PSA Rise

mmalar97

I had a RP in August of 2005. PSA tests for the first 3 years were 0.0. In the 4th year it was 0.1. I am now out 5 years and 3 months and it has risen to 0.2. I went to my surgeon and he said that any rise in the PSA is questionable. He also said that 0.2 is the limit. He said that I could have pelvic radiaition now. I just went through tongue cancer back in December of 09, and had 40 doses of radiation post surgery. The doctor said that he would like to retest my PSA in April of 2011(5.5 months out). He felt that he would like to monitor the level, and give my body a chance to recoup from the 40 doses of radiaiton I had January 2010 through March 2010. Do you think this is good medical advice, or should I go for pelvic radiation now? Michael

Kongo

PSA
Michael, I am sorry that you find yourself dealing with all the decision making stuff all over again after five years of undetectable readings. As your surgeon pointed out to you, the new standard for defining biochemical recurrence after RP is 0.2 ng/ml and rising, which is where you seem to be. The radiation you received last December complicates things a bit and although I am sure your surgeon is on top of his game, I would suggest you pose this question to radiologist who specializes in treating recurring prostate cancer about whether or not to delay treatment now. Since 2005 there have been some technical advances in how radiation is delivered to the prostate and the additional dosage very accurately delivered may not be as big an issue. Additionally, you may wish to consider hormone therapy in conjunction with radiation treatment.

From what I have read, the sooner you seek salvage treatment the better the long term prognosis and I would be nervous about waiting another six months. What would they be doing to monitor the level if they weren't planning another PSA until April? If your really want to see if it for sure is going up (and it sure seems to be) do it again in one month not six. Given the apparent PSA velocity your readings show, I would be keen to address it as soon as possible.

Best of luck to you.

cyberator_2

PSA Rise
mmalar97 (Michael) - I'm in a very similar situation to yours. I had a RP in August 2005, my PSA was undetectable until four years after surgery, where it turned up at 0.1. That was in July 2009. In October 2009, it went to 0.2. Since then, I've been getting it checked every 3 months and at my last check in Sept 2010, it was 0.23. Personally, I am not rushing into SRT. I don't see the need to. Many factors have to be considered. For example, your pre-surgery PSA, your pathological Gleason score, whether or not you had extra capsular extension, perineural invasion, the time to PSA recurrence, PSA doubling time and, of course, the absolute PSA number. SRT will only help if the cancer is in the prostate bed - that is - if it is even cancer that is causing the PSA to register. It could be benign prostate tissue left over after excision of the prostate that has been slowly growing and is just now beginning to register on a PSA test. No treatment in PCa comes without the risks of side effects. I don't want to stray you away from Kongo's advice or recommendations. I've read many posts from Kongo and I highly respect his insight and opinions. He has obviously conducted extensive research. But, for me? I'm going to take my chances - get more data, study the trend in my PSA doubling time and see what happens. When I hit a PSA of 0.4, I'll pull the trigger on SRT. While it is true that the earlier you start SRT, the better the outcomes, there is also a good chance that SRT may not be curative (because the cancer wasn't localized to begin with) and you can potentially end up with a rising PSA anyway, but now with added side effects such as urinary incontinence, urethral strictures and/or bowel incontinence. It is not an easy decision. Best of luck to you in whatever you decide to do.