Prostate Cancer confirmed 2 years ago - is it normal to wait for cancer to spread?

pz1657

Over two years ago I was diagnosed with prostate cancer with samples being tested and coming back positive. Since then my doctor is monitoring my PSA levels which seem sporatic … one day I will have an 8 and then upon retesting it drops down to a 4 …. overall my PSA has been slowly increasing but ignoring the sporatic spikes is still below 5. Is this normal to watch PSA level and wait until the level jumps before doing prostate cancer treatment?

Old Salt

Apparently, you did have a biopsy; what were the results? You can paste the report in your response, if that's more convenient.

Also, please give us a precise time line of your PSA test results.

More in general, I would advise you to be on top of what is going on.

VascodaGama

Yes, you need to be on top of what is going on. Only certain low risk cases that have been diagnosed with prostate cancer are suggested for "observation ". For instance, introduced into a program of active surveillance.

Was that mentioned to you?

pz1657

no … no mention of active surveillance …I'm 63 years old btw. I was told we could monitor PSA every 6 months (or if we see a spike every 3 months) and that doing so would allow us to monitor the progression of prostate cancer … given my dad died of prostate/colon cancer and my brother who is 3 years older than me has prostate cancer … for treatment he had his prostate removed, then chemo … now hormone therapy … I am …. I'm due for my PSA test but given my emergency operation which I believe would impact getting samples via the rectum and the fact that I have lost 14 lbs (mostly due to loss off muscle) from 180lbs down to 166lbs, I'm thinking I'm in a hope and pray period for the next 5-6 months

Any suggestions appreciated.

Old Salt

Given your family's history, you are at higher risk

As mentioned in my earlier post, what were the results of your earlier biopsy?

I have a feeling that a biopsy and/or an MRI will be in your near future. In that context, let me mention that a transperineal biopsy stays clear of the rectum.

Where are you located? It may be time to get a second opinion. Without casting blame, and lacking solid data, I feel (!) that you have not received optimum care so far.

Clevelandguy

Hi,

Sounds like you need an MRI and then a MRI guided biopsy to determine if your cancer has spread or gotten more aggressive. What was your Gleason score from your first biopsy ? A second opinion from another Urologist might be in order. To answer your question, if your PSA increases at an accelerated rate that should drive further investigation. Maybe another scan or biopsy. The results of the scan/biopsy could drive further actions like surgery or radiation or possibly active surveillance. With your family history your situation needs some attention.

Dave 3+4

Steve1961

if i were you i would find another urologist..reach out to a major institution..i had a terrible urologist whom i thiught was good until instarted questioning and realized things didnt add upm.. I personally believe you should’ve had an MRI by now and the biopsy and a PSMA scan

pz1657

Feb. 2, 2021 - PSA 4.27

Mar. 6 2021 - PSA 4.17

March 18, 2021 - Diagnosed with Cancer of Prostate. Unfortunately I can find the biopsy result which they discussed the 10 needle samples and X (3 is the number I recall) in local area were positive.

Sept. 3 2021 - PSA 5.07

Sept. 21 2021 - PSA 4.13

Jan. 4, 2022 - PSA 4.22

Mar. 28 2022 - PSA 4.03

Sept. 9 2022 - PSA 4.69

March 9 2023 - PSA 5.63

June 12 2023 - PSA 5.3

Dec. 21 2023 - PSA 8.07

Dec. 29 2023 - PSA 4.72

Other information: On May 27, 2024 I had emergency surgery due to bowel blockage. For the next two months I have a Ostomy bag. So in the August 2024 timeframe a second operation will occur to put me back to normal.

Old Salt

You should be able to get the biopsy data from your urologist. It's very important for a rational discussion of your situation.

pz1657

I requested a copy of the 2022 Biopsy data and I'll post once the doctor sends it. I also asked the doctor whether I should do my regular 6 month PSA test or wait due to my emergency operation and recovery.

pz1657

Here is the information from my California/Bay Area doctor.

2021 FINAL PATHOLOGIC DIAGNOSIS:
Prostate, right, biopsy: Prostatic adenocarcinoma, Gleason grade 3+3 (Grade group 1)

Prostate, left, biopsy: Benign prostatic glands and stroma

Electronically Signed Out

as/3/15/2021
Ankur R. Sangoi, M.D.

Specimen:
A:Right prostate needle biopsy
B:Left prostate needle biopsy

Gross Description:
Specimen A, "right prostate needle biopsy" is received in formalin and consists of 7 tan soft tissue cores, ranging in length from 1.5 cm to 2 cm. Entirely submitted in cassette A1-A2.

Specimen B, "left prostate needle biopsy" is received in formalin and consists of 6 tan soft tissue cores, ranging in length from 1.3 cm to 1.9 cm. Entirely submitted in cassettes B1-B2.

(EN)

Microscopic Description:
Right prostate: Sections demonstrate 2 of 6 cores involved by prostatic adenocarcinoma (supported by combination immunostain performed showing cytoplasmic racemase reactivity without p63/CK903 basal cell staining), Gleason grade 3+3 (Grade group 1), measuring 4mm/12mm and 3mm/17mm.  Perineural invasion is present without extraprostatic extension.

Left prostate: Sections demonstrate prostatic glands and stroma negative for malignancy.

There is nothing critical about the PSA testing and no reason to do it until you are recovered from all of the bowels stuff.

Old Salt

Thanks for that. I second the final sentence:

There is nothing critical about the PSA testing and no reason to do it until you are recovered from all of the bowels stuff.

However, the perineural invasion is something to be concerned about, and will require follow-up in the not too distant future.

Josephg

All PCa cases have differences, and we must recognize that.

For example, my PSA raised to 5.2 before I was advised to have a biopsy and subsequently an MRI. By that time PCa had escaped the prostate and I am now in a local metastasis situation.

Waiting does have its risks.

GeneK

https://csn.cancer.org/discussion/328147/prostate-cancer-confirmed-2-years-ago-is-it-normal-to-wait-for-cancer-to-spread

I was diagnosed in June 2022. One positive sample out of 12 and low Gleason score. At the time, my PSA was 8.8, up from 6.9 in March. I was told I should do active surveillance, but I chose to have treatment. I had cyberknife treatment in September 2022 and my PSA has gone down consistently and is now below 1. I get a blood test every 6 months. If your PSA number is up & down, it could be due to having a digital rectal exam before your blood test or one of many other factors affecting PSA. Even riding a bike will spike your number.