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PSA Results Not what i hoped for

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Posted 11/15/2017 6:13 PM (GMT -5)
PSA came back at .046. Not ready to jump off a bridge, but not happy.
So my history is ...
RALP January 2015

PSA <.02 through October 2016
January 2017 - .02
Feb 2017 - .02
May .033 (changed to Labcorp)
August .033
November (Now) .046

So this isnt looking good. Seeing Dr (surgeon, Tewari) Friday, i'm quite sure he will say do nothing till it hits .1, then do imaging (which i think is pointless?)
RO that i in August (Zelefsky at MSKCC) said possible recurrence (after .033) but wouldn't say probable. Said to continue following up with Surgeon, and come back and see him if/when a clear trend develops.

I'm inclined to wait and do nothing until after my next PSA. But not sure.

____________________________________________________________

Dx Age 64 Nov 2014, 4.3
BX 3 of 12 cores positive original pathologyG6, G6, G8 (3+5)
downgraded to 3+3=6 by tDr Epstein, JH
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology – G7 (3+4), ECE, Margins, LN, SV all negative
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033 November .046
Decipher test, low risk, .37 score

Post Edited (Pratoman) : 11/15/2017 4:17:19 PM (GMT-7)

Posted 11/15/2017 6:25 PM (GMT -5)
are you testing every three months then? If so, I'd be inclined to wait for one more data point.

But a trend does seem to be developing.

Hate to say, but...

Andrew
Posted 11/15/2017 6:29 PM (GMT -5)
Found a doubling time calculator here...

www.doubling-time.com/compute-PSA-doubling-time.php

Doubling Time = 12.02 month
Doubling Time = 1 years
Velocity = 0 ng/ml/month

This is only using the results from Labcorp, of .033, .033, .046, not the .02 from the hospital lab.
Posted 11/15/2017 6:35 PM (GMT -5)
yup, another data point would be good given that. One more increase and you've got a clear trend.

Andrew
Posted 11/15/2017 6:40 PM (GMT -5)
PRATO-- U were cruising.--_ go back to hospital lab.. they probably got some cross-eyed hippie at labcorp./// Let us know!! NEPOL.....
Posted 11/15/2017 6:58 PM (GMT -5)

Hello Pratoman,

There's not a fellow here who doesn't worry anytime there is an uptick in PSA levels ... it's just part of the game, isn't it?

My oncologist encourages me not to worry about small upticks, especially when they are in the low decimal range. From time to time, I have also seen my PSA go back down. This last time, for example, it went down by several hundredths.

Meanwhile --- sounds like you are showing due diligence and staying on top of things.

My oncologist is very proactive, compassionate, and vigilant --- with that in mind, he has me visit the lab each month --- it allows us to track any worrisome trends, and also to make adjustments, when needed. I'm so used to this routine now, I guess, that I would start to feel uneasy if I didn't visit the lab each month.

You're staying on top of things --- that's the main thing --- remember that PSA can fluctuate, from time to time --- watch the trends --- stay vigilant --- but also know that you are doing well along the way, my friend.

Handshake of friendship and brotherhood, from across the miles,
"Cyclone" ~ Iowa State University
Posted 11/15/2017 7:53 PM (GMT -5)
Sorry Ken. Hope you are able to reverse that trend -

Wilderness.
Posted 11/15/2017 7:59 PM (GMT -5)
Hey Pratoman: Hope it isn't a trend........maybe a Blip??

May you and all beings be well.

Roger
Posted 11/15/2017 8:41 PM (GMT -5)
Ken, not great BUT, not a thread.....listen to Tewari. He and Zelefsky are quite an impressive set of bookends. You are very fortunate to have them.

One of the many quotes I take comfort in:

"At the end of the day, all we need are HOPE and STRENGHT....
HOPE that our prostate cancer will get better, and STRENGTH
to hold on until it does"

Hold on, be strong and RELAX!
Posted 11/15/2017 8:50 PM (GMT -5)
That may be starting to trend. You can't use PSADT calculators - PSADT isn't validated for PSAs under 0.1.

You haven't yet met either of the two criteria in the Roswell Park study. One is two consecutive increases over 0.03. The alternative risk factor was an increase of +0.05 ng/ml per year. You are just barely on pace to hit that benchmark (+0.13 in 3 months would translate to +0.052 in 12 months if that pace continues). Your next 3-month PSA will be more informative.

/pcnrv.blogspot.com/2016/08/low-detectable-psa-after-prostatectomy.html
Posted 11/15/2017 9:36 PM (GMT -5)
Prato, I agree with the others, the next PSA in 3 months would give you a better datapoint.

Hang in there and live life.

Your Friend
Cajun Jeff
Posted 11/15/2017 10:05 PM (GMT -5)
Thanks everyone for the comments.
I am trying to take this news in stride, for now. Allen, as you (and others said, the next test will be informative. I'm thinking if it's up again, I may need to revisit the RO. Saw Zelefsky this past summer who told me to see him again when there is a clear trend. I may decide, should the next test show that clear trend, to see another RO, only because it's closer to home, should I need treatment.
I'm still hoping against hope that it stabilizes and I plan on doing my best to keep calm (i.e. Lower inflammation) and eat properly (i.e. Cashless clay model)

Only question is whether to retest in 3-4vm0nths (I'm planning on being in Florida for the winter) or retest in a month. Something I'll ask The Dr on Friday

@TA, thanks for your post, the part that resonated with me as much as anything was... "There is an open controversy as to whether salvage radiation therapy, even if given after biochemical recurrence (a confirmed PSA ≥ 0.2 ng/ml), translates to a survival benefit. Fewer than a third of patients with a post-prostatectomy biochemical recurrence experienced systemic progression"....so I'll stay on top of this, but not jump to treatment too quickly.

@ Gary....thank you again.

@Jeff, so glad for your good news
Posted 11/15/2017 11:53 PM (GMT -5)

Tall Allen said...
That may be starting to trend. You can't use PSADT calculators - PSADT isn't validated for PSAs under 0.1.

You haven't yet met either of the two criteria in the Roswell Park study. One is two consecutive increases over 0.03. The alternative risk factor was an increase of +0.05 ng/ml per year. You are just barely on pace to hit that benchmark (+0.13 in 3 months would translate to +0.052 in 12 months if that pace continues). Your next 3-month PSA will be more informative.

/pcnrv.blogspot.com/2016/08/low-detectable-psa-after-prostatectomy.html

good reading.

"Fewer than a third of patients with a post-prostatectomy biochemical recurrence experienced systemic progression"

^^^^ I don't understand this. only 3 of 9 men with PSA's >.2 went on to metasisis. What am I missing? This isn't right.
Posted 11/16/2017 9:21 AM (GMT -5)

island time said...

Tall Allen said...
That may be starting to trend. You can't use PSADT calculators - PSADT isn't validated for PSAs under 0.1.

You haven't yet met either of the two criteria in the Roswell Park study. One is two consecutive increases over 0.03. The alternative risk factor was an increase of +0.05 ng/ml per year. You are just barely on pace to hit that benchmark (+0.13 in 3 months would translate to +0.052 in 12 months if that pace continues). Your next 3-month PSA will be more informative.

/pcnrv.blogspot.com/2016/08/low-detectable-psa-after-prostatectomy.html

good reading.

"Fewer than a third of patients with a post-prostatectomy biochemical recurrence experienced systemic progression"

^^^^ I don't understand this. only 3 of 9 men with PSA's >.2 went on to metasisis. What am I missing? This isn't right.

Seems(to me) to match up well enough with previous data average years after BCR until mets( 8 years?) and average after mets until death(5?). Considering the age of so many of us, and how long it takes many of us to BCR, and average age of death for males(78?) and considering what kills the vast majority of us, I am really not all that surprised to hear only 1/3 of BCR progress to actual mets. Pleased, but not all that surprised.

At least as surprising to me was this fact: /pcnrv.blogspot.com/2017/07/how-soon-after-surgery-should-salvage.html

Somebody said...
. Kang et al.found that, among men with capsular perforation, PSMs, or seminal vesicle invasion after surgery, only 17 percent actually went on to have a true biochemical recurrence.



But just like with the original decisions about treatment, it leaves us with yet another rock and a hard place, doesn't it, sort of? IOW, who is going to be in the lucky 2/3, and who is going to be in the not so lucky 1/3?

Ken, sorry to hear about your steady advance, and surprised. Puzzling, considering your post op path. But as others said, more points are needed. Don't you have another current thread discussing the possible effect of certain drugs on your PSA? It does make one wonder, but who knows. There are so many variables.

Also, did you read the new thread by Trimix, whose surgeon intentionally left some prostate tissue near the bladder behind? Some results over the 6 years:
RP 5/11,
8/1/11-PSA .06,
10/26/11-.16,
3/12/12-.157,
9/2012 PSA was .278
11/2017 PSA was .349

Now, that is an interesting set of numbers and doubling times. Like 4 or 5 years avg, since the initial big jump 5 months after surgery. Not sure that has anything to do with your concerns, just interesting.

Post Edited (BillyBob@388) : 11/16/2017 7:29:09 AM (GMT-7)

Posted 11/16/2017 10:03 AM (GMT -5)
Billybob, I don't recall a thread about drugs and PSA. Although who knows with the supplements.

One thing I am thinking is, I take a daily fish oil which is a high concentration of EPA/DHA, for Triglycerides. I'm wondering if that might have an effect. Thinking of dropping it.
Posted 11/16/2017 10:15 AM (GMT -5)
Perhaps consider dropping the fish oil, replacing with regular consumption of fish. I've concluded that a principle of healthy nutrition is food over supplement.

Best to you -
Wilderness.
Posted 11/16/2017 2:31 PM (GMT -5)
Prato
Not great news, but I agree with others it will take at least another test before considering it a trend. When I was in the two decimal range both after surgery and later after SRT my PSA stayed at low numbers (.04 or below) for several years and then made a pretty sudden jump to single decimal. Just my 2 cents experience of unreliability of doubling time trends at low numbers.
Jim
Posted 11/16/2017 3:04 PM (GMT -5)

Pratoman said...
Billybob, I don't recall a thread about drugs and PSA. Although who knows with the supplements.

One thing I am thinking is, I take a daily fish oil which is a high concentration of EPA/DHA, for Triglycerides. I'm wondering if that might have an effect. Thinking of dropping it.

Yes, you are right as I think on it some more, I think it was "statins vs blood sugar" something like that, which led into discussions of possible harms of increasing blood sugar/insulin, including possibly on PC/PSA.

I wonder if the fish oil actually helps your TGLs? Because hasn't a correlation(not causation of course) been shown between TGLs and recurrence?

Do you ever wonder whether to **** or go blind? I do.
Posted 11/16/2017 4:27 PM (GMT -5)

BillyBob@388]At least as surprising to me was this fact: /pcnrv.blogspot.com/2017/07/how-soon-after-surgery-should-salvage.html
[quote= said...
omebody"]. Kang et al.found that, among men with capsular perforation, PSMs, or seminal vesicle invasion after surgery, only 17 percent actually went on to have a true biochemical recurrence.



Then what this is saying is that....

.03 = 100% chance of BCR....and only a....
17% chance of reaching .03

Also....once BCR is reached...

33% chance of Metatisis.

as far as prat goes....the way I read it is.....anywhere between .03 and .15 is considered early SRT...and the numbers inside that range have similar outcomes. How they came up with zapping at .03 as opposed to .1 isn't explained. I guess they just figure...if we know it's going to rise....why wait? EDIT: But that can't be true either. If the results are the same at .03 as they are at .1.....then *everyone* is better off waiting....as you could get years before .1....and still have the same outcome.
Posted 11/16/2017 4:41 PM (GMT -5)

island time said...
How they came up with zapping at .03 as opposed to .1 isn't explained. I guess they just figure...if we know it's going to rise....why wait?

It is explained in the section titled "Why start sooner than sRT/wait-and-see, but later than aRT?"
Posted 11/16/2017 7:50 PM (GMT -5)

Wilderness said...
Perhaps consider dropping the fish oil, replacing with regular consumption of fish. I've concluded that a principle of healthy nutrition is food over supplement.

Best to you -
Wilderness.

This is a good idea, thanks. My PCP/Cardiologist told me to start the fish oil for triglycerides, but i can get them down with diet, i've done it before. Going to do this.
Posted 11/16/2017 7:56 PM (GMT -5)

BillyBob@388 said...


I wonder if the fish oil actually helps your TGLs? Because hasn't a correlation(not causation of course) been shown between TGLs and recurrence?

Do you ever wonder whether to **** or go blind? I do.

Dont remember about the connection between TG and recurrence.
Posted 11/16/2017 8:24 PM (GMT -5)
I've been puzzled by all this in light of my low risk Decipher score.
So i contacted Oncodx and asked for a copy of the GRID report, which drills down on all of the various factors that make up the score. I didnt understand it all but got the gist of it.

So then i asked if there was someone in the technical area i could speak with because id like to get an idea to what extent the Decipher details could inform a decision as to when and whether to treat.

Tonight, a couple of hours later, i received a call from the President and Chief Scientific Officer of OncoDx, i believe he is the developer o the Decipher test. Pretty cool. He was extremely generous with his time. We spoke for about 20 minutes.

The gist of it is, no guarantees (of course) but the results show that my tumor has a very low likelihood of proliferation, and of attaching itself to bone, or other organs. Also, "poor response to Radiation treatment" which is what the GRID stated, doesnt mean i wouldnt respond, but that it might require higher dosage. He mentioned that MSKCC / Zelefsky is known for their methodology of higher dosing. (thanks TA).

Told me that they often see rising PSA that levels off, close to .1. In view of my positive margin on frozen section, its possible some cancer cells were left behind and that is what is producing the PSA. But its also possible that those cells are indolent and will not turn into anything menacing. Especially in view of the fact that its been almost 3 years since surgery and my PSA only recently started to rise.

In short he said no rush to treat, in fact "dont rush to treat" , and waiting would not likely hurt me, or affect the outcome.

So all in all it was a positive conversation. It would have been a great conversation if he said he could give me guarantees. LOL.

Great guy, actually gave me his cell and email and said to reach out anytime.
Seeing Dr tomorrow.
Posted 11/17/2017 8:02 AM (GMT -5)
Good luck at the doctors. Hope you hear things that ease your mind. For what its worth, I agree that there is no rush to treatment. With a PSA that low scans would probably be pointless and then where do you radiate?

Tom
Posted 11/17/2017 9:40 AM (GMT -5)
Prato,
other than age, we have a similar path report. So thanks for sharing and great points by all. So much great info to grasp.
All the best ...i favor early SRT than later.
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