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PSA on the rise post RRP

Bubs52
Posts: 1
Joined: Apr 2011

I'm looking for a few knowledgeable opinions.
My Stats:
10/08 PSA 5.8 Biopsy 5/8 cores Positive, Gleason 4+3
RRP 11/08 Path report 80% Gleason 4, negative margins, 12 pelvic lymph nodes clean, pushing up to but not through capsule as reviewed by Tumor board. One nerve bundle intact, T2c, N0.
Ultrasensitive PSA results:
1/09 0.03
4/09 0.02
7/09 0.01
10/09 0.02
3/10 0.02
7/10 0.03
1/11 0.05
4/11 0.07

Seems to me like a steady tick up, the next uPSA test should be very telling. And yes, hard not to be concerned at the steady progression. I have not heard from my Uro Oncologist yet but my guess is they will tell me it's undetectable and retest in 3 months. I believe their threshold is 0.10 before taking any next steps.
Thoughts? How do I keep my head in a happy place? I am a fit 52 yr old professional with a great, busy life. Tough not to get distracted. Plus, I have lots of experience with PCa from my Dad so I know too much about the potential road ahead.

bdhilton
Posts: 752
Joined: Jan 2010

Buds-
My surgeon and oncologist (both world renowned) do not believe in the ultra sensitive tests that your care givers are giving….With my PSA the “ZERO” results they are looking for is less than 0.1 (the test does not look below that number) …I do know that one of the reasons they do not use the ultra sensitive test is the amount of stress it causes the patients in general (and my surgeon is William Catalona the guy who brought us the PSA test)….

All I know is that my doctors tell me I am zero...

Best to you and totally understand the stress associated with your 90 day PSA test and results…

VascodaGama's picture
VascodaGama
Posts: 1515
Joined: Nov 2010

Bubs52

You are a survivor and so you know that being anxious wouldn’t help in sorting out the matter with the cancer. Hilton above refers well about the stress your rising PSA is causing you.
The rise surely indicates activity of prostatic cells (producing PSA) but doctors need to be sure that they are cancerous. There have been cases (though rare) where benign cells left from surgery produce low levels of PSA. This is the reason why the medical community take the stance as you comment of “…it's undetectable and retest in 3 months…” , when confronting a slow rise like yours. They want to be sure that it is cancer.

My opinion as laymen at the chronology of your PSA, it is that you may be experiencing recurrence, however, you need that next “uPSA test should be very telling” as you comment.
The graph on the behaviour of the PSA in your case indicates a series from surgery with an initial down curve to nadir (0.01), then a rise, then a plateau of six months, and now a continuous rise. This is common in patients after RP. From here you may see a continuous plateau (up/down variation of 0.03 to 0.05), or a rise which would indicate recurrence.

PSA= 0.07 is low. The NCCN guidelines recommend 0.20 as a threshold to classify a case as Biochemical Failure (recurrence). The protocol in some renown institutions (JH) treating prostate cancer take a mark of PSA=0.40 as the trigger to start a salvage treatment.
Some more elements from your pathologist report could give you additional references to your present diagnosis.

I do not know what could make your “head in a happy place”, but for me knowing the details of what is happening and what is expecting, gives that sense of control and relaxation. You may know that your case has survival rates of over twenty years.
Try to read articles by typing the names in a net engine regarding “PSA behavior in recurrence status” and “salvage treatments for prostate cancer”.

Hope my insight is of help.
Welcome to the board.
VGama

ob66
Posts: 214
Joined: Apr 2010

Let me give you a situation where the "ultra sensitive" helps vs. hurts (adding stress). I have a very aggressive attitude in "attacking" my PCa and have had from the start. My first two PSAs post daVinci surgery were non-ultrasensitive and were under the "gold standard" of 0.1. My third was my first ultra-sensitive at 0.05 at the 8 month mark. Then three months later I had another ultra sensitive at 0.07, still under the standard, but rising. It was decided with my Gleason of 8 and seminal vesicle involvement that RT should be done, which it was. I was in total agreement, even though some might argue overtreatment with validation. But it fit for me. Since that time I have been for the last year I am at less than 0.0l but with lupron "on board".

My point, if no ultrasensitive that decision would have been taken from me. I will gladly take the added stress to be able to do everything in my power to turn back PCa. JMHO.

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