PSA rising

PSA Rising and the best time to act
There is a bit of truth that you have time to consider what you should do, especially if you have a run of the mill Gleason 6 and your biopsy indicates only 1 of 12 at 4% positive. But, take the time to efficiently consider your alternatives. You might want to visit a radiation oncologist for a consult and to consider the options. If you choose an experienced radiation oncologist, you will get excellent results with fewer side effects. But, there is an art to choosing your expertise.

When I was making my decision, I took almost a year to finally decide on brachytherapy. I also had a rule which was passed on to me (and I pass on to you): choose a cutoff PSA which you will not exceed. I chose 8, as my informer did, to avoid going over a 10. A PSA greater than 10 implies, in the research community, an intermediate level of risk as opposed to a low level or risk associated with early stage PSA <10.

You might want to look at ways to lower your PSA while you ponder your therapy: 1. change your diet (go to a Mediterranean diet, go low fat, no red meat, low milk, etc. ) 2. Exercise 30 minutes a day, 3. increase Vitamin D levels, 4. Consider curcumin, celebrex, other anti-inflammatories (Consult your doctor).

Whether you need to act now depends on what your PSA is telling you. Check your PSA doubling time (PSADT) -- usually you can put it on a linear graph and you can see where your PSA is projected to be when you have scheduled your therapy. It it is close to 10, you may be increasing your risk level. You are still in a good position i.e. early stage, but even then, about 10% of early stage will have recurrence. If you are in intermediate stage (higher PSA between 10 and 20) your risk increases and 30-40% will have a recurrence down the line. You have to analyze your PSA to get a trendline and interpret it to see where you are going. Some people do Active Surveillance for up to 5 years before seeking treatment, depending on the PSA, annual biopsies of Color doppler ultrasounds. If your doctor is a country doctor and doesn't know about this, find a more knowledgeable doctor.

The problem with most doctors is that they do not understand these things and frankly are not experts in prostate cancer (neither am I, BTW). I suggest that most men should empower themselves and follow Dr. Stephen Strum (he has a book) and get educated.

Disclaimer: I am not a medical doctor, so I am only relating my own personal experience. You have to seek the appropriately skilled doctor to consult with.

Kentr said:

Not my intention to "spook" you
The reason I told you about the way the PSA can be influenced is so that you will know the facts. If you abstain from certain activities for a few days ahead of your test (riding a bicycle, heavy labor or sexual activity) you (and your doctor) will get a more accurate PSA reading which is important when it comes to treatment decisions.

Like I said in my previous post, no offence was intended regarding your particular doctor or hospital. Further, we all understand you want this gone from your system and feel the same way.

I have a couple of friends that have had their prostate removed. For one, it has worked out well and it's been ten years. (Adding an edit: His PSA now is right around 10 and his doctor is not overly concerned) The other one also has his cancer under control but still has problems with "leakage." I don't know anyone that has had brachytherapy so maybe I've just been really lucky. Like I said, it's not an exact science so the more research you do regarding treatment options, the better. That way, once you finalize which direction you wish to go, you'll feel confident in your decision.

Best of luck to you and keep reading.....

psa rising
Welcome to the club that none of us want to be in. I am also very new to this and my journey as yours is also just beginning. I see right off that we are a lot alike or at least have very similar thoughts and circumstances. I am 53 y/o and was diagnosed in June. PSA jumped from 2.8 to 3.9 in in 6 months, then down to 3.3 in a month, which was June. I had and still have pain in the right groin or testicle area. My biopsy showed 1 of 12 cores pos with less than 5% involved. Gleason 3+3. (My pain though is poss related to disc in my back which I have had a long time but has never radiated to the groin. I got some good advise on my thread and I will be seeing a neuro surgeon as soon as possible. But first I am going to have open rp on Aug 9th (next Tues.)I have read many diff thoughts from many diff people. I know that I am one of the few that end up doing the open rp but I am also in the mindset of just getting it all out, even the seminal vessels and lymph nodes. Also I like the idea of the surgeon being able to see and feel the prostate and surrounding areas. My main goal is to be cured of this. I am fully aware of the side effects and did not take that lightly whwn making my decision but in the end I personally will have more peace of mind knowing at least its out and though the cancer may very well show up in the future it will not come from the prostate that I KNOW has cancer in it. Others have done well with the many other options avaliable and I certainly respect their choices, because in the end we all have to accept our decisions and we are the ones that will live with them. I am having my surgery locally (Baton Rouge, LA). I also have a lawn service and I as you enjoy it even though it is hot out there. (By the way if anyone reading this has had any treatments in Baton Rouge could you let me know how its going). I wish you the best. Keep us posted, Johnny

Many Options
Slong,

Several men with a lot of PCa in the rear view mirror have given you some sound advice to ponder. At 53 with an early detected cancer of low quality you have many, many options. Many men choose surgery for the reasons you articulated, to get the cancer out of their bodies and be done with it. Unfortunately, about 35% of the men who choose this route eventually see their cancer return and they must then pursue additional treatments which compound the risk of serious side effects. Of course, other treatments have failure rates too...nothing is perfect...but some of the newer treatments have a higher success rate for men with low risk cancer that has been early detected. I believe you owe it to yourself to fully explore alternative approaches so that whatever you finally decide to do, you will have the peace of mind of knowing that you have done your homework and are basing your decision on a well thought out approach rather than a gut first reaction.

All treatment course carry the risk of adverse side effects. For surgery, those risks include varying degrees of incontinence, erectile dysfunction, penile atrophy, and potential complications in recovering from major surgery. Many men, particularly young men such as yourself, are much less affected by these potential problems and quickly recover much of their former function. For other men there are varying degrees of effect, depending a lot upon the skill of the surgeon and their physical shape. Most men regain continence and some degree of erectile function (assuming ther nerves are spared) within a year. However, there are cases where things don't work out so well and there are many, many threads in this forum that highlight the difficulties in regaining previous function that you should read.

Newer forms of radiation often have less risk of these side effects but depending on the type of radiation could risk some loss of ED in the future. There are also varying degrees of long term success and some techniques have better records than others. Brachytherapy, SBRT, IMRT, IGRT, Proton Therapy, HDR Brachytherapy, are all techniques you should research and discuss with your medical team. Some are more appropriate for early stage cancer than others. If cancer returns following radiation treatment, surgery as a follow-on treatment is often more difficult to perform and could complicate side effects involving incontinence and ED.

Another option you should educate yourself about is active surveillance. Many men are diagnosed with indolent prostate cancer with low PSA readings and very low percentages of involvement (such as what you described in your own pathology). The theory here being that men with indolent prostate cancer will never be at serious risk and treatment poses more of a health risk than simply watching it closely and see if it develops. If it does develop, studies have shown that intervention can be taken with little risk.

The only way in which you can make an educated decision is to educate yourself through reading, consultations with a variety of specialists, and determining the priorities in your life. I do hope you take the time to conduct a thorough investigation of the many options open to you at this point.

In my own case, with a Gleason of 3+3, PSA = 4.3, 1 of 12 cores positive with 15% involvement, negative DRE, no family history, and T1c; I eventually chose to be treated with CyberKnife, a form of SBRT radiation, last June. Fortunately, I have had no adverse side effects and my PSA has receded to a level of 0.8 ng/ml. CK is certainly not for everyone but it is an effective treatment for men with pathologies like yours with a much lower risk of potential side effects. In the course of your research, I would encourage you to put CK on your list of options to consider.

Whatever you decide to do, it is a decision only you can make, and the many men who regularly post here will support your decision and provide advice and encouragement as you progress.

Best of luck to you.

K

Kongo said:

Many Options
Slong,

Several men with a lot of PCa in the rear view mirror have given you some sound advice to ponder. At 53 with an early detected cancer of low quality you have many, many options. Many men choose surgery for the reasons you articulated, to get the cancer out of their bodies and be done with it. Unfortunately, about 35% of the men who choose this route eventually see their cancer return and they must then pursue additional treatments which compound the risk of serious side effects. Of course, other treatments have failure rates too...nothing is perfect...but some of the newer treatments have a higher success rate for men with low risk cancer that has been early detected. I believe you owe it to yourself to fully explore alternative approaches so that whatever you finally decide to do, you will have the peace of mind of knowing that you have done your homework and are basing your decision on a well thought out approach rather than a gut first reaction.

All treatment course carry the risk of adverse side effects. For surgery, those risks include varying degrees of incontinence, erectile dysfunction, penile atrophy, and potential complications in recovering from major surgery. Many men, particularly young men such as yourself, are much less affected by these potential problems and quickly recover much of their former function. For other men there are varying degrees of effect, depending a lot upon the skill of the surgeon and their physical shape. Most men regain continence and some degree of erectile function (assuming ther nerves are spared) within a year. However, there are cases where things don't work out so well and there are many, many threads in this forum that highlight the difficulties in regaining previous function that you should read.

Newer forms of radiation often have less risk of these side effects but depending on the type of radiation could risk some loss of ED in the future. There are also varying degrees of long term success and some techniques have better records than others. Brachytherapy, SBRT, IMRT, IGRT, Proton Therapy, HDR Brachytherapy, are all techniques you should research and discuss with your medical team. Some are more appropriate for early stage cancer than others. If cancer returns following radiation treatment, surgery as a follow-on treatment is often more difficult to perform and could complicate side effects involving incontinence and ED.

Another option you should educate yourself about is active surveillance. Many men are diagnosed with indolent prostate cancer with low PSA readings and very low percentages of involvement (such as what you described in your own pathology). The theory here being that men with indolent prostate cancer will never be at serious risk and treatment poses more of a health risk than simply watching it closely and see if it develops. If it does develop, studies have shown that intervention can be taken with little risk.

The only way in which you can make an educated decision is to educate yourself through reading, consultations with a variety of specialists, and determining the priorities in your life. I do hope you take the time to conduct a thorough investigation of the many options open to you at this point.

In my own case, with a Gleason of 3+3, PSA = 4.3, 1 of 12 cores positive with 15% involvement, negative DRE, no family history, and T1c; I eventually chose to be treated with CyberKnife, a form of SBRT radiation, last June. Fortunately, I have had no adverse side effects and my PSA has receded to a level of 0.8 ng/ml. CK is certainly not for everyone but it is an effective treatment for men with pathologies like yours with a much lower risk of potential side effects. In the course of your research, I would encourage you to put CK on your list of options to consider.

Whatever you decide to do, it is a decision only you can make, and the many men who regularly post here will support your decision and provide advice and encouragement as you progress.

Best of luck to you.

K

LUCYd; PSA=<0.01 equals to Remission Levels</b>
LucyD

Welcome to the board.
Your husband’s doctor has been testing the PSA with an ultra-sensitive assay third generation with high tolerances to the 0.XXX (3 decimal places). This is a very minutious testing not followed by the majority of doctors when evaluating progress of PCa, and it is known to cause “PSA Anxiety”. The standard followed by all trends on prostate cancer care have a LDL (low definition limit) of PSA=<0.01.

Looking into the chronology of your husband’s PSA, his results in the past 2.5 years all fall in the lower remission level of =<0.01, which is not indicative of recurrence.
The tiny difference of 0.001 between the last two tests is completely insignificant.

Some other causes other than PCa could as well be playing a role in the rise. Tolerances as higher of 0.03 are common in cases where the test has been done in different assays from different makers at different laboratories. In same cases of surgery small pieces of benign prostate tissue is left behind and this also produces a small quantity of PSA.

Surely some doctors have established threshold triggers for treatment which in the case of your doctor is PSA=0.04, however, it is questionable to consider recurrence based solely on such low-low levels of serum. Other data before surgery (PSA) and info from his pathologist report after surgery (and age or symptoms) are matters to be considered too.

Finasteride (Proscar) is a 5-alfa reductase inhibitor drug used to lower DHT in the body. It is used by oncologist in the care of low grade cancer (Gr2-3) and as a preventive way to control low risk cases. The side effects from Finasteride are minimal but they exist so that your husband should be aware of them before taking it.
For peace of mind, I would recommend you to get a second opinion from a medical oncologist on PCA. You have more than enough time to investigate details on the problem.

Congratulations for the Remission levels.
Hope the next PSA keeps the 0.01 mark.

The best to you
VGama

Note; You may continue Q&A here or start your own separate thread, if you prefer.