PSA Results - time to act

Came back at .082
Based on the past rate of rise. I was expecting something between .072 and .074. So I’m a bit concerned. Six weeks ago, at my last blood draw it was .068, and 2 1/2 months beforevthat it was .060. But whatever, seems to me that it’s time to treat.
RO told me at .068 that he would be comfortable treating me without ADT if I prefer, but if it gets to .1, he would be much less comfortable. So I don’t want to wait.
Seeing the surgeon tomorrow, probably my last visit with him.

IM WONDERING if the increased rate of rise means anything at this point.

Prato -
I agree that you have all the evidence you need to move on to SRT. Over my long history with PCa I've had long periods of very slow rise that then quickly accelerated. I went for a few years after surgery with very low numbers -- .02 or so then a sudden jump to .1 then a couple more years followed by sudden jump to .2 and then .4 within just a few months. After SRT I went for nearly 4 years undetectable at 0.00 then a small jump to .02 or so for another year or so, then about a year and a half ago it started rising quickly and doubling times plunged from from over 6 months to less than 3 months.

It's an erratic beast. In some cases - e.g, mine - it seems to doggo for a long time until it eventually comes up with a mutation or clever way around our immune defenses. Then it can advance quickly.

I don't have any recommendation as to whether to also do ADT - you and your doc will have to hash that out. But, FWIW, I've been on Firmagon for 3 months now and so far have had none of the side effects I've heard so much about. Other than some injection site pain for a couple of days after the monthly shots, I wouldn't even know I was on anything.

Best of luck.
Jim

I think it's close to the time to start talking to the RO about planning the next treatment.

ask if you can take a spider into the treatment room. Maybe you could become spider man ...

and I'd get TA's read on this too.

Treatment city, next stop, exit to the right.
Andrew

Sorry about the increase. I have no knowledge of PSA increases after surgery and SRT other than whats reported by members so cant offer any advice. You did your homework well before most so you're in good shape to act early. The SRT seems like an obvious decision now, but the HT is a tough call.

Hi Pratoman. sorry to see this trend developing, but it seems you're on top of it already. You may recall my penchant for math and graphing stuff.... so I took the liberty of plotting your numbers in a way I found somewhat interesting for my earlier PSA rise.

The comments in this thread sound a little unclear on how steady, or how rapidly, the PSA is trending. The key is doubling time, and whether or not it's indicating something happening. Biological growth trends tend to follow a logarithmic pattern, letting you calculate a doubling time.

Here's a link to a simple analysis. I plotted the PSA and the natural log of the PSA to identify the trends, including projections for a few months.
PSA trends and projections

Actual data are in green numbers, projections in black.

The LN (natural log) plot lets you see a fairly steady trend in the doubling time. The measurements vary a bit, but using a linear (straight line) curve fit it seems to show an average doubling time of just under 10 months.

In my humble opinion, it does look worthwhile to consider follow up treatment. Based on this projection it would take another year for it to exceed the usual recurrence value of 0.2. The natural log trend being so steady though might suggest there is indeed something going on. You might ask your docs about it.

when can they start SRT? I know with what I know now i'd get he shot! good luck man. you got this!

PS: re: rate of rise at UL levels: remember I recently had a TRIPLE in 3 months, thus I am right behind you hovering around .06. Which then proceeded to remain unchanged 3 mos later and 3 month after that went down a bit back into the new- and higher by this lab- undetectable range. So, I'm not sure if an apparent faster rise on one reading means a whole lot. I woudn't think if my triple was ominous(seemed so to me at the time), that it would then stall and even reverse course a bit. But then again, I certainly don't know for sure.

Best wishes on your new Journey Prato.

"When you say "i'd get he shot", do you mean the ADT shot? If so, just curious as to why."

yes, Lupron. but it's your call. this is your last shot at a cure. I would hit it like Mike Tyson.

Tall Allen said...
I don't think that numerical analysis will get you very far with numbers this small, but the rising trend seems clear.You may recall that the Koulikov study found that either two subsequent increases in PSA, or PSA velocity of 0.05 ng/ml/yr or greater was prognostic for BCR. Now, you've had both.

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

Of course, you may be among the 37% with that that is free from recurrence at 7 years, but that is a gamble.

Thanks Allen, hope, I don’t feel that lucky to gamble with this.

And yes, I have the Koulikov study printed out to bring to Dr Tewari for my “farewell” visit

Sorry about the rise, good luck with your treatment.

Pratoman said...
Peter, I shall wear sunglasses to sleep to shield myself from the glow.

It will be a very small glow from what I hear

Something keeps cooking, Ken. Time to get control of it. Waiting much longer will only increase the need for ADT to improve the probability of success. Why risk it?

You are as prepared for SRT as anyone could be. Use your laser focus to get simulation and RT started posthaste.

No more dilly-dallying.

Ken,
If you have a magnifying glass, you could start treatment right away. Just sit in your backyard and focus the sun's rays a couple of inches below your belly button.
I don't have enough knowledge to give an opinion about whether to add ADT.
While I know you didn't want to see a PSA rise, I hope the fact it puts you on a clear course gives you some relief.
Best wishes, my friend.