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PSA goes back up after RP 6 yrs. ago

Da Wizzard
Posts: 8
Joined: Mar 2014

Question that needs some advise, help by responding if you have insight to issue.

(age 66 ,190 pounds, caucasion, excellent overall health except for this issue) )

Had RP via Da Vinci 6 years ago, pre RP Gleason 6...post RP Gleason 7. For 6 years the PSA follow ups were less than zero  point one ( 0.1 ).....Dec. 2013 a PSA test reports PSA = point one (  .1)......6 weeks later an ultra sensitive PSA = point one zero three ( . 103)....I'm worried that Ca is back....read articles that this is Post op anxiety....OK ....I got it.........question is what to do ? Dr. recommends to wait till it peaks up 3 times for it to be considered a recurrance....OK, that's the Dr's standard protocol.......asked , "What is the treatment ? ".....IMRT for 7 1/2 weeks , Monday to Friday.........any opinions out there......I shall get a second opinion (most likely driving to John Hopkins, Baltimore, MD ) after the next test....stressed and worried it's back.

 

Is IMRT the way to go ? Reading about Proton Therapy ? confused..

 

VascodaGama's picture
VascodaGama
Posts: 1554
Joined: Nov 2010

I recommend you to RELAX and spend time worrying about something else.

The tinny increase of 0.003 could “easily” be due to assay’s deviated tolerance, which could go higher as 0.005 points. Your doctor’s recommendation is sensitive and just.

Congratulations on yet another remission level.  Laughing

Enjoy.

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

Da Wizzard,

I agree that you ought to wait for another reading and be wary of very slight fluxations with ultra-sensitive PSA tests.  Frequently these minor variations are within the standard deviation brackets for the test.

On the other hand, there is really only one thing that causes your PSA to rise after the prostate has been removed.  If your PSA does continue to rise it is evidence of recurrence and the standard treatment in a case such as yours is IMRT to the tissue area surrounding where your prostate used to be.

I hope your readings are a fluke but just in case it is smart that you are seeking second opinions and studying what the next steps might be.

Best of luck to you.

 

K

Da Wizzard
Posts: 8
Joined: Mar 2014

I am not worried about going from .1 to .103...........I went from 6 yrs. of less than 0.1 ( < 0.1) (nothing) to +.1 (something).

lewvino's picture
lewvino
Posts: 1006
Joined: May 2009

I know it is hard not to worry. But follow your Doctors recommedations. The slow rises as you have reported can cause anxiety but you have to look for the doubling time. As mentioned .2 is considered a recurrance. Even at .2 the doctor had me retest in about six months and then it had gone to .3 and I had salvage radiaiton. My PSA today is 0.

Just got the news this morning.

Lewvino

hunter49
Posts: 204
Joined: Oct 2011

great news Lew any side effect from radiation?

CarlosAlberto2
Posts: 17
Joined: Sep 2013

 

Da Wizzard

During 6 years you had <0,1 and now you have 0,1, what means a change from undetectable to the minimum detectable. Even so, please see the following site

http://urology.jhu.edu/newsletter/prostate_cancer829.php

By this site, as you can see in the 15 years table, who has the recurrence after 3 years, had a gleason score below 8, and PSA doubling time higher than 15 months, has a 95% of probability to be alive in the next 15 years, even not doing additional treatment.

So, don´t worry too much, of course you need medical opinions, but I would say that you may wait long time before be concerned!

Wish you long and healthy live!

 

 

 

CarlosAlberto2
Posts: 17
Joined: Sep 2013

You need to read the article carefully.

First what is considered recurrence -- more than 0,2

PSA doubling time -- time to double the PSA after PSA has reappeared (detectable 0,1)

So, by this definitions you are not yet with recurrence, and you can calculate the current doubling time (0,1/0,003x number of months between the 2 PSA readings).

Regards

Da Wizzard
Posts: 8
Joined: Mar 2014

Hi,

Thank you for all responses as I'm still anxious as to the PSA level not being less than 0.1 ( < 0.1 )......but next Friday, March 21, 2014 I go back to the Dr. and he should have the results of another Ultra Sensitive PSA test that I am going to get in the next few days. (awaiting his Rx in the mail for the test).......thanks again to all responders to my question.

I have been reading a ton of literature from the John Hopkins web site....my wife tells me to stop as it only gets me upset but I feel the more knowldege I have the better to ask questions. Guess it's wait and see for now...later

hopeful and opt...
Posts: 1317
Joined: Apr 2009

Your wife is a genius,,,,,listen to her....sounds like you are gettings  these tests too oftten?....many surgeons do not prescibe ultra sensitive tests for their patients. Like you many worry too much.........Think about the positive moments in life.

richardlvance
Posts: 10
Joined: Aug 2010

Get a 2nd opinion. Go to an oncologist that's not in the surgery or radiation biz.

 

If the PSA does get to the pint that they consider a recurrence its likely all you

need is an androgen blockade (pills and an injection).

There is no point in radiation unless you know where to radiate...

 

This is likely an artifact of the testing lab(s). Use a moving average instead

of looking at single points.

 

God bless, worry solves nothing and causes a lot of pain.

Da Wizzard
Posts: 8
Joined: Mar 2014

Hi,

Just received latest PSA results....

Recap.........Had RP 6 yrs 5 months ago....Gleason 6 pre surgery and Gleason 7 after surgery...

A.) For 6 yrs all PSA results were "LESS THAN 0.1  (<0.1 ).......

B.) Dec. 2013.....PSA = point one  (.1 )

C.) re-test two days later, Dec. 2013....PSA= ponit one ( .1 )

D.) six weeks later , Jan. 2014....Ultra-sensitive test PSA = point one zero three ( .103 )

E.) eight weeks later, March 17, 2013...Ultra-sensitive test PSA = point one two two ( .122)

going to Urologist on Friday to discuss results.

Currently, bummed out, disappointed, etc.......is IMRT next ? 

That's what the Urologist sort of suggested after last visit in Jan. 2014 when PSA was .103

Any suggestions or comments will greatly appreciated...thank you

 

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

Da Wizzard,

Since you have had your prostate removed, there is really only one thing that can cause a slow but steady rise in your PSA readings and I am sure you know what I'm talking about.  Recurrence following RP is not uncommon, even after six years, and there are many options available to treat this situation.

I'm interested to know what your urologist is recommending now that a trend is forming. If he encourages you to wait and see and think you should seek second opinions.  What would you be waiting for?  Many studies suggest that the earlier yout treat a recurrence the better your chances of long term recovery.

Likely options at this point are radiation to the area surround where your prostate used to be.  This is known as IMRT radiation and it unvolves 20 or more sessions.  It may or may not be done in conjunction with some form of hormone therapy that will be designed to slow the growth of PCa whilie undergoing radiation.  HT is not curative and it does carry risk of side effects, some of which can be serious, so be sure you understand what is likely to happen when you start that regimen.  Radiation is considered curative but there can be possible side effects as well but most of these pass fairly quickly.  Be sure your radiologist thoroughly reviews with you the potential side effects here a well.

One of the difficulties in treating this is the uncertainty as to exactly where in your body the PCa resides.  While the most likely spot is in the tissues immediately adjacent to where your prostate used to be, in fact the cancer can be in many other spots far removed from when is often referred to as the "prostate bed."  When they radiate this area, they're really just making the best guess possible lacking any other evidience.  Be sure to discuss with your urologist and consulting doctors methods that might be successful in pinpointing where your cancer may be but since your rate of rise is rather slow at this point, it may be that it is only at the microscopic level and can't be detected by even the most modern technologies.

Best of luck as you deal with these issues.

 

K

Da Wizzard
Posts: 8
Joined: Mar 2014

First of all , Thank you all for the comments and Kongo, your last comment was spot on...I went to the urologist that's been on my csae since thr RP ,DaVince method, back in Oct, 25, 2007...He's has actually become , sort of a friend, but he is honest by telling any good news and bad news, he is very up front which to me is a plus.

 

I went to him yesterday, Friday 3-21-14, and he said :

A.) Psa is (now) .122.......was .103 (Dec. 2013)....was August 2013... <0.1 (for 6 yrs.)......he said to forget about the last two digits of the Ultra -sensitive PSA test.....look at the .1 in Dec and Jan. and now March....to him it has not changed...

but the Ultr-sensitive  PSA test might be signialing a very slight upward trend.....103 to .122......his recommendation was to keep an eye on this trend and lets not do anything as long as it is below POINT TWO, (.2 ).....he noted that if it does not reach .2 then protocol does not even consider it a recurrance.....I agree with him as to this .2 concept as per things I have read ( mostly from John Hopkins Hospital )....but something has happened....< 0.1 for 6 yrs......

B.) I read that the most common pathology was T1c...I did not know mine so I asked...he told me that T1c is for PRE-OP and that mine is now a Post surgery pathology that is : P3 No Mo....I found out that Seminal Vesicle and Lymph Nodals were Negative.... Great news as per what I have been reading on web-sites.

C.) I asked what would be the recommended possible plan if the PSA trends up over the .2 treshold...I have been reading about three types of first step options: IMRT....PROTON THERAPY....something at UCLA, I think it's CYBER-KNIFE or RADIO -something........anyway, the Dr. explained all three to me....he noted that Proton Therapy is exact but we don't know exactly where the cells are ?.....he said Cyber Knife is similar as it will cover where the prostate was, sort of a rectangle area ......IGRT / IMRT would be what he is leaning to as a recommendation as it covers a scattered area that will include the prostate bed and the sourounding area....he felt if I were to consider what to do if the PSA goes above .2 it would be IGRT / IMRT....but all three therapies are available not far from his office...I would note that his group of Drs.that work together owns a new facility that does only IGRT / IMRT...but as per my readings, IMRT is usually the way to go at this stage if needed......the Dr. ruled out any HT at this time , as he felt the IMRT would do the trick because my Gleason 7 just reached the margin area and was not full blown outside the prostate. Thus, only IMRT should work.

 

D.) additionally, he spoke of the doubling time as an key element to any further treatment. He noted that he has a patient that had RP and then the PSA went to .2....he said this patient opted to still wait for another rise and that was 10 years ago...wow, lucky guy, to stay at .2 for 10 yrs.

finally, he asked me when I want to get another PSA test and office visit...offer was 2 mo., 3 mo. 6 mo....he told me that he knew I was conservative and wanted to stay on top of this.....he was right, I selected 2 months, for another Ultra-sensitive PSA test and office visit. Friends and wife have kidded me that I would go daily if it had any beneficial aspects.

Well, thank you all and lets hope modern medical science can keep us alive and healthy.....Da Wizzard 

 

 

Da Wizzard
Posts: 8
Joined: Mar 2014

previous comment should have been MARCH 17, 2014..........NOT 2013.....THANKS AGAIN

VascodaGama's picture
VascodaGama
Posts: 1554
Joined: Nov 2010

Da Wizzard

I am sorry for the increase. Still I think it better you follow your doctor’s recommendation and get another PSA test to satisfy his definition of recurrence. PSA=0.2 is the standard of the urological associations around the world.
In any case, the constant increase in ultra sensitive assays of tests done two months apart (your case) could already justify a recurrence diagnosis and therefore an earlier salvage treatment done before the threshold of PSA=0.2. This timing is something to be decided by you. What makes you feel better and in what you believe best. The outcome rates from earlier SRT do not differ much in small variations of PSA levels.

Typically the treatment of choice in similar cases is IMRT. The field of attack may vary and include apart from the prostate bed some lymph nodes at the iliac area. The pathological stage and info of post OP will be considered in the decision on the radiation field by the radiologist, and this is important for you to know because it may subject you to additional risks of collateral/indirect damages. However, once we decided to go through salvage radiotherapy, we should be looking for the “complete job” providing total cure. It is a good move to discuss in advance with a radiologist in regards to the possible side effects due to the field he most recommends.

Adding hormonal treatment in a RT combo is good. The purpose is to sensitize the cancer cell’s androgen receptors so that this will help in the “kill” by the radiation. The radiation portion is the one that can provide cure. This outcome, however, can only be verified in a combo treatment once the hormonal effects are cleared from our body. It will take time and cause stress for most of the patients, and the carrying physicians may want to know the final results of the RT the soonest, which could influence their suggestion on the protocol.

In my case of SRT post failed RP, I did only radiation reaching a nadir 13th months post RT (PSA=0.05) but experienced again biochemical failure and started ADT (hormonal treatment) 4 years after SRT when the PSA increased reaching the mark of 1.0 ng/ml

Each case is different but the sequential in treatments have not altered much since the beginning of the era of the PSA (1997). At present we can avail of newer drugs that will change the way we treat PCa. I am hopeful for the “discovery” of a good one while the Sequentials manage to control the advance of the bandit.

Best wishes and luck in your journey.

VGama  Wink

Da Wizzard
Posts: 8
Joined: Mar 2014

Summary:

6 yrs. after RP , psa was ( <0.1)

Dec. 2013 ...................(   .1 ) regular PSA Test

Jan. 2014.....................( .103 ) ultra sensetive PSA Test

Mar. 2014....................(  .122) ultra sensitive PSA Test

May 2014....................(   .091) ultra sensitive PSA Test........it went down........I'm Happy.....but confused......

Going to the Dr. in 3 days..........if it went up again I was considering doing IMRT.......why wait......let attack this CA the sooner the better is

my feeling and belief.......why let it get bigger and spread.......attack it sooner.......the Dr. was wait and see as it did not get to (.2)

and thus is not technically considered a recurrance of Ca...........is this going down just a margin of (+ or --) error in the PSA test.....

Did Ca cells if they returned die off on their own.........does that happen.......just confused............any advise for me to ask the Dr. in 3 dys will

be great as now I don't know where I stand.......also, thank you all so much for past advice and sharing.....Da Wizzard.....PEACE

 

 

VascodaGama's picture
VascodaGama
Posts: 1554
Joined: Nov 2010

Da Wizzard

You got another tiny value worrying you with no particular meaning at the moment.

 

The variations could be due to inflammation or recurrence or lab mess-ups but even with a salvage treatment already in mind this result wouldn’t alter the way to judge the affair. I think that a much higher PSA value with meaning would give you peace of mind. You would have a trigger to start the treatment.

Doctors advice salvage RT in guys of your status when fast rises occur and when the PSA reaches the traditional threshold of 0.20 ng/ml. This reasoning comes from many past studies done to find the benefits of salvage treatments at define earliest thresholds.
We get a consensus but the problem is that we have no means of locating the cancer when this is tiny colonies so that there would not be a aiming target to radiate. The radiation would follow a protocol pre defined from, again, past studies that have shown best marks in successful outcomes. All is done on guessing and we will have to endure the problem of the side effects caused by the treatment.

Why subjecting ourselves to such risks if nothing can assure us complete remission?

In any case one needs to treat but should choose the best timing and after obtaining proper diagnosis. SRT done on guessing looks for areas at the prostate bed (where it used to lay) and close lymph nodes but cancer could be hidden at far places too. Locating the bandit and zippppping it out for good is the purposes.
Typically low PSA values correspond to small tumours of less than 2 mm in size which size are undetectable in traditional scan machines (CT, MRI, Y-rays, etc). The best in the market to locate micrometastases are techniques that use special contrast agents. The USPIO examination with feraheme and the Combidex are best for locating cancer in soft tissue (lymph nodes). The C11 or F18 choline (FACBC) PET/CT scanning and the (68)Ga-labelled PSMA ligand
PET/CT examination are good to locate cancer in bone and soft tissues. The latest is now on trials to which you may try getting involved. Here are the details;
http://clinicaltrials.gov/ct2/show/NCT01808222

Combidex can be accessed in Holland only. It detects sizes of 2 mm. Here are some information;
http://www.prweb.com/releases/2013/4/prweb10600077.htm

Other reviews on contrast agents can be read here;

http://www.ncbi.nlm.nih.gov/pubmed/24135632

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843747/

http://survivornet.ca/en/news/pet_mr_detects_prostate_cancer_recurrence

 

 

When you comment “…my feeling and belief.......why let it get bigger and spread.......attack it sooner....“, it shows that you are out of date. Your confusion does not allow you to reasoning well. You need advice from specialists.

 

Hope for the best.

VGama

 

GSDk9's picture
GSDk9
Posts: 2
Joined: Aug 2014

I'm at 7 years after my prosatate removal, and it was a terrible operation, being opened up below in order for 2 surgeons to spare the nerves, etc. Even with the great news of the exterior biop of the removed prostate, that showed ZERO cancer cells on the exterior portion of the prostate, my PSA began to rise, slowly but surely at once. After the terrible operation, and months of healing, I would never elect to do it again, knowing what I know now and it didn't seem to make a bit of difference. Each case is different, but let me share this, my PSA is now at 3.1, so was it really worth it? For me no. I am 60 now, and slowing down a bit, ache a little more than usual, but is it the cancer or the age? LOL I know this, what directly effects my health and mental well being is stress. I bagged corporate America and all the BS and takers, and now live on a secluded mountain top in Tennessee and promote the Import German Shepherd Breed. If you want and need love and support, buy a high end German Shepherd to lower your PSA, and enjoy what days are left. In my opinion, there is no cure, so enjoy today.

hopeful and opt...
Posts: 1317
Joined: Apr 2009

I am glad that you have found a cause in your life, promoting the German Shepherd Breed.

I am sorry for the aggrevation that you have experienced.

Generally reaching a PSA of 0.2 is a sign of the continuation of the disease, and other treatment(s) is required.  A PSA of 3.1 high. When you say that that you " ache a little more than usual, but is it the cancer or the age? " I wonder if you are referring to aches in the bones? At any rate a bone scan is required to see if there has been metatisis to the bones. It is imperative that you visit with a Medical Oncologist, the best that you can find to determine a course of diagnostic tests and immediate treatment.

mertens_richard
Posts: 3
Joined: Aug 2014

I followed your posts and find them incredibly distressing for what has been done to you.  The word 'cancer' completely devastates many people but sadly, as you are now finding out, cancer of the prostate is not at all like other cancers.  If they found cancer in my prostate, I wouldn't even blink.  Basically, at my age of 55, it'd be a surprise if it wasn't there. (50% chance at that age).  How many biopsies?  The more you drill the more oil you will find is the saying.  Something you said did fly up and slap me and that is your doctor has an interest in a IMRT center.  This conflict of interest is called self referal.  That is not to say he is unethical but I and many others believe that self referal is fraught with ethical challenges.  You need another doctor, preferably one who has no financial stake in any aspect of PSA testing kits, surgery centers or other treatment centers.  And your numbers are miniscule, the result of a rejiggering of the standards based on some very shaky studies that some doctors are simply calling garbage.  Prevention and detection has been the battle cry regards cancer and in the case of most cancers that is good advice.  In the case of prostate cancer, though, what we have is a detection industry that has increased surgery rates by 18 fold with NO INCREASE IN SURVIVABILITY vs those who have never even been PSA tested.  Please, get another doctor.

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