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Elevated PSA

vtjhansen
Posts: 2
Joined: Jun 2011

I am a new member and have some concerns. I am 67 and had an RP done 18 years ago. My PSA was undetectable for over 13 years. It then showed up @.3. I have been tested every quarter for the past 4+ years and the scores as follows. Starting 3/6/07 to 5/10/11. PSA/QTR PSA .3, .23, .19, .39, .51, .63, .76, .94, 1.22, 1.36, 1.45, 1.89, 2.41, 3.19, 5.65, 6.35. I hope someone can share with me what I should be doing now as I can't go back. I have had several discussions with several doctors over the years. They were not concerned until my score either doubled or was above 4. I'm there. It seems that Radiation is the only option for me now, but nobody knows what area to concentrate on. I have had an X-ray, & CAT Scan both negative. It was suggested a PET Scan be done to help locate/isolate the potential problem area. I want to be educated as to the best procedure for me to follow to get good results. I am a member of my Man to Man group which has been very helpful. I believe there is a sense of urgency at this time and look forward to your advice. Jerry

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

Jerry,
It is encouraging to read that you have been a survivor for the past 18 years. Also you have done an excellent job on keeping your records. That is very important! As you most likely know the rise is an indication that your cancer has come back. I'm very surprised though that the Doctors did not address the psa rise sooner since you had an RP procedure.

The doctors goal now is to find the recurrance. I would continue as suggested with the PET Scan. I believe as you have mentioned that Radiation and / or hormone therapy is what you will be deciding on.

I'm sure others will chime in with their opinions also.

Best of wishes and keep us updated!

Larry (lewvino) age 56
Gleason 7
Davinci Robot for primary treatment

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Jerry, as lewino said so well, it is an inspiration to hear from long term survivors such as yourself. Welcome.

Frankly, although I certainly don't know the entire story I am astonished (not in a good way) that your medical team has allowed this to go on for so long without taking more definitive action. I would be running toward a new medical team as fast as I could.

Besides radiation hormone therapy may be appropriate in your case to curb the growth while the figure out a radiation plan. After so long, you could have cancer almost anywhere. I think you need a team that will use some of the latest scanning technology to find it.

Best of luck to you.

K

VascodaGama's picture
VascodaGama
Posts: 1588
Joined: Nov 2010

Jerry

This was another “bump” in your long journey. I hope you get that treatment and that you find yourself back to the normalcy of your life.

Recurrence is certain and PET scan may tell you if micro-metastasis exist in localized or distant lymph nodes. There is another tests which seems to be reliable in identifying bladder and prostate cancer metastasis named “USPIO MRI” this is an image study with contrast that has been successful in pinpointing micro-metastasis.
You can google the name or read these abstracts on the matter;
http://emedicine.medscape.com/article/379996-overview
http://www.ncbi.nlm.nih.gov/pubmed/21311336

Your doctors want to clarify if you are systemic (distant metastasis) to which case the success of radiation would be minimal.
That happened with me. I had salvage radiotherapy for recurrence with a PSA of 3.8, 6 years after RP. The odds were minimal too but my Gleason score at surgery was 5 (2+3) and the PSADT between RP and SRT was at 14 months. Unfortunately, I experienced recurrence again (systemic case) and now I am on hormonal therapy.

The famous oncologist Dr. Charles Myers says that recurrence with a PSADT at 18 months is of a type of cancer non aggressive and that patients can do without a treatment (???). You can listen to his comments in regards to “Recurrence after RP” in this site;
http://askdrmyers.wordpress.com/2011/02/09/cancer-recurrence-after-rp/

Recurrence with a PSADT smaller than 6 months is indicative of aggressive activity. In your case the PSADT is of 12 months which is typical of medium aggressive cancers. However, recurrence after remission of an extended period of over 13 years may indicate that the cancer is not totally localized. In fact occult micro-metastasis may have existed since your first diagnosis 18 years ago, and only after 13 years it has shown up its “face”.
Dr. Charles Myers comments that he believes that cancerous stem cells had been dormant in the lymphatic system and for some reasons it “switched-on”.

Kongo suggestion above is comprehensive in starting HT while waiting for a decision on the treatment. The hormonal drugs would not interfere with the radiation treatment, if such chosen and it would be beneficial in slowing the progress of the cancer as well as certifying if your case is refractory.

Hope you get a decision for your case.
Welcome to the board.

VGama

VascodaGama's picture
VascodaGama
Posts: 1588
Joined: Nov 2010

Jerry

As commented at your other thread, your doctors want to radiate following typical protocols for recurrence cases similar to yours.
Detailed radiologists prefer to get as many info as it is possible (eMRI, etc) and draw fields to particular cases. By doing so, they can avoid areas that would be free of cancer and engage in places indicative of positive metastasis. This is common if the patient has past history of colitis, etc. You can inquire them about the image studies.

Hormonal treatment can be started if and when radiation fails. This is not a newer modality. Doctors tend to evaluate the progress of micrometastasis with a reliable PSA without any “masking” from HT.
Once such recurrence is certified then they will subject the patient to a sort of “salvage” hormonal therapy.

Wishing this insight is of help.

Vgama

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