PSA Testing | Rising, concern?

VascodaGama said:

We could consider still Remission

Hi Filipino,

I could not understand well your question. Are you concerned with the increase of the PSA (0.05 to 0.08 to 0.10 ....) or is that you are suspicious of the last test result for being done at a local laboratory. Surely the results done at different laboratories can give different results. Apart from that some assays have higher or lower limit of detection (LLD) which in the case of the last result of 0.10, could mean that the value would be anything lower than 0.10 ng/ml. Usually laboratories represent their assay's LLD with the sign "<" before the value (<0.10 ng/ml).

You can check the above, in any case, the last PSA is classified as remission by many oncologists that use the threshold PSA=0.1 in a guy that had the combination treatment of RP plus RT. Five years in remission may be the right way of thinking. However, the constant increase could also mean biochemical failure signifying that your dad will need further intervention in the future. In your shoes I would ask him to continue vigilance with periodical PSA tests. Usually the concern starts when the PSA shows constant increases three times after nadir (your dad's nadir was 0.05 and the following increases are only two: 0.08 and 0.1), and also when the PSAdt (doubling time) is lower than 9.5 months.  

The typical treatment after RP+RT failure is hormonal (ADT). This is done with agonists injections and/or antiandrogens pills, but depending on the patient's age, other health issues or situation in terms of access to hospitals (some provinces in the Philippines are really remote), it can be done with orchiectomy (permanent castration). ADT works at any level of the PSA meaning that your dad can follow vigilance for a period according to the instructions of his doctor. Asymptomatic patients in good health and well fit manage to wait till their PSA reaches a threshold higher than 5.0 ng/ml to start the treatment. Older patients may wait further till their PSA reaches 10.0 ng/ml. Your dad's is at very low (<0.1) levels.

During a period of my PCa case I used the laboratories of Makati med and St Luke's medical center when on assignment to the Philippines.

Magandang araw.

 VGama

I thank you so much for the detailed reply. I too have a feeling that this new place that he went to (which was a little clinic) might have caused our fear of the numbers going up. I am aware of St. Lukes in Taguig! That hospital is amazing and the staff excellent. He had both his surgery and radiation treatment there. We are big fans of that place. 

We have always gone there for his PSA tests, but as mentioned, with Covid, travelling these days is not as easy due to lockdowns and quarantine orders. I am trying to think of the results, theyve always been 0.02, 0.05. 0.02. 0.05, and this is the first time where it registered a 0.1. I do know that St. Lukes uses ultra sensitive testing, Im not quite sure about the clinic. 

Again I am going off of memory and I do apologize for not having all the information immediately in front of me, but I beleive his gleason score was a 7. He is super healthy, excersizes frequently, walks, runs, does not drink, does not smoke. He does use pads, but has no problem controlling his urine, etc... 

It's never easy hearing of a spike and I am hoping that the spike was due to the lab switch. He is 67 years old and as mentioned, in great shape.