PSA jump in 2 weeks

It could be stress, but more importantly it could be something other than stress. At a minimum, I’d want to test it again in a couple of weeks to see what it is doing. The long term trend you cited is chugging along in the wrong direction.

It wasn’t 100% clear…what is the history of your PSA tests over the last years?

I was on AS at Hopkins with 6 of 12 cores 3+3 with 2 cores over 50% volume. My AS doc encouraged treatment saying they didn't have anyone in the program with those volumes at my age (50). A few months later my PSA broke 5 and I decided to proceed with treatment. Pathology after surgery was 3+4.

I'm curious what conditions will bump you out of AS when you go in with 3+4? Have you had MRI or other scans?

Some background for me - Oldernow

My PSA was between 5 and 9 starting in the late 90's. I had 5 negative biopsies through 2018 but then my PSA started climbing. By 2022 it was up to 20. I ended up having a MRI that showed suspicious regions. In the fall of 2022, had a trans-perineal biopsy using the MRI data as a guide at Cleveland Clinic - Found a few areas of cancer with a Gleason score of 3+4.

A biopsy sample was sent out for genomic testing. This Decipher test showed my cancer was at the high end of the moderate range for metastasis. My urologist and a consulting radiation oncologist decided that at my age (76) the best course of action was 28 radiation sessions while on ADT (Androgen Deprivation Therapy). ADT drastically cuts your testosterone to starve any remaining cancer cells of their favorite source of nourishment. The radiation sessions were short but time consuming with travel to and from the hospital for 28 weekdays in a row. The ADT was/is another story. Lots of negative side effects from the 6 month injections. I have had two with the third scheduled for early April 2024.

The combination of radiation and ADT seems to be working. My PSA went from 20 at the start of radiation last summer to a current level of <.03 (considered undetectable). The ADT took my testosterone lever from a normal 556 range to less than 10. I am told that after the third shot wears off sometime in October that the testosterone should slowly start recovering and the nasty side effects should go away. I'll continue getting PSA tests over the next few years to make sure it doesn't start going up again. I guess after a few years of a stable low PSA it could be considered a cure. Not sure about that however.

You're welcome -

Yes - decision time is difficult. I never had the option of AS. For years the doctor said that since the biopsies hadn't found cancer that my high PSA was probably due to an unusually large prostate. When they finally found cancer by using the trans-perineal approach (which allows better access to the prostate) it was too late for any form of AS. As my urologist said - "You have to do something"

Sadly, my adventures aren't over yet. I have developed what looks like radiation proctitis. I'm currently scheduled for a full colonoscopy on Feb. 1. Hopefully the symptoms I am having will be self limiting so I can avoid starting yet another round of treatments.

Stay strong and continue to get as much information as you can. I always make sure I am well armed with as much information as I have available before each doctor visit. I guess that gives me a feeling of power. The doctors are always impressed with the fact that I take the time to learn about all the available options. I am never afraid to ask questions...