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Increased PSA 8 yrs after prostatectomy

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Posted 7/27/2024 7:04 PM (GMT -5)
Diagnosed in 2016; Gleason score 9; Prostatectomy 9/16; Radiation therapy late 2016 and hormone therapy. PSA has been undetectable ever since until this week. It is .03 and I’ll see my Urologist this Tue. Of course I’m freaked out as I thought I was good after almost 8 years. Thoughts?
Posted 7/27/2024 8:00 PM (GMT -5)
Welcome Dave. First of all, relax and enjoy the weekend. I was high risk, like you, but used radiation rather than surgery. One increased PSA is but one data point, and could even be a test anomaly. You will need to continue testing frequently, quarterly, to see if a trend develops. If so, it may mean some more treatment, but far too early to determine what that may be. See the urologist, get some more testing and see what develops. We have many great meds now for the men who have systemic disease so there is much to be positive about.
Posted 7/28/2024 5:12 AM (GMT -5)
Dave, welcome also from another surgery patient. I came in at G7 (3+4), and I'm 9+ years. I think JNF is right, you'll need to get another PSA in a couple of months, and then watch it quarterly for a while. At 0.03, it's still darned low, low enough that it's unlikely for scans to find it. You may end up needing another shot of spot radiation, or a medical intervention--it's just too soon to say.

You could also ask your Uro for a referral to a medical oncologist, to get them lined up in case you do need them in the future. Even a consult at this point with them would be helpful, to understand what they'd be looking for or planning for you.

It is also possible that in a month or two, your PSA is back down to undetectable. It does happen that way.
Posted 7/28/2024 6:08 AM (GMT -5)
Thank you for your responses and advice. It is much appreciated. After having so many good PSA tests, it was a real gut punch to see it increase even though I always knew that it could happen. I’ll keep you posted after my Urologist appointment and thanks again.
Posted 7/28/2024 7:19 AM (GMT -5)
Hi Dave - I would tell you to relax also but that is much easier said than done for most men so do the best you can. You have a math problem right now, not a death sentence so keep your perspective balanced.

There are a number of men here recently who have had pesky low PSA readings for some years before anything can done at all (especially those with both surgery and radiation treatment). Some men even get an undetectable on their second test. It is a problem with highly sensitive testing that provides a minimal value possibly years ahead of the minimum defined value of PSA = 0.20 that is the current threshold for any action post surgery for most men.

Your URO visit may be a disappointment in your eyes as he/she will just want to keep an eye on your PSA and consider the newer PSMA PET scan when you get to >0.20 which could be in months, years, or not in your lifetime. The PSMA scan can be a game changer for many men if the PSA source is revealed and directly treated. It also can be negative at low PSA levels so not perfect but way better than past scanning methods.

Hang in there, PCa recurrence is always a possibility so something we all live with as higher risk men.
Posted 7/28/2024 8:45 AM (GMT -5)
Thanks Mumbo…your comment re my upcoming Dr appt is well taken. I figured that he will probably tell me that we will retest in a few months and go from there. I know that many advances in PC treatments have happened since I was diagnosed in 2016 and I’m thankful for that.
It’s always helpful to hear from others who are going through or have gone through what I am because we all understand too well, these feelings and fears. Thanks again.
Posted 7/28/2024 3:59 PM (GMT -5)
Hi Dave, I get that it's a gut punch feeling seeing that you (temporarily????) lost that < sign. But take heart.

First, there is a strong possibility that it's just a blip, very low PSA amounts can come from other places, although not that common r that its lab error.

Second even if its real , it will likely be quite a while before its actionable

third, considering its 8 years to BCR, if it is BCR, chances are pretty good it can be taken care of easily enough. Mitigating factor is G9, but still, you'll likely be able to kick the can down the road for quite a while.

Again, thats all IF its real, it may be, it may not be.
Posted 7/29/2024 12:34 AM (GMT -5)
Hello Dave. I had my robotic surgery in 2016 as well. Mine was at a VA Medical Center. In January 2025 it will be nine years. I was a pT3a. The pathology report indicated that the malignancy 'abutted' the surgical margin, but the surgeon remarked it was still considered a "negative margin". about as close as it gets. You didn't mention where you get your PSA tested. Assays seem to matter. I get mine checked at the VA annually. Although it has come back undetectable on occasion, 80% of the time it low detectable. A few years ago it went as high as .03, but .02 is most common. Although my most recent PSA taken in June 2024 came back .01. Go figure. I mentioned to my primary care doc that it must be detecting benign tissue. He seemed to think that was a distinct possibility. The strange thing is I get my PSA checked on a routine basis with private insurance through Quest, and have also had it tested through Labcorp. Undetectable across the board. Labcorp <.006. Quest <.02. The VA uses a different assay than Labcorp or Quest. I understand your concern. When I hit .03 I thought it might be the start of a BCR. Then it dropped. So, in my experience, assays do make a difference. If you don't mind me asking, who tests your PSA? You are in a wait and watch mode. Maybe your doc will order another test in a month or two to see if the needle has moved in one direction or another. The uncertainty was always the hardest part for me. I just formed a plan of action in case the PSA continued to rise, and put it to rest until the next test. You've had a darn good run and I sure hope it continues. In the meantime, live in the moment and enjoy each day. All the best.
Posted 7/29/2024 6:45 AM (GMT -5)
So I’ve always had my PSA testing done at my Urologist office and occasionally at my PCP for annual physicals. I’m trying to keep everything in perspective and realize that this could just be a blip but as you all know, it’s difficult to keep that old feeling of fear from creeping in. I’ve never thought in terms of “cured” or “cancer free” but after almost 8 years, it is easy to sort of let your guard down re your disease.
Thanks to all who have shared their experiences and thoughts. It truly does help to hear from others who know exactly what I’m going through!
Posted 7/29/2024 7:17 AM (GMT -5)
Dave, whether warranted or not, your reaction is totally understandable. I think most of us would react the same way.

:::Breathe:::
Posted 7/29/2024 8:20 AM (GMT -5)
Make sure they are using the same lab....My MO switched labs and freaked me out. He told me the reading of .03 is undetectable with this lab.... check it out
Posted 7/29/2024 8:50 AM (GMT -5)
Thanks Steve…will do.
Posted 7/29/2024 10:46 AM (GMT -5)
There are quite a few places where undetcable means <0.04. So you'd be the same if you were going there. You had your surgery years ago. When/if your PSA rises again there is nothing for your urologist to do. (other than order more tests and refer you to someone else). Where are you located? You'll want to find a MO at a center of excellence to coordinate future moves. Here's hoping you get your < back.
Posted 7/29/2024 11:58 AM (GMT -5)
Located in Indianapolis.
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