). However, there comes a point where the hope of a plateau becomes more wishful thinking than a likely prospect. In any case, I'm pretty relaxed for now and just seeing where my ducks are before I worry about getting them in a row

Post Edited (DjinTonic) : 2/21/2024 6:46:38 PM (GMT-8)

Djin, I can tell by your posts that you are frustrated by this very slow rise in PSA. I know it is a wait and see game, but maybe a PSMA test will alleviate your frustration. If it shows nothing, great, but if it does spot something you can act on it. In either case you are being proactive which might eliminate the guessing game. With RA being where it is today, the chance of knocking it out is much better now if it is needed.
I appreciate all that you do here for all of us and I hate to see you going through this. I am sure you know that we are all here for you and will support whatever decisions you make.
Stay positive and as always my best wishes going forward.
Jack

Looks like you have a plan. I am happy you are not frustrated. Keep the positive attitude up.
Best wishes,
Jack

the only one here with MD specializing in prostate said...
my uro and I were thinking that if I climb to 0.1, we'll schedule a consult (only) with an R.O. specializing in PCa and at 0.2 we'd consider a PSMA scan

So glad to hear that you are receiving, and listening to, solid advice.

After 6.5 yrs, your favorable test results in the barely-detectable range are very encouraging for the long term, especially after 5+5 Bx…very encouraging.

Post Edited (Casey59) : 2/25/2024 11:24:36 AM (GMT-8)