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RISING PSA AFTER 22 YEARS

jimmie webb
Posts: 11
Joined: Sep 2014

 22 years after having my prostate remove because of cancer , my psa have rosed from 0.000 to 0.080 psa was done on 3/24/14 .Repeated psa test on 9/02/14 reading was 

 3.9 , any here have any ide

REPEATED PSA ON 6 NOV 2014 , RESULT WAS 0.091 NG/mL . WHAT COULD BE CAUSING IT TO DROP WITHOUT ANY TREATMENT?

I DID WHY THAT MOLASSES/BAKING SODA THINGS FOR ABOUT 6 DAYS BEFORE I LEFT THE U.S. TO GO TO THE PHILIPPINES .

SHOULD I DO ANOTHER ONE NOW , OR WAIT UNTIL I HEAR FROM MY DOCTOR IN THE U.S. . THERE IS ANOTHER LAB HERE

IN ANGELES WHERE I CAN HAVE IT DONE BUT I THINK THE LAB HERE JUST DRAW THE BLOOD AND SEND IT TO ANOTHER LAB 

TO HAVE IT DONE , BUT I AM NOT SURE ABOUT THAT .

VascodaGama's picture
VascodaGama
Posts: 3240
Joined: Nov 2010

Jimmie

Welcome to the board.

Without a gland in place, the PSA should be zero but the urethra also produces tinny portions which are detectable in the bracket of the 0.0X ng/ml. In such a way, the initial values with three decimal places (ultra sensitive assay) could be serum produced from benign cells. These would not turn into cancerous unless you got such cancer causing gene (in the DNA). Even though, the sharp rise in six months does not correspond to typical recurrences and that could be though to be from a laboratory error. How far can you trust the laboratory (or laboratories) you have been using? 
Can you tell about the units used by the laboratory (ng/ml or mmol/L)?

Sharp rises in high values, as shown in your results of six months, are typical in cases of infections in patients with the gland in place. Urine test can provide a clue about existing infection/inflammation, but I would suggest you to repeat the PSA in a trustful laboratory for peace of mind.

The possibility of a recurrence after 22 years is always there. You could have been a case related to micrometastases with a low aggressive type of prostate cancer that turned to be indolent in the 22 years of survivorship. I would think that a sharp rise in PSA serum found in blood would occur if the prostatic cells producing it had direct access to a blood vessel. Can you share details of your initial diagnosis. What was the Gleason rate? Do you remember about your clinical and pathalogical stage?
What type of surgery have you done?

The first thing is to investigate about the veracity of the results.

Best wishes for continuing remission.

VGama  

jimmie webb
Posts: 11
Joined: Sep 2014

I will post that information youask for tomorrow or tonight i have to find it.

thanks

jimmie webb
Posts: 11
Joined: Sep 2014

dianosed age 54

psa 7.31 prostate 30cc

volume acid posphatue 0.41

negtive bone scan

RRP March 1992

cath removed 20th day

pathologic final report

cleason 2/3 tumor within one cell layer of margin

involvement of the margin cannot be ruled outpost op (HCT 29.7) (HGB10.3)psa o.oo1 1992 psa 0.000 - 2014

penile implant April 1993

AMS 6 Nov1993

VascodaGama's picture
VascodaGama
Posts: 3240
Joined: Nov 2010

Jimmie

From your descriptions at the time pos surgery you had a very low aggressive type of cancer Gleason score 5 (2+3), and the pathologist found non extracapsular extensions. This may be the reason behind your success in the long period of remission of 22 years. I wonder what is your doctor’s opinion regarding this latest surge of the PSA. Are the measuring units in nanograms per mililiter?

If the increase relates to serum produced by prostatic tissue, one should think that these are pieces left behind during surgery or from cancer that survived and “lives” somewhere else. Sometimes tiny pieces of tissue are left behind in radical retropubic prostatectomies that survive if attached to a tinny blood vessel. Surgeons vacuum constantly the cavity but in the messy operation cannot assure a total cleaned fossa before sewing up.
We are only guessing so I still believe that you should recheck the PSA test, this time done in another trustful laboratory, at a place that uses ultra sensitive assays with results in the two or three decimal places (0.XX ng/ml).

In case you get another high value of PSA then you may think that you got a recurrence so that you will need a salvage treatment. You should consult a specialist in prostate cancer (preferences given to a medical oncologist) for guidance. Typically the treatment is radiation of the prostate bed and lymph nodes in the iliac region. This is the traditional places where cancer hides but at your age of 76 (54+22) probably doctors would recommend hormonal treatment. It all depends on your present health status and your wishes in regards to the side effects. In any case you should start with exams regarding your lipids, image study (MRI-3T) and bone scan to try finding any apparent metastases.

As I commented above, repeating the PSA test will clarify doubts and may give you peace of mind.

Best wishes and luck n your continuing journey.

VGama

jimmie webb
Posts: 11
Joined: Sep 2014

I misread my psa because i didn't us my reading glasses psa result was 0.109 ref range 0.000-3.900 .Saw urologist yesterday ,he take a urine and done a dre .there was no cancer cells in the urine and he found no lumps what my prostate use to be. i am do another psa the middle of Nov and send it to him .if the reading reaches 0.2 he will give me a shot of radiation. he also said he would take some picture if the psa reading is 0.2 . I will be in the Philippines for my winter vacation if the reading reaches 0.20 i will come back right away . thanks for the information and i will keep you all posted on my condition . 

thanks

jimmie webb
Posts: 11
Joined: Sep 2014

RESULT        REF RANGE       UNIT                                                                                                                                                                                                                                         0.080            0.000-3.900     NG/ML  I WILL ASK MY UROLOGIST WHAT PROCESS THEY ARE USING . I AM FROM CHICAGO .IL AND ALL MY HEALTH CARE IS DONE AT NORTHWESTERN MEDICAL CENTER IT IS RATED NUMBER 1 IN THE STATE OF IL.

VascodaGama's picture
VascodaGama
Posts: 3240
Joined: Nov 2010

Jimmie

You may be happy and relieved in knowing your real PSA result (your eyesight is playing tricks on you). PSA=0.109 ng/ml is still an increase but it accommodates better the histology of your recurrence. Your doubling time (PSADT) is over 18 months so that the trigger threshold of PSA=0.2, recommended by your doctor, may take a long time before you get it. You will be older so that any decision on a salvage therapy should be done at that time. Mean while you can follow up the situation with periodical test at 3 months intervals.

I wonder where you will be in the Philippines. My last professional assignment was at Cagayan de Oro in Mindanao. While living there I used the laboratory of Manila St. Luke’s to get the PSA and other lipids results. Medical consultations were done at JH in Singapore and Japan.

Enjoy the vacations.

Maligayang Pagbati

VG

jimmie webb
Posts: 11
Joined: Sep 2014

ANGELES CITY LOCATED OUT THE OLD CLARK AIR BASE WHICH NOW CALL CLARK FIELD .THERE NOW A INTERNATIONAL AIPORT ON IT THIS WHERE I ARRIVAL AND DEPART FROM ON MY TRIPS THERE. HOME IN 15 MIN AFTER LANDING ,GOING THROUGH CUSTOM , AND PICKING UP BAGS . MY HEALTH IS EXCELLENCE I HAVE HIGH BLOOD PRESSURE , HIGH CHESTEROL AND CLAUCOMA ALL IS CONTROL BY MEDICATION . I WALK 3 MILES EVERY DAY AND PITCH FAST PITCH SOFTBALL EVERY SUMMER . I CAN STILL SPEND 6 DAYS A WEEK WITH THE LADIES AND TWICE ON SUNDAY . HA HA HA I KNOW OF TWO LABS I TRUST TO HAVE MY PSA DONE IN ANGELES CITY . THE HEALTH CARE IS AS GOOD AS WHAT YOU CAN GET IN THE U. S. IT'S BETTER THAN BEFORE

IF I WANT I CAN USE MY TRICARE , ALL THE DOCTORS HAVE OFFICES OUTSIDE OF THE HOSPITAL ,IT IS CHEAPER TO THEM ( 500 PESOS ABOUT $ 11.60 FOR VISIT ) LOT OF MILTARY RETIREE LIVING THERE AND MOST ARE DISABLE VET SO THEY CAN USE THE VA HOSPITAL IN MANILA . I JUST LIVE THERE 6 MONTH OUT THE YEAR COME BACK TO THE U. S. TO PLAY BALL AND SEE MY DOCTOR . MEDICATION COST IS HIGH THERE IT IS SOLD BY THE PIECISE . THERE WITH A RAO  OFFICE WITH A MAILROOM PAY A  MONTHLY FEE AND YOU CAN RECIEVE MAIL THERE

TAKE CARE AND I WILL KEEP YOU UPDATED ON MY RISING PSA , MY ULROLOGIST SAID MY CASE IS SOMETHING HE HAVE NEVER SEEN BEFORE.

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