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PSA Opinion

Just returned from getting my nearly 5 and half year PSA results,I was a bit concerned it seems to have upward trend was 0.07 today six months ago was 0.05.
The only treatment I have have had was my RP my PSA was 0.3 then over the 5.5 years is now 0.07.
My Doctor was not worried said it is not acting like prostate cancer going from 0.03 to 0.07 over 5,5 years.

My concern is if this continues with every 6 month test surely I will reach the bench mark for recurrence should I be concerned and doing something about it and what is the PSA number for reassurance ?
Tony W

Re: PSA Opinion

Hi Anthony,
I see this is your first post, so welcome to YANA.

Anthony the shift in your psa by 0.04 points over a five and one half year period is not sending alarm bells through my mind ether. True your psa is trending upwards, which is not what we want, but the doubling time currently is not cause for concern. Ideally your psa post RP should be low <0.03 and stay low. Clearly that is not the case in your situation, but the % increase is relatively small, and you will have plenty of time to explore other treatment options should a biochemical recurrence be established.

Anthony it would be very helpful if you are able to give us your psa pre treatment, biopsy result (gleason score, number of positive cores and %), staging (the T numbers), your post treatment pathology result, and your age. With the above information it will give us a better understanding of your situation and thus improve our ability to offer some help.

best wishes,
john

Re: PSA Opinion

Thank you very much John my pre surgery PSA was 9 Gleason 4x3 =7 had my RP in April 2010
but I'm very worried about the upward trend and I'm not sure what action I should take.
As I stated my urologist was not concerned which I don't understand because every 6 month test is higher when do we do something about the constant rise?and what can be done.
Hate to sound like a drama queen my cousin was DX after myself exact number had surgery again one week after me !! he died 7 months ago.
Tony.

Re: PSA Opinion

Tony, with your level of concern which is certainly understandable, why not begin to research your options. One step in this direction would be to explore with your Pca caretaker as to whether you may benefit from a regimen of Avodart?
Best wishes Don O.

Re: PSA Opinion

Thank you Don for your reply I don't feel like just doing nothing like my urologist suggested well he didn't say that he said don't worry about it !! So easy for some Doctors to say.
Thanks Tony.

Re: PSA Opinion

Tony,

Very unlikely this is reoccurrence. This is most likely a small amount of benign prostate tissue left behind after your RP. I believe that is why your Urologist is saying not to worry.

Fred

Lower the anxiety level a tad or three!!



Hi Tony,
While I can understand your agnst regarding the situation that you find yourself in now, with only a 0.04 rise in psa over five plus years, it is highly unlikely that commencing investigations currently would identify any suspicious activity in ether your prostate bed or lymph nodes. If your psa readings were in the order of a higher magnitude, say 0.2 to 1.0 that would be a different matter. Your Urologist is adopting a watch and wait approach, which to my mind is appropriate for now. I do think however, that your Urologist needs to convey the current strategy in terms that make better sense to you.

Tony below is a link to a journal article relating to biochemical recurrence. It is a little dated (2005) but still very appropriate to the circumstance that you now find yourself in. Have a good read and seek to reassure yourself that if you are on the path to a biochemical recurrence, your current psa signature indicates that you may be dealing with a pussy cat rater than a tiger.

http://urology.jhu.edu/newsletter/prostate_cancer829.php

best wishes,
john


p.s. Fred's comments re some residual prostate tissue is entirely plausible and would account for the slow rise.

p.p.s Tony tell us your age?

Re: Lower the anxiety level a tad or three!!

Thank you John I will be 66 next week July 14 thanks for reminding me .

Re: Lower the anxiety level a tad or three!!

Well Tony our best wishes for your birthday next week. And here I was thinking you were a nervous young pup LOL.

Seriously though Tony, whilst your slowly rising psa is a concern, albeit a long term one for the present, your chances of enjoying your twilight years along with all of us, sound good methinks. Try not to let PSA anxiety take hold of you. If say you came on here with a rapidly rising psa over 0.5, doubling time less than 3 months. my demeanour would be a lot more sombre and distinctly urging you to commence investigation post haste. So wake up tomorrow morning and enjoy your day and no doubt many more to come.

Do let us know your next PSA result.

best wishes
john

Re: Lower the anxiety level a tad or three!!

Thanks John received this from a GP friend of my daughter and still a young pup.

Tony:
Your PSA appear to have risen from a base of 0.03 in 2010 to 0.07 today. That is not exactly something I would be worried about if I was wearing your shoes. If it was to go on rising at even 0.02 ng/ml every 6 months for another 5 years it would still only be 0.27 ng/ml 5 years from now. Strictly, yes, that would be slightly above the technical indicator for biochemical recurrence post-surgery (which is 0.2 ng/ml), but think about this this way ...
Let's say that your PSA did rise to 0.27 by 2020 (as described above), and it went on rising at the same rate for another 20 years ... then by 2040 your PSA level would be 0.27 + 0.8 = 1.27 ng/ml. That's still way lower than your PSA level was when you got diagnosed. If you were 60 years of age when your were first diagnosed, you would then be 90 years of age. I really don't see a problem that is worth spending any time worrying over here.
What you are much more likely at have is a tiny amount of normal prostate tissue that was left behind at the time of the surgery that is growing extremely slowly and is therefore generating very low levels of PSA.

Re: Lower the anxiety level a tad or three!!

Ok Tony, it sounds like you are now in a better frame of mind today. Time will tell what unravels in your situation. But time of course is a wonderful asset, so make the most of it. Surely you have better things to do than mulling over the sword of damocles.

The analogy plotted by the GP, whilst projected on know PSA history is spot on. Let us see where we are with you in say a year. We will have a better picture by then.

best wishes
john

Re: PSA Opinion

Tony:
There may be a velocity issue in your PSA numbers that is not being addressed; namely:
(1) A rise of .02 over the five year period following your RP
(2) A rise of .02 in the last 6 months
Don O.

Reply to Don

donald oberlin

(2) A rise of .02 in the last 6 months.


Good point Don, but a 0.02 rise in six months equates to almost a two year doubling time and that of course assumes a linear rise. Take my own situation for example, and remember I still have my prostate.

For the six and one half years following my radiation treatment, my PSA was 0.1 (+ or - 0.03). Then 12 months ago it spiked to 0.22. Good grief I thought, better get my affairs in order. Next PSA, it is back down to 0.17 and that is where I am currently at, almost eight years post treatment. I guess what I am trying to say is that until such times as the baselines for biochemical recurrence are reached (0.2 for RP and 2.0 for Radiation) PSA stasis, progression and or regression are just interesting statistics.

By the way Don how have things been going with you? I confess to reading your blog from time to time and noticed a scarity of entries lately. How did things pan out with the esteemed Dr Myers?

Re: PSA Opinion

John/Tony

John

All of us are fortunate to have your participation on this site. Your advice and counsel is always well thought out, factually supported and constructive. I am much appreciative of your expressed interest in my online journal and my general well-being.

I am doing reasonably well which of course means fewer journal entries. I conducted a fair amount of research (and thought long and hard) before choosing Dr. Myers as my Pca physician. I remain convinced that I made the right choice.

Tony

John may be right i. e., there is little cause for concern. On the other hand the more research you undertake at this point the better prepared you will be if push comes to shove. In my judgment the velocity aspect warrants further attention. Part of your research effort in this regard could include more frequent PSA screening at least for a short period of time.

Re: PSA Opinion

Anthony,

I have been following this disease for more than 5 years and I have never seen a reoccurrence after an RP that had a linear progression. Velocity and Doubling time is not very useful at near undetectable levels. I have seen a lot of reoccurrence after RP and no one had a linear progression like the one you have reported. Your current PSA rising pattern is something that does not need to be treated. Your Urologist is correct.

Fred

Re: PSA Opinion

Hello Anthony

It occurred to me that my PSA chart may be of some value to you, and you might consider doing one yourself if you haven't yet......

http://www.yananow.org/images_Mentors/CharlesPSA.jpg

Hmmm..... Not sure what will come up with this, it's from May 13th of 2013.

I highly recommend Proton Radiation if and when the time comes, as I've detailed in my story. Notice also that the rising PSA curve is an exponentially rising growth curve, ever increasing with the explosion of antigens (?) in the prostate gland.

charley coryn

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