Question about Biochemical recurrence

456 retired

Gentleman,

New guy to this site but old guy in the program. I had my Robotic in 2010 that pushed the PSA back to .008 for three years. The PSA has been slowly creeping back up to a current .238. I have been looking for the right questions to ask, and came across a point made by a contributor on this site. How does one know that the prostate cells,  presumable left behind in the surgery, shown by the rise in PSA are cancerious or benign? I'm 72 and luckly in pretty good health other than this. I would like to avoid SRT complications and hope there are a few years ahead. Thanks for your input.

Jim

Old Salt

There will be a few years ahead

The possibility that your current PSA level is due to cells that had escaped from the prostate prior to the surgery needs to be considered as well, unfortunately! In that context, it would be highly useful to know the pathology of the excised gland. Can you provide that info, please?

VascodaGama

More than a few years ahead

Retired

Welcome to the board.

I cannot fully understand your inquire. Do you want to know if is there any possibility that the increasing PSA belongs to benign cells?
Or are you inquiring if you can avoid a salvage treatment due to your age, in particular avoiding SRT?

The PSA alone that you provide is not enough to substance an opinion. I doubt that the increase from 0.008 to 0.238 in four years belongs to a piece of benign prostatic tissue left behind. It could be from a cancerous piece left behind or from metastases already set before the surgery. By logic you do understand that benign tissue do not duplicate the PSA in such amounts, unless one is confronting a hyperplasia case (when the whole gland is in place). The number of cells increase so that the PSA increases too. Benign cells duplicate and die maintaining the initial number. Cancerous duplicate and do not die. They take the place of benign (squeezing those away) and travel to other friendly places were they manage to survive and expand.
There are robotic cases where tiny benign pieces were left behind producing serum but such do not duplicate as seen in continuous increases (your case).

SRT can be nasty but administered by responsible and specialized physicians is a friendly approach more than what one may think. The isodose planning can be done according to what it is needed and it can be planned to avoid those areas critical for risks or side effects, at the wish of the patient. It also can be done based on proper image studies (PSMA PET/CT plus 3tMRI) locating the bandit, therefore limiting the scope of attack, avoiding areas of concern.

Hormonal manipulations (ADT) also manage to hold (at its track) the advancement of the cancer if one's type of cells respond to the treatment. This works well during many years and can be administered intermittently, allowing periods of recovery away from symptoms. ADT is also linked to risks and side effects. Some guys experience mild symptoms but some got them nasty. One needs to be fit in terms of heart health and diabetes.

I suggest you to share more details so that survivours can provide you ideas based on their experiences.

Best wishes.

VGama

456 retired

Biochemical recurrence

Gentleman,

DaVinci 0n 4/5/2010

PSA stayed < .008 thu 11/26/2012

Then .044 12/6/13

        .057   6/4/14

         .079 12/5/2014

         .112   6/4/2015

         .115 11/11/2015 

         . 151 5/31/2016

         . 238  2/1/2017

At the surgery I was 3.8 PSA, pt2c, 3+4(7) Gleason, carcinoma confined to prostate approx. 10%

My surgeon offered that if I was 60 rather than 72, there would be no question but to do SRT. My older brother went through a similar pattern and had difficulties with both the prostatectomy and SRT. His PSA is over 50 now and scans are still negative. 

I have tried the internet nomograms of both Johns Hopkins and Sloan Kettering with the outcomes being radically different. I very much appreciate your insights and suggestions as I'm still looking for the questions and hopefully answers. VGama, I think that is yes to both your points.

Thanks again

Jim

 

 

 

 

 

 

 

 

 

        

Steelchuggin26

Unfirtunately such subsequent

Unfirtunately such subsequent rises and breaching the 0.2 threshold does indicate biochemical recurrence. Benign cells left behind would not rise psa levels like that. You could probably do hormonal therapy in place of radiation, but it too has sude effects that must be considered. 

 

Hate to hear that ut looks likely tyat it has recurred,  but it still can be controlled, or even cured .

 

VascodaGama

Rrecurrence

Jim,

I agree with Steelchuggin opinion. You have clinical failure so that you should look for a salvage therapy. AUA recommend to sart a therapy when the PSA gets to 0.4 but you can start before as recurrence became evident. I would recommend you to get second opinions from a radiologist and medical oncologist. I also suggest you to read about the side effects involving radiation or hormonal therapies. Here is a link to help you;

http://www.ccjm.org/index.php?id=105745&amp;tx_ttnews[tt_news]=365457&amp;cHash=b0ba623513502d3944c80bc1935e0958

Best wishes,

VG

permanent anxiety

Confromal Radiation

Completed 39 treatments with confromal low dose radiation for T1c, with no masses and competely encapulsated. Also had BPH (62 grams). 3 of 12 postive needles , Gleason 6 < 50% ca in each needle. Injected with 6 month Eligard and started RT treatment in 06/08. PSA's have been as follows since 2008. Nadir .01 on competiton of radition 6/08. Down from 4.5 on original dx/biopsy. PSAs  have ranged from Nadir of 01.1 to 0.93, (also had an 0.93 & 0.9 draw) with frequent ups and downs in between. Never above 1.0. Had settled in at 0.6 from 7/13 to 0.48 9/16. And now, back up to 0.84 3/17. Been bouncing around as high as .93 (11/09) and low 0.48 9/16.  Numerous draws as Internist and Urologist didn't like variance in PSA progression. Rad Ono didn't have a problem with PSAs,  and was concerned that they were tracking PSAs too frequently. Left RO and continued to be followed by Urologist and Internist. Uro was impressed with drop to 0.48 om 9/16, now his semi-annual draw came in at 0.84 on 3/17 and that will get his attention. Wish I had RP, but that's history. I was deemed successfully treated by RO after 6 years and PSAs not exceeding 1.0. Am concerned that they've been all over the chart and Radiation may not have been the play. Anybody out there with variable PSAs on 20 or so draws approximate 8 year period? Don't know if it is normal or if ca was ever completly eradicated, or it may have come back. Eligard shrunk prostate to 50 grams, and that's what they did RT on. Prostate still has BPH tissue, negative on DRE. On flomax. Urologist did find polyp on prostate, removed it, biopsy came back negative for ca but did have BPH tissue. Other than above everything works fine with U&B functions, sex thing of past. 69, good health, very active, no other problems.

VascodaGama

Unique bounce PSA

PA,

Your screen name fits well in this forum. Once diagnosed and treated nobody assures cure and anxiety sets in at every PSA test. Your story is unique for its extended 8 years in bounce PSA. I have read about long bounce periods in RT patients but the longest was 4 years before reaching a nadir. I would believe that your nadir was the test of September 2016 P=0.48 ng/ml.

I am curious regarding your late biopsy and interventions. Can you tell us how many cores have been drawn? What was the content of the polyp, any calculi? Do you have urination problems? What about image studies? Are you taking other medications or supplements that could be masking the PSA?

The increase from 0.48 to 0.84 in six months could be a cause of diagnosed BPH or due to other reasons that may have influenced the day you drawn blood. Recurrence in guys with the gland in place is typically attested after three consecutive rises or when the PSA reaches nadir plus 2.0 ng/ml (2.48 in your case). Surely nobody knows if such serum origins from a metastasis away from the gland.

Best wishes,

VG