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recurring elevated psa

snowbucko
Posts: 4
Joined: Oct 2011

I was diagnosed in 1998 with prostate cancer, PSA 9.7, gleason 6/10, followed by a right
nerve sparing radical prostatectomy 1 month later in Jan of 1999. The pathologist stated all margins where clear.

The PSA numbers are as follows: 3/5/99 0.1
remained the same for several years
2/5/05 0.1
1/11/07 0.3
6/8/11 1.45
7/7/11 1.37
10/5/11 1.66
As you can see, the numbers are on the rise.
I have just scheduled a nuclear bone scan for next week under the assumption that might be the next logical place the cancer may have been hiding. Are there any other ideas out there that I might have overlooked?

psa 9.7

hunter49
Posts: 201
Joined: Oct 2011

is ur psa 9.7 now

snowbucko
Posts: 4
Joined: Oct 2011

No it is 1.66 now

hopeful and opt...
Posts: 1303
Joined: Apr 2009

other treatment, such as radiation or hormones . Generally treatment is indicated at 0.2 after a radical prostatectomy.

Are you currently receiving hormone therapy? Are you now seeing a medical oncologist?

VascodaGama's picture
VascodaGama
Posts: 1540
Joined: Nov 2010

Snowbucko

Welcome to the board.
The constant increase of PSA indicates recurrence. Most probable the bone scan comes negative to metastases for the low level at 1.66. Usually scans detect cancer producing PSA over 10.
Recurrence in similar cases is commonly caused by cancer growing at close lymph nodes. This is the usual place where cancer firstly hides before travelling to other parts in the body, but one do not know exactly in which nodes it is growing. This is a cancer known as Oligometastatic which refers to a stage when the cancer is in the transitional state between localized and systemic.
Dr. Charles Myers is working with a group of other physicians and we all expect for his publish results and findings in the treatment of oligometastatic cancer. You can listen to his videos on recurrence, etc., in these sites;
http://prostateexperts.com/2011/02/09/cancer-recurrence-after-rp/
http://csn.cancer.org/node/212197

The treatment to similar cases to yours involves salvage radiotherapy (SRT) which is administered with or without adjuvant hormonal therapy (HT). Radiation is successful in irradiating the cancer, but it must hit the bandit. The success is very much dependent on a “guessing” theory that the cancer is in the line of the rays.
Proper diagnosis of your present status is important and you will need to have in hand the results of the pathologist’s report post surgery. Pathological stage will play an important part in the diagnosis. DRE is also recommended to check for any deformation at the prostate fosse.

Unfortunately tests or image studies are not yet perfect to show microscopic tumours. The best falls with a MRI 3-tesla to picture the anatomy of the inner pelvic area and a USIPO-MRI which may be the best test to find metastases at the lymph nodes. This test is being done at Sand Lake Imaging in Orlando, Florida, using feraheme as the contrast agent. Bone scintigraphy scan even if negative will help in future references to your case.

Hope you get good responses to your quest.

The best.
VGama

snowbucko
Posts: 4
Joined: Oct 2011

The bone scan came back negative. The next step to locate the "hiding cancer" is a pelvic MRI. I don't believe we have he ability to perform the testing in my area that is described by VGama. I will discuss this with my physician.
I am worried about the SRT treatment. I have heard reports of increased incontinance due to this procedure. I have not had this problem and do not need nor want to have this problem.
A new symmptom has recently arrived which may or may not be associated with the elevated PSA. I have extreme left side lower back pain. this pain often begins after a few hours of sleep, the pain is enough to wake me, the rest of the night is spent awake. Acetometiphine is helpful, often times the pain continues through out the day.
I do not have a scheduled appointment until late December, everything done so far has been on my own. I may try and move my appointment up.

tarhoosier
Posts: 182
Joined: Aug 2006

Sno:

Your most recent psa #s indicate (by MSKCC) a doubling time of ~20 months. This is common for G6 tumor cells. This means you have some years before the psa rises to a level to risk symptoms. Even without current treatment by radiation, this means you have at least 20 years of survival, with the treatments we have today. Not to mention those in the future. The risk of death by PCa in men with such numbers is quite small which is a consolation.
I believe that diet and supplements can delay this psa rise even further and have seen it in men like yourself with small amounts of slow growing disease. You have a very long way to go.
You do not mention your age, an important part of the calculation in any planning.

VascodaGama's picture
VascodaGama
Posts: 1540
Joined: Nov 2010

Snowbucko

Good news on the negative bone scan. If you cannot find facilities to get the MRI I described above, at least procure for facilities with modern equipments doing 3-testla endorectal examinations (eMRI). Color Doppler may as well help in locating the cancer that is causing that recurrence PSA. (http://csn.cancer.org/node/228118)

You have not shared your story and data at diagnosis neither the contents of the pathological stage, Gleason score, etc. This info is necessary if you want to get proper advice from experienced guys in this forum. Your age and present health (other illnesses) are also important to get a more concise status of your case. They all interweave in the process of diagnosis and treatments.

The pain you are experiencing may not be related to PCa. Bone metastasis usually relates to higher levels of PSA. However, I would recommend you to get a bone densitometry test to verify of the status of your bone (osteoporosis) which makes an integral part of the matters related to prostate cancer and its treatment. PCa loves bone and grows happily there. Patients on hormone therapy accompany the treatment with bisphosphonates to prevent bone loss and cancer.
Inform your doctor about the symptom because you can check for any related problem at the area in your next MRI (lower abdomen and pelvis).

SRT may affect incontinence particularly if the sphincter is not “healthy enough” after the surgery. I had open surgery in 2000 and SRT in 2006 but never experienced incontinence.
You can read about my experience with recurrence in this post; “Ultra-sensitive PSA may help”; http://csn.cancer.org/node/229375

As commented by Tarhoosier, your PSADT (doubling time) is long in the 20th month mark (better), which is above the critical threshold of 14 to 18 months, considered by many doctors as the midterm for aggressiveness. This is indicative that you have the luxury of time to do your researches in a salvage treatment but recurrence is confirmed and you should not be “loose” and let the problem pass unattended.
Knowing what was happening to me earlier gave me peace of mind in accepting my Karma.

The best to you.
VGama

snowbucko
Posts: 4
Joined: Oct 2011

My age is 57, at the time of diagnosis I was 45, at surgery I was 46. The gleason score is mentioned in the first post. I have always been very healthy, slender, and athletic. I did have a bout with hepititas when I was in my 20's. The only reason the cancer was even found was due to an annual DOT physical with my physician/friend who convinced me to have a rectal exam, my first.
I have my first appointment with a noted oncologist in Dec. I don't believe that time frame will affect the end result. I intend to do another PSA in mid December, that will provide the physician with the latest results.
Our facility has the capability of performing a eMRI. I have consulted with the technicians and will have this test done prior to the oncologist appointment also.
I greatly appreciate the feed back and support.
I hope I have the peace of mind to accept my karma

Thanx again
Norm

hopeful and opt...
Posts: 1303
Joined: Apr 2009

for example there are 1.5 and 3.0 magnets......that provide finer resolutions

crhoads
Posts: 7
Joined: Dec 2010

Was your PSA ever <.1 or was it always .1

Also, why didn't you start radiation when it hit .3 back in 2007?

Just curious.

thanks

VascodaGama's picture
VascodaGama
Posts: 1540
Joined: Nov 2010

Norm

The meeting with the oncologist in December will give you the peace of mind you so much deserve. Meanwhile get informed as much as you can (read a book on PCa) and prepare a good list of questions for the meeting. Include a search on the facilities close to where you live, in case you are recommended for SRT.
As much educated and knowledge you get on the cancer, lesser anxious you become and success can be expected.
Try to get copies of past data from the hospital where you had surgery. This will help your doctor in his decisions.

I still do not know your Gleason score. You wrote above; “gleason 6/10” but what is it ?

The Gleason is composed by three numbers as this X+Y=Z. The first number (X) relates to the Gleason grade (aggressiveness) which composed the majority of the type of cells found in the core. The second (Y) relates to the grade of the second majority found in the core. The third is the sum which classifies the score and therefore the risk status. Grades go from 1 to 5 (3 to 5 since 2005 norms) and scores go from 2 to 10 (6 to 10 since 2005).

My Gleason score was 2+3=5 (composed of grade 2 and 3 type of cells). What was yours?
(http://www.prostate-cancer.org/pcricms/node/165)

Have a good and Happy Halloween evening.
VGama

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