PSA 12 years later

I really don't have all my history available at hand but thought I would ask.
In December 2012 I had a Rp, Followed by 36 visits of RT I do remember mention of seminal tubes being affected, anyway my question is that for 10 years my PSA was always .01, then 2 years ago it started to change to .05 then .07. It stayed at .07 then almost 1 year to a day it is now .14 My Urologist quit last year so I asked my GP she said that my numbers are normal, what say (anybody) Thanks.

Hello - There have been a few threads about this PSA situation (RP followed by RT) this year. Seems that there is no universal answer but “keeping an eye on it” tends to be common and waiting for PSA to get high enough (>0.20) so that a PSMA scan might have a chance of finding something are typical.

Are the numbers normal?, probably not but it happens. Is it a big deal?, to be determined… You might consider going to 6 month testing but nothing more than that. You might consider finding an oncologist that is knowledgeable in prostate cancer at some point. The urologist does not have much to add at this point and this gets beyond regular docs pretty quickly.

JNF - sorry, we posted similar answers at the same time

Agent, I assume your GP was thoroughly knowledgeable about your PCa history including the surgery and radiation before declaring your PSA increase was normal. Was she your GP at the time you were referred to the urologist that led to your diagnosis and treatment?

I had my pet scan when my PSA was .05 and that is when they found nodules in my lungs.... That was 2020. Now after 4 years on ADT no cancer in my body......

Hello Agent. I'll just echo the responses you have received and suggest you ignore your GP and find a medical oncologist with experience treating prostate cancer. And...good luck to you!

Jim

Yes the PSA tests have been at the same lab for the last 10 or more years. I even sent a second message , via the portal to my GP adding some history so as to remind her, just crickets.
Health care in Florida seems to have really gone downhill since Covid. We have less doctors and they pay less attention.

Agent, you and I have a very similar history. 12 years without much of a problem. However, My post RP PSA persisted. Then HT and radiation. Fast forward, I aited a few years ago for my psa to rise before seeking help since my Uro retired. It went over 1.0 quickly and I got concerned. PSMA scan f-18 showed three pelvic lymph nodes shining brightly. Went to both a Urologist and a Medical Oncologist (Med. Onco is with Northwestern Cancer Center Chicago). The Urologist said Hormone treatment for life. (Uro is the head of Urology at Lutheran General park ridge Illinois.) He also opined that seeking out radiation for lymph node involvement was a waste of time.

My Medical Oncologist recommended radiation with hormone therapy, combined 1st and 2nd Gen for, 18 months. Luckily, next door to the Oncologist is the Northwest Proton Center. I inquired there first because I had prior radiation. My Radiation doctor said proton therapy is perfect for what needs to be done. I've been on Firmegon and Abiraterone for a few months now and scheduled to begin 28 proton sessions on June 10.

Steve n Dallas said...
Are the PSA Tests being done at the same lab every time?

I see this question often. As a patient you should get the same comparable results not matter what lab you use. If you believe this is not true, how do you know your tried and true lab isn’t consistently providing false negatives?

Hello - there are a few men here lately with PSA creeping up slowly over a very long period of time if you read through the posts. In a perverse way, that is actually a good thing as there is plenty of time to consider the situation and no fire to put out. Likewise, it is also a bad thing as there is no obvious problem to solve and it will take time to arrive at a treatment plan if and when needed.

It appears that the general approach for slow PSA rise over time now is to let the PSA increase until a PSMA or similar scan can find some evidence of the source of PSA increase so treatment options can be considered. Jumping on ADT as a solution is typically not a good idea for these cases and hopefully your new doctor will not propose that as it stops the discovery process.

All of this takes time so get ready for no quick solutions and more waiting. Your PSA has just got to the interesting point and now you move into another phase of medical attention. Heck, the next test could be below 0.20 so some confirmation testing will be done but no hurry.

lapilot said...
Looks like I just joined the club. Twelve years ago had robotic surgery and two years later required IMRT/IGRT (72 grays) because of a 1mm positive margin. For the past 8 years PSA has been <0.02 ng/ml to 0.02 (Quest Labs post-prostate PSA blood test every 6 months). Just received that my PSA came back at 0.05 ng/ml. Hoping this is a fluke, but if not hoping a very slow rise in the future.

Sorry to read this, after such a long period of time. As you said, could be a fluke, let's hope so. Even if it's not, you are a long way from needing any treatment. Please keep us posted.

What was your Gleason score after surgery, I didn't see it in your signature?

what was your Gleason score, from surgical pathology. Your timing is similar to mine, my PSA became detectable at the 2 year mark, and at the 3 year mark I had SRT + ADT. Finished salvage and ADT 5 years ago

My surgical pathology was g7(3+4)

It GS 7 (3+4) with a 1mm positive margin.

Just a side conversation going on it appears...

I have no idea at all what to expect with a pet scan, and can't wait to find out!

PET scan is like a CT or MRI in procedure . Many times, PET and CT scanners are combined into a single machine given the common equipment needed.

The difference is with the tracers. PET uses radioisotopes of one form or another that hopefully highlight what is being looked for by the PET unit. PSMA is expressed by prostate cancer so a PSMA tracer that tends to cling to the PCa cells is used and are hopefully highlighted in the scans. There are other organs and parts of the anatomy that tend to attract tracers as well so the radiologist has to segregate the known locations from the suspicious locations.

Positive PSMA results tend to be accurate, negative results not so much if PSA is low or if there is a different type of cancer going on that does not exhibit PSMA. Just another scan with contrast otherwise to most people.