Rising PSA after Radical Prostatectomy - Doubling time

CarlosAlberto2

One year pos RP and PSA stable

I just received PSA result one year after RP . And, thanks God, still at same value of 0.03 than previous test 3 months ago. We never know if the bandit is alive, but at least ,it not doing bad!

Best for you all

Carlos

 

VascodaGama

CarlosAlberto2 said:

One year pos RP and PSA stable

I just received PSA result one year after RP . And, thanks God, still at same value of 0.03 than previous test 3 months ago. We never know if the bandit is alive, but at least ,it not doing bad!

Best for you all

Carlos

 

Congratulations

Congratulations, Carlos.

Remission is so nice to have it. I am very happy for the news.

Another excuse for a glass of Esporao Red.

VG 

CarlosAlberto2

15 months after RP

Just to update. PSA 15 months after RP continues on 0.03

My doctor passed me to 6 months monitoring due to stable values. It´s a good notice, but I will keep at least one more test at 3 months, before that. But of course I will celebrate with 2 glasses of Red Esporão (following V Gama preference), 1 by the result and the second for my 60 birthday.

Wish you the best

Carlos

CarlosAlberto2

Back to forum 3 years after RP

Hi!

I´ve been absent from the forum because I wanted to forget my situation and live my life as better as possible.The results of PSA after RP started to 0.05 but has been decreasing to 0.03 and finally to 0.02. Everything was very nice, and life beautiful! Today I got the result of last analysis related to 3 years after RP. And the hell came again. In six months growed from 0.02 to 0.14. According my readings relapse is considered only when there are 2 sucessive readings of 0.2ng/ml. However with the speed of increase I´m afraid that the relapse is a fact. Has everyone experienced similar situation without relapse?

Dear Vasco, I call for your expertise now. I will go to my urologist this Friday, to what I must be prepared? I believe that he will tell me to wait 3 months and do another test, to see evolution and speed and take conclusions. Do you believe I need to ask for a bone scan or PET scan?

Thanks my friend

VascodaGama

There are means to control Recurrences. Do not panic

Hi Carlos,

I am sorry for the PSA increase. In any case you should try to be positive avoiding anxiety. At first instance the increase could be thought to be recurrence but it could also be a laboratory error. Either you confirm the result (laboratories keep the blood sample for ten days) requesting a repeated test (they do it free of charge) or wait for another PSA test done in preference at the 6th week (or later) from the first test. For peace of mind you can do the test by yourself at a reliable laboratory (I use Aqualab) if your doctor doesn’t agree with your wish in having it earlier.
Please note that our NHS covers this test so that any GP can give you the referral. At your own expense it would cost you 32 euros.

When a constant increase of the PSA is verified, the status is called Biochemical Failure. Once the increase passes the PSA=0.20 ng/ml mark, the status is upgraded to Recurrence. Intervention (salvage treatment) is done at a PSA >0.40 ng/ml. The above is typical but one may decide to have it earlier or much later; however, there is no evidence that having a salvage treatment done earlier (as soon as we get an increase) one get better outcomes. You have time…..don’t panic.

It is true that the PSA after radical prostatectomy should stay low (< 0.05 ng/ml) because we have no gland producing PSA serum, but there are rare cases when tiny pieces of the prostate tissue is left behind (at negligence of the surgeon), which will grow and increase the PSA serum. These could be benign or cancerous cells. That is the reason for doctors to consider at least two consecutive significant increases (PSADT < 14 months starting from the first increase) for declaring recurrence at an earlier date.

I recall that post manual laparoscopic surgery your pathological stage was classified pT2c N0 M0. The report upgraded your Gleason score to 7 (3+4) and it neither found extra capsular extensions nor seminal vesicles involvement. I wonder if any check has been done of the lymph nodes. I do not know where you were treated or how reliable the doctors and facilities are. To continue treatment you may consider changing to medical oncologists or specialists on radiotherapy (both; oncologist radiologists and modern radio facilities).

Recurrence doesn’t mean that you are doomed. You can kill the bandit with salvage radiotherapy (SRT). This is the sequential treatment that better can assure cure. Typically it is done at by IMRT machines which facility is found at major hospitals or at radio-nuclear facilities. There are differences in equipments so that you should look for the latest models and modern machines. Coimbra and the Porto’s IPO may have the best in Portugal.
In any case your first step would be trying to locate the hideaways of the bandit so that you can have higher assurances of a successful outcome. In Coimbra hospital they do the latest technique in image studies, using special contrast agents in PET scans. These may find tiny tumors at a PSA level above 1.0 ng/ml. Can you wait for your PSA to increase to that level?

In your next meeting try discussing about salvage treatments and means of locating the cancer (ga68 PSMA PET/CT scan). The traditional way uses the data from an MRI and is done in the dark (kind of guessing). They radiate the prostate bed and local lymph nodes but the cancer cold be at another location. That was my case so that I recurred again after the SRT.

I hope that the all saga was due to a laboratory error. Probably your next post will confirm that. I am available to help you in understanding facts based on my experience (send me a csn mail). Just do not panic. Read my story regarding PET exams in here;
https://csn.cancer.org/node/290854

Best wishes,

VGama

CarlosAlberto2

Friday cisit to doctor

Thanks again Vasco for your advices. I´m very thanhkeful for your comments. I went to the doctor last friday, and basically he was a bit surprised with the result of 0,14 ng/ml. He says first is not common such a fast progression in six months from 0.02 to 0.14, and even when my margins and nodes pós- cirurgy forense analysis were clean. So first of all he want me to repeat the test 1 month later, on same lab. Base on the result we will proceed. If it was a wrong test by some reason, everything is OK, but if the result is the same or if there is any progression his opinion is to go for salvage radiation. His opinion is that is preferable earlier than wait for further progression. I´ve asked about simultaneous hormon treatment, and he told that depends on the result and speed of variation, but he was not yet clear. Just said that we will discuss later with the second test result on hand.

My previous test was made at 12 of February so I will a bit anxious up to middle of March to know this second test result.

Thanks again and Regards

Carlos

 

 

Old Salt

CarlosAlberto2 said:

Friday cisit to doctor

Thanks again Vasco for your advices. I´m very thanhkeful for your comments. I went to the doctor last friday, and basically he was a bit surprised with the result of 0,14 ng/ml. He says first is not common such a fast progression in six months from 0.02 to 0.14, and even when my margins and nodes pós- cirurgy forense analysis were clean. So first of all he want me to repeat the test 1 month later, on same lab. Base on the result we will proceed. If it was a wrong test by some reason, everything is OK, but if the result is the same or if there is any progression his opinion is to go for salvage radiation. His opinion is that is preferable earlier than wait for further progression. I´ve asked about simultaneous hormon treatment, and he told that depends on the result and speed of variation, but he was not yet clear. Just said that we will discuss later with the second test result on hand.

My previous test was made at 12 of February so I will a bit anxious up to middle of March to know this second test result.

Thanks again and Regards

Carlos

 

 

Makes sense

to repeat the test in a month and go from there.

Good luck!

CarlosAlberto2

Thanks Old Salt. I´ll do it,

Thanks Old Salt. I´ll do it, and try to stay calm up to get the new results. Anyway I´m not very hopefull on this eventual lab error. So, I´m trying to prepare the best decision when needed to next step. And my main questions here are:

When to make the radiotherapy? immediattly even with 0.14 or wait up to two consecutive readings of 0.2?

Do the radioterapy alone or with simultaneous Hormone therapy? I heard that efficay of RT with HT is higher, but I am afraid that starting now the HT I am shortening the life time of possible HT if there is no cure.

 

Vasco I´ve tried to pick up your mail adress to send you a message in portuguese and local informations, but I had no sucess. 

 

Regards 

 

VascodaGama

CarlosAlberto2 said:

Thanks Old Salt. I´ll do it,

Thanks Old Salt. I´ll do it, and try to stay calm up to get the new results. Anyway I´m not very hopefull on this eventual lab error. So, I´m trying to prepare the best decision when needed to next step. And my main questions here are:

When to make the radiotherapy? immediattly even with 0.14 or wait up to two consecutive readings of 0.2?

Do the radioterapy alone or with simultaneous Hormone therapy? I heard that efficay of RT with HT is higher, but I am afraid that starting now the HT I am shortening the life time of possible HT if there is no cure.

 

Vasco I´ve tried to pick up your mail adress to send you a message in portuguese and local informations, but I had no sucess. 

 

Regards 

 

Don't Panic

Carlos

I have sent you a mail. I understand your worries but you need to do things coordinately and timely. A PSA of 0.14 is very low. There are guys with PSA levels much above 20. The doubling time may be critical but it is too early to certify such velocity. You doing it well in researching means for a SRT in case recurrence becomes apparent.
You should also look for RT facilities in Portugal, as well as gathering information regarding the side effects that RT may cause.

The combination treatment of hormonal plus radiation is better but in SRTs done in the "dark" (without identified targets) the hormonal portion will cause the PSA to go down, making this marker unpractical to judge treatment success. You should also research about the side effects caused by HT before deciding.

I recommend you to wait till the next PSA test to verify recurrence. Be positive.

Best wishes,

 

VG

CarlosAlberto2

Update to my last post
After

Update to my last post

After my PSA test of 0.14, and following the recomendation of my doctor urologist, I´ve made another PSA test 2 months after on same lab and just received the result. It cames surprising lower with 0.06. I asked the lab to repeat the sample and they confirmed same result. Well, is still an increase from previous 0.02, but came to a level where my doctor urologist says to do nothing, and repeat the test on June.

So I have for now a relax period of 2 months.

Wish to all the best

Regards

 

Old Salt

CarlosAlberto2 said:

Update to my last post
After

Update to my last post

After my PSA test of 0.14, and following the recomendation of my doctor urologist, I´ve made another PSA test 2 months after on same lab and just received the result. It cames surprising lower with 0.06. I asked the lab to repeat the sample and they confirmed same result. Well, is still an increase from previous 0.02, but came to a level where my doctor urologist says to do nothing, and repeat the test on June.

So I have for now a relax period of 2 months.

Wish to all the best

Regards

 

That's nice

You can breathe more easily now.

Have a glass of (your best) port!

VascodaGama

Good News

I also join the party with glass of Port.

I am glad for the news about the PSA. Please contact me whenever you want to talk on the matter. We can go over it while enjoying a golfing day.

Best

VG

Josephg

VascodaGama said:

Good News

I also join the party with glass of Port.

I am glad for the news about the PSA. Please contact me whenever you want to talk on the matter. We can go over it while enjoying a golfing day.

Best

VG

Good News

I will also join all of you tonight with a toast to the news!

CarlosAlberto2

Good news

Thank you guys. I am enjoying these moments and having fun, taking advantage of periods of good weather to my last pleasure, playing golf. And enjoying family dinners with a good portuguese red wine.

Vasco, if you come to Lisbon call me, to go play golf together. I just started one year ago and my handicap is still high (28) but for fun. If I go to Algarve I also will call you in advance. 

Abraço Vasco

Regards and best wishes to all.

 

Carlos

CarlosAlberto2

Concern again

Sorry by my long silence of 1 year. Let me update my progress:

Since April 2016, the PSA has been stable at 0.06 but this last test done past week gave a result of 0.09. It is exactly 4 years after RP. I Know that some specialists consider "undetectable" when<0.1, but I am already in the border line, and what concerns me is the increase in 3 months from 0.06 to 0.09. Well I will have a visit to my Urologist this Friday to know what is his recommendation. I believe I will not escape from radiation sessions, my dought is at what level of PSA is more effective. I have read different papers, but in general the recommendation is to be done before PSA reaches 0.2 . Some thoughts or experience about this? I would appreciate.

 

Max Former Hodgkins Stage 3

CarlosAlberto2 said:

Concern again

Sorry by my long silence of 1 year. Let me update my progress:

Since April 2016, the PSA has been stable at 0.06 but this last test done past week gave a result of 0.09. It is exactly 4 years after RP. I Know that some specialists consider "undetectable" when<0.1, but I am already in the border line, and what concerns me is the increase in 3 months from 0.06 to 0.09. Well I will have a visit to my Urologist this Friday to know what is his recommendation. I believe I will not escape from radiation sessions, my dought is at what level of PSA is more effective. I have read different papers, but in general the recommendation is to be done before PSA reaches 0.2 . Some thoughts or experience about this? I would appreciate.

 

My read

Carlos,

It seems to me you are assuming the worst regarding your numbers. Most likley your doctor regards the drift in results still simply udetectable, and not a recurrence. As you noted, doctors and clinics vary on the tripwire level for this.  Ask your clinic what their own definition of recurrence post-RP is, which I'm certain you will do Friday.  I'm interested in what they say.

Dr. Peter Scardino, Chairman of Surgery at Sloan-Kettering Cancer Center, NY, writes that The best chance for success [with salvage RT following RP] is to have the radiation before your PSA reaches 0.5, though the earlier the better.  (Dr. Peter Scardino's Prostate Book, page 459) Whomever you got the .2 number from sounds as if they just drove that number way lower, perhaps arbitrarily.  Dr. Scardino also adds on the same page, "If the PSA rises above 2.0, the odds for a cure decrease significantly."

It may be that they will tell you that your PSA simply remains undetectable by their metrics, and nothing but periodic testing needs to be continued at this point.  You know that none of us is a doctor; we share only our layman's opinions.

max

VascodaGama

Stil in tranquil waters

Carlos,

I think you are still navigating tranquil waters. The increase may have a meaning but it's still very low and far from the 0.2 you commented above. Constant increases mean biochemical recurrence, leading through wards clinical failure. For such timing, your urologist will have a threshold to trigger intervention. Typically NCCN (AUA) guidelines use PSA=0.2 to declare recurrence and PSA=0.4 to start a salvage therapy. There are no studies confirming that treatment at <0.2 would provide longer survival than at 0.4.

Most probably your doctor will suggest salvage radiotherapy (sequential after RP) when your PSA reaches his threshold. However, I would recommend you to try getting a PSMA PET image study to locate the bandit. This can shorten the scope/field of radiation and probably limit the risks and RT side effects. Surely the probabilities of detecting the bandit are higher if the PSA is above 0.2 (higher better) at the time of the scan.

I know how easily you become worried so it wouldn't surprise me if your golf handicap has increased to 36 (the capicua of your age, I guess). Again, I advise you to wait till such PSA gets a definite meaning and then proceed coordinately. This might take years (if any). Radiation in PCa therapies affects the colon so that you should start thinking in including in your annual health check up a colonoscopy.

Best wishes.

VGama

Josephg

Urologist versus Oncologist

Hi Carlos,

Hang in there.

I see only 2 rising PSA scores in your description.  As such, having a third sequential PSA score is generally recommended, before making any projections on trends and rates of change.  That third test is three to six months away.  I suggest that you continue your research (which you are already doing), but also make sure that you take time to enjoy life, and those persons in your life.

Just my lay person thoughts.

I wish you good luck and success on your journey.

CarlosAlberto2

My visit to Doctor, this Friday

Hi dears Max. Josephg and Vasco

I just came from my urologist (always the same that made the RP) and he told me that this value (0.09) is still on the range of undetectable, but because is a raise he asked me to do another PSA test on 4 months (July). He told me that the biochemical failure is considered only when ther is two readings above 0.2, but he racommends to proceed with radiation treatement before that value. His normal procedure, according him, is to proceed with radiation when there is two consecutive and significant increases above 0.10. I asked for example and he told me if you have a measurement of 0.12 nd 6 months after you have a test of 0.15 . We immediatly repeat this last test and if confirmed it would be his racommendation to proceed with radiation. However, he told me, I am still far from that triggereing point, and I am not yet in biochemical failure.

So, Vasco, I will continue at my golf, which you are right, due to this reason , my handicap was suffering.

Thanks guys for your support and I wish you the best.