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Posted 7/8/2019 4:16 AM (GMT -5)
Good morning;

I would like to explain my father's case. He now has 68, and ten years ago he was diagnosed with protata cancer, gleason 8, stage 2tc. He underwent surgery with robot da vinci with positive margins, having a a firts psa of 0.02. The psa gradually increases until it reaches 0.5 after more than a year of operation. Rescue radiotherapy is practiced, being the first psa after radiotherapy 0.006. The psa has remained undetectable for the last 8 years until March of this year that in its annual routine analysis, the psa had increased to 0.17. The terror returned to the family. We went to deliver the results to the oncology, and she asked that the analysis be repeated again after 3 months. Today the results have arrived, and they have been again, 0.002 !!.

My question is this. This increase to 0.17 may have been somewhat punctual ?. Maybe due to some type of infection ?. Or a laboratory error ?. Can you help me?

Thanks

Post Edited (Marc_____) : 7/8/2019 7:15:36 AM (GMT-6)

Posted 7/8/2019 4:42 AM (GMT -5)
I do not think there is any way to explain this sudden peak save instrumental error. I would confirm the return to a good number after 3 more months for just in case but, in my opinión, you can relax. After all these years you have good reasons to believe PCa will be stopped for a long time if it ever returns, which it does not seem apparent right now.
Posted 7/8/2019 7:47 AM (GMT -5)
I would agree that there was likely some kind of laboratory error. The return to very low values suggests the single high reading was an anomaly, and can be ignored. It will continue to be valuable to regularly test to confirm the low trend.

He will likely be around for a long time to come.
Posted 7/8/2019 8:11 AM (GMT -5)
Thank you very much for your comments. As I have said, since rescue radiotherapy, my father has been close to 9 years undetectable. He has never undergone hormonal treatment, and the two treatments have received (radical prostatectomy, and rescue radiotherapy by positive margins), have always been with curative intent. The oncologist discharged him last year, and the annual psa control was done with his family doctor.
My father told me that a few days before the blood test he had a small urine infection. That would explain the psa of 0.17? When we returned to the oncology with this unusual result, we asked for a new analysis at 3 months, since it was not normal against the trend of the last 9 years. And this analysis, as I said, has returned to normal, psa = 0.002 psa really very low.

I have also read that after years of radiotherapy there may be punctual spikes, which should be normalized after a few months. Could this be the case?
Posted 7/8/2019 8:37 AM (GMT -5)
The radiation spikes you refer to are only experienced by men who underwent radiation as the primary treatment. Since he used surgery and removed the prostate the radiation spikes or bumps would not apply to him.

Most likely a lab error.
Posted 7/8/2019 8:40 AM (GMT -5)
PSA is a marker of prostatic tissue. When the prostate is removed there are not reasons to detect any psa. Peaks happen to guys that have radiation alone. about infection, there is not any prostate that can be possibly infected. Small values of psa may be detected due to benign tissue left for a short period of time after prostatectomy. Also some instruments confound psa with similar proteins or they just cannot discriminate between very small values since they are calibrated to detect ordinary higher psa levels. But anything above 0.1 is caused by PCa or it is an occasional lab mistake. At least, I do not know about any other possible explanation.
Posted 7/8/2019 8:58 AM (GMT -5)
it is really very strange but the important thing is that the psa has been reduced to 0.002 of naturally form in this control. I think that for this reason, oncologists face a rise in psa of this type (below 0.2, which is the cut-off point to indicate a biochemical recurrence), request a second analysis to verify this increase. The human body is an incognita.
Posted 7/8/2019 9:23 AM (GMT -5)
There is a very important "rule of thumb" for all prostate cancer cases with regard to the PSA test results:
    Due to the inconsistent nature of PSA testing, never make a critical treatment-based decision as the result of only a single atypical PSA reading.
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