Prostrate cancer PSA

Stephens1961

I am a 60 year old man that has had his prostrate removed Sept 2021. I had a PSA of 36 with a Gleason score of 6. Stage 2 because of the high PSA but also BPH

I had been on active surv since 2013 PSA of 2 . In 2013 I had my first biopsy were one needle out of 12 cores showed Gleason score 6 on 5 % on the needle but spend 3 days in the hospital with Sepsis after the biopsy. I have had 4 separate biopsy’s since with MRIs with CT scans and Bone scans. All negative except the 2 MRI showed in the Prostrate 2 possible locations of cancer.

My last biopsy before prostrate removal was a saturated type 32 samples with MRI imaging were cancer was again found on one needle 25% Gleason 6.

My latest after surgery my PSA is staying at 4. It should be at less than .01. My latest test was a PET scan and results is negative.

my Urologist is working hard trying to find answers but I am trying to see if others have had this type of situation

I am heathy and feel as good as one could at 60 years old after major surgery.

Old Salt

Time for a more sensitive scan and a consult with a medical oncologist with experience in prostate cancer.

These days, PSMA scans are an attractive option.

Stephens1961

Thanks I did have a very sensitive PET Auxim

VascodaGama

Hi,

Apart from an error in the laboratory testing, I can't see any logical meaning that could justify a PSA of 4.0 ng/ml in a case with the story you describe above. How about repeating the test?

I wonder what has been the PSA histology since September 2021 after RP. Typically the first test is done within 3 to 4 weeks post surgery and followed by a test 3 months later. You are exactly at the three months milestone.

Can you tell when and which tracer was used in the PET scan.

Best

VG

Stephens1961

 10.2 mCi of Fluciclovine F18 

4.1

3.59

3.71

Stephens1961

My PET scan was Thursday Jan 13, 2022.

VascodaGama

Thanks for sharing.

I presume that the PSA of 4.1 was the first done after RP. The last one of 3.71 would represent a decline. In any case, all the results signifies biochemical failure and probably recurrence as our body takes about two to three weeks to dispose/clean the PSA serum in circulation.

In my case of Gleason 6 diagnosis (back in 2000) I had a high PSA of 24.2 ng/ml with negative imagery tests but a voluminous cancer occupying 2/3 of the gland which justified the initial high PSA. However, like in your case, I had biochemical failure soon after RP with PSA of 0.20 ng/ml at the 5th month.

Oncologists considered me having micrometastases which seems to be typical of Gleason rates 3 and below that do not forms solid tumors. They are thought to exist at the urethra and prostate bed, not spreading to distant areas. Tradional MRI or CT scans would not detect these metastatic colonies. I would suggest you to repeat the PET scan using a PSMA isotope. The F18-PSMA would be my choice in the area adjacent to the bladder.

Please read this andthe links attachedtothearticle;

https://jnm.snmjournals.org/content/61/supplement_1/1262

bestwishes and luck in your journey.

VGama

Stephens1961

Thank you for your reply !!!

can you tell me what type of treatments you have had to

keep your cancer in check for over 20 years?

Its been a long battle so far and your helping!!!

VascodaGama

You can read details about my long story in surviving PCa through my threads listed here:

VascodaGama — Cancer Survivors Network

One should agree that treatments' protocols have improved along the years and each case is different even if thought to be similar. My story is not to be compared but you can use it to educate on the matter and be better prepared to discuss with your doctor on your next steps.

I did RP followed by SRT and then ADT in a sequential manner. Nowadays doctors choose combination therapies which seem to have higher success. Though therapies are not free from risks and side effects so that you need to find what gives you comfort and trust and then advance wisely.

Guys here will help you understanding the facts.

Best,

VG

Old Salt

To emphasize what I wrote earlier and what Vasco suggested as well:

The axumin scan is an excellent one, but its 'mechanism' is distinct from that of PSMA type scans. The latter target PSMA, a protein found near the surface of prostate cells. In many prostate cancers this protein is more highly expressed, but this is not always the case. Therefore, although one cannot state that this type of scan is better at detecting the location of 'wayward' prostate cancer cells, it does offer a different approach that might be worthy of consideration, especially because the axumin scan didn't find anything relevant.

Clevelandguy

Hi,

If it was me I would wait for a few more PSA tests to see if your PSA number is progressing at a high rate or just hovering around the 3-4 level. You would think with gland removal your PSA should be undetectable, hard to tell the cause at this point. I would think something is definitely going on if your next few tests indicate an ever increasing PSA #. Sometimes you have to wait a while for the cancer to shows itself on any type of scan.

Dave 3+4

moksha2022

Thanks for this thread - it was the kind of discussion I was looking for.

My question - see the PSA number graph below. What confuses is me is the "normal" range shown. In 2017 "normal high" drops from 3.0 ng/ml to .99ng/ml. Why? Also, based on these PSA numbers and my age (65+) I have had a biopsy - and yet another. I'm seeing 3+4 and 4+3 and 3+3 Gleason scores on 3 of 12 cores. I'm awash in technical data here - and trying to come up to speed, but it's a bit overwhelming.

Thanks!

Stephens1961

https://csn.cancer.org/discussion/comment/1692532#Comment_1692532

Thanks for the info

after my many needle biopsies I would suggest a MRI on your prostrate to see how the tumors are growing. Active survaliance is always good, ask if they can look further in your biopsies to see the type of cancer and if the genes show how aggressive the 4+3 is.

good luck on your journey!!!

Old Salt

It looks to me that your PSA dropped from 2.9 to 2 (roughly) and then went up to about 3 and then 4 (Jan 2021). Since then, your PSA has dropped a bit. The green lines don't make much sense to me. For instance, only people (not taking ADT type drugs) without a prostate can have a zero PSA. Moreover, 'normal' PSA values go up (slowly!) with age.

I gather you are in an active surveillance program? Whatever, I agree with Stephens that further investigation is warranted.

Sorry if I misunderstood.

moksha2022

I am in the lead at "misunderstanding" all of this - you'll have to catch up. (or fall back) ;-)

The last biopsy done in early December 2021 and was definitely guided by an MRI.

Here are the results:

==============================================================

Pathologic Diagnosis

Malignant neoplasm of prostate [C61] - primary.

A. Prostate, right lateral base, biopsy:

Prostate tissue with no significant pathologic change

===> all remaining right side prostate samples (B through E) repeat above.

   

===> Below are the findings on the left side. (F through J)

F. Prostate, left lateral base, biopsy:

Prostatic adenocarcinoma, Gleason score 3+4=7,involving 2 of 2 cores and 40% of the tissue

Perineural invasion

G. Prostate, left lateral mid, biopsy:

Prostatic adenocarcinoma, Gleason score 4+3=7, involving 2 of 3 cores and 10% of the tissue

H. Prostate, left apex, biopsy:

Prostate tissue with no significant pathologic change

I. Prostate, left mid, biopsy:

Prostatic adenocarcinoma, Gleason score 3+3=6, involving 1 of 1 core and 5% of the tissue

J. Prostate, left base, biopsy:

Prostate tissue with no significant pathologic change

-------------------

K. Prostate, ROI #1, biopsy: (ROI = region of interest)

Prostatic adenocarcinoma, Gleason score 4+3=7,

involving 3 of 3 cores and 60% of the tissue

• Perineural invasion

=========================================================

That's it .... I'll be getting another PSA measurement at the end of January and then consulting with my medical wizards on how to proceed. Surgery?

Stephens1961

Thanks for recent MRI guided results.

a PSA of 4 at age 60 plus could be considered normal and if you have BPH. The score of 4 + 3 will be a concern but only in one side of your prostrate which is also good!!! Surgery is one option that you will need to be talked about but look at other options depending on your overall health. It’s not a pleasant surgery and it does takes weeks or months to recover. The skill of your surgery should be asked don’t hold court but be straight forward.

Good Luck and keep asking question and research on the side effects of each.

moksha2022

BPH = https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087

"Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement — is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems."

The three letter abbreviations never end!!!

Thanks. ;-)

Stephens1961

https://csn.cancer.org/discussion/comment/1692382#Comment_1692382

My journey has moved to both radiation and hormone treatment at the same time. I have received on shot of Lupron and will start my 40 +\~ treatments. I have had numerous discussions with my team and the truly believe it’s in my prostrate bed and possibly in my lump nodes so they are going to treat them with radiation. 50/50 to be cured but I have looked at all the possible side effects and I made my choice. Cross your fingers for me I believe this will be a long journey.

Dont give up!

Dont ever give up!!

VascodaGama

Congratulations for reaching to a decision. This is always a stressful moment in our PCa journey. I will cross my fingers with you for a successful end.

One hour before each RT section I used to drink water to have the bladder filled as means for protection.

I wonder if you had a testosterone test done before the Lupron shot. Surely this is not important in the overall combination treatment but it can be useful as a reference database in your journey.

Best wishes,

VG

Stephens1961

https://csn.cancer.org/discussion/comment/1694884#Comment_1694884

No levels tested yet but scheduled before the next shot in 90 days.

Stephens1961

The Lupron shot has been tolerated so far, hot flashes for the first few weeks and one overnight episode of my joints hurt and super over heated. Radiation treatments have effected my bladder and bowls but both have been controlled to date with drugs. Energy level much lower but with warm weather approaching hope to get back out walking 2-3 miles a day and doing light repair projects that I enjoy. I think the saying you have to feel worse to get better fits.