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Sudden PSA jump from .04 to .10, 5 years after Radical Prostatectomy

jceo
Posts: 1
Joined: Apr 2018

Hi,

My dad had a radical prostatectomy 5 years ago.  His Gleason score was 3+4.  His PSA was zero a while after the surgery, eventually it crept up to .04 and has stayed there for the past year or so.  He had a PSA test at the end of Januray and it was still .04.  Just the other day he had it tested again as part of his physical and it was up to .10.  It seems odd to me that his PSA could more than double in around 3-4 months.  He is adamant about getting radiation therapy now before his PSA gets even higher.   A while back the Dr mentioned a PET scan but now said that they probably wouldn't be able to see anything since he is only at .10.  He is 70 now.  Any thoughts or ideas?  Thank you

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3275
Joined: May 2012

jceo,

Three thoughts: 

1. Your dad's oncologist is correct: A PET will never detect prostate cancer in a man with a PSA of .10

2. Your father is correct in wanting to begin salvage (second-line) radiation therapy NOW.  Best Practices say radiation therapy (RT) must be begun before a PSA of .5 is reached for optimum outcomes.  (Source: Dr. Peter Scardino, Chief of Surgery, Sloan-Kettering Cancer Center, NYC, at page 450 in his book entitled Dr Peter Scardino's Prostate Book)

3. His rate of PSA rise is entirely possible, not difficult to believe at all, despite being dormant for years.  It began from such a tiny amount that any growth at all is going to be doubling his numbers very rapidly, at least initially.

Radiation can be curative (that is, kill all remaining cancer cells) in cases of relapse following prostectomy.  Nothing else is curative: Not hormonal therapy, not chemo.

His chances of returning to full remission are probably good, and this is most assuridly not a cause for panic. But the sooner RT is begun, the better.

max

VascodaGama's picture
VascodaGama
Posts: 2987
Joined: Nov 2010

When confronted with a surge in the PSA of tiny values lower than 0.1 ng/ml, the first thing one should do is to certify that such increase is real. Lower values can be a cause of equipment noise or a simple matter of using different assays. Some got the LLD (low limit of detection) at a value of 0.1 which would represent any value from 0.01 up wards.

I wonder about your above comment in regards to “… His PSA was zero a while after the surgery…”. What is your meaning of zero?
In PCa matters, “Zero” is usually a term used by many doctors when the value of the PSA comes lower than their remission threshold value. This can be any number, and many old physicians use the threshold of 0.10 ng/ml to match the old type assays’ LLD of <0.1. In fact, all PSA tests have a value (not zero). MY doctor’s threshold for remission was 0.03 but the majority use a PSA=0.05 ng/ml.

The best is to repeat the test one month later or every three months periodically (at the same lab). In any case, if recurrence is assumed to exist, a salvage treatment doesn't assure better outcomes (in terms of cure) just for the sake of being done earlier. One needs to locate the cancer (the best) or plays roulette and guess where it hides. To this extent a PSMA-PET is at the present the best exam that, by existing experiences, manages to identify random PCa at PSA levels above 0.5 ng/ml.

A salvage treatment will add side effects to the ones your dad already got from surgery. Your dad's age and other health issues could also prohibit/interfere in further therapy. Much consideration should be exerted before any decision. The quality of life of the patient is always in jeopardy but one needs to do something, coordinately and timely.

Best wishes,

VGama

 

cf
Posts: 3
Joined: Feb 2015

Hi - I do think that the doubling factor is important, and a lot of doctors really watch that carefully.  My personal experience is that 3-4 months is not unusual for doubling.  I am 69, had a 3+4 Gleason score and had a radical prostatectomy 5 years ago last October.  My PSA was stable at the <= 0.01 for almost 5 years (would have been nice to have it longer!).  The PSA then started increasing every quarter by about 0.02.  When it hit 0.01, my Oncologist recommended RT with Lupron (salvage).  I always look to my spouse for advice since she teaches O-Chem and reads all the serious lit.  We agreed to do the salvage which comprised of 33 days of radiation together with 6 months of Lupron.  This routine ended on Feb 4, 18.  I will say that the RT was not horrible, but I am glad I was not working since I ended up taking a 20 minute nap every day.  It also has some side effects on your where the radiation hits the prostate bed and some of the surrounding tissues - urinary and bowel issues, but pretty minimal for me.  The Lupron is the thing I liked the least since it increases your appetite while also enabling you to gain weight and doesn't clear out of your system for maybe 6 months or more after the last shot.  It also does give you hot flashes, and for me they are more frequent now that the Lupron should be decreasing in my system.  As soon as I finished the RT, I started an exercise program offered at the Univ of Colorado Anschutz Cancer Center.  The program lasted 3 months and included a personal trainer twice a week.  It has helped a lot, and now that the program ended I do an hour of exercise 5 days a week, mostly resistance training an core workouts.  Anyhow, this is only my own experience but I thought you might find it useful since I am about the same age with the same Gleason, etc.  Be well, and best of luck to your father.

Old Salt
Posts: 720
Joined: Aug 2014

PSA assays need to be done on the same instrument by the same lab. This is especially true when the values are low.

I gather from jceo's write-up that the assays were done by different labs. Therefore, do follow up and confirm that there is indeed an uptick.

Godble55
Posts: 2
Joined: Apr 2018

On 1/17/18 I was diagnosed with prostate cancer PSA 26, Gleason 4+5=9.  I'm 60.  I did not want surgery, chemo, or radiation.  "First, do no harm. Let thy food be thy medicine and medicine be thy food." Hippocrates.  I prayed to God and believed for answers.  Consequently I learned about integrative cancer killing "protocols" from multiple sources, videos, the internet, books and cancer tudor, all providing testimonies of success and telling about the same multiple protocols that have been known about for many years.  Two months later my PSA is 16.  It dropped to where it was two years previous.  So far, so good.  I've also radically changed my diet to no sugar or alcohol, no processed meats, and a few other things to feed myself nutrition and starve the cancer.  It's folly to do the same things and expect different results.  God bless you and your father. Smile

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