Low But Slowly Rising Post-Surgery PSA Over 13 Years

billmoore

I had a radical prostatectomy in 2001.  My pre-surgery PSA was 11, my Gleason score was 7-8, and there was cancer in the seminal vesicles, but none in the margins or lymph nodes.  I've had no post-op treatment of any kind.  My post-op PSA went to less than .04, but has gradually crept up over the 13 years since my surgery and is now .31.  The increases ha e been roughly linear.  I was at .15 in 2008, and experienced a .03 decrease in 2011.  I am not one to pursue aggressive measures to stomp out a condition that may or may not be indicative of a recurrence.  And in fact, in a discussion with my urologist two years ago, I was told that based on the very slow progression of my PSA, I may just be harboring some residual condition that's not going anywhere, and that he could no reason for further treatment unless I were to experience a sudden and significant PSA spike.  I am 71 years old, in excellent physical condition, and have no other health issues.  What do you think? 

VascodaGama

Significant increases

Bill

Welcome to the board.

PSA= 0.31 is low, however the continuous increase from 0.04 (ng/ml) along your 13 years of survivorship is significant. Your doctor has not recommended any other test (apart from the PSA) to look for a possible reason of the increase but I think that you could get tested, such as CTC (circulating tumour cell) count and an image study (MRI-3t), just for peace of mind.

In some cases after prostatectomies there have been tinny variations in PSA due to small pieces of prostatic tissue left behind. These may be benign and it would produce the serum. In any case, recurrence is not identified by a spike but by continuous increases, which is your case.
Some doctors in situations similar to yours would declare recurrence when the PSA reaches their threshold to trigger action in salvage therapies. AUS recommends the threshold of PSA=0.2 ng/ml. What is the marker of your doctor?

This is a difficult situation for you at 71 and healthy. Probably your best shot is to get a second opinion from other specialized institution (Mayo, Johns Hopkins, Sloan Kettering Cancer Center, UCF, etc).
You wouldn’t need to get treated right-a-way but it would provide you with means of control, in case things get “sour”.

Best wishes.

VGama   

billmoore

VascodaGama said:

Significant increases

Bill

Welcome to the board.

PSA= 0.31 is low, however the continuous increase from 0.04 (ng/ml) along your 13 years of survivorship is significant. Your doctor has not recommended any other test (apart from the PSA) to look for a possible reason of the increase but I think that you could get tested, such as CTC (circulating tumour cell) count and an image study (MRI-3t), just for peace of mind.

In some cases after prostatectomies there have been tinny variations in PSA due to small pieces of prostatic tissue left behind. These may be benign and it would produce the serum. In any case, recurrence is not identified by a spike but by continuous increases, which is your case.
Some doctors in situations similar to yours would declare recurrence when the PSA reaches their threshold to trigger action in salvage therapies. AUS recommends the threshold of PSA=0.2 ng/ml. What is the marker of your doctor?

This is a difficult situation for you at 71 and healthy. Probably your best shot is to get a second opinion from other specialized institution (Mayo, Johns Hopkins, Sloan Kettering Cancer Center, UCF, etc).
You wouldn’t need to get treated right-a-way but it would provide you with means of control, in case things get “sour”.

Best wishes.

VGama   

Another PSA Decrease

My latest PSA was .29, down from .31 six months earlier.  My urologist says my readings appear to him to be consistent with the continued existence of benign prostate tissue.  I assume that's tissue that was left after the prostatectomy.  I appreciate your recommendations on the additional tests and the consultation with a more specialized facility.  For now, I'm not so concerned that I feel I need to pursue either, but will keep them in mind if further PSA results should seem to warrant.  By the way, my prostatectomy was done by Dr. Fray Marshall, the then head of urology at Emory University Medical School.  I believe he acquired his skills under Patrick Walsh at Hopkins.  Unfortunately, Dr. Marshall died a couple of years ago.  I continue to do my followup at Emory.