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How significant a factor is PSA velocity in recurring PCa?

Hi everyone,
Well, my suspicions were confirmed: my PCa has recurred (after 7 years of nothing). I've updated my survivor story for the whole story. But my slight confusion is this: have I been wrong to assume that a rapidly rising PSA (which mine appears to be) requires treatment even if it's still contained within the prostate?
A PET scan of 4 weeks ago revealed bi-lateral recurrence, but no spread beyond the gland. I am awaiting one of the super-sharp biopsy - but as I have to work in Australia for 6 weeks, my onco is putting me on casodex to keep the cancer contained within the prostate.

He doubts that focal treatment will be possible, because the tumours appears to be widely spread, so we're probably looking at whole gland treatment. I'm 64, so QoL is an issue.

My confusion stems from the fact that as a friend/fellow warrior said" If it's taken 7 years to recur, it can't be very aggressive - yet my PSA has gone from 0.38 in March 2017 to its current reading of 3.7 - a ten-fold increase in less than a year.

Having looked at whole gland treatments, none seem to have minimal side effects. I've also seen some research suggesting that active surveillance seems to have comparable outcomes to salvage treatments. I'm also looking at less drastic options: re-purposing metabolic drugs (metformin, etc); photo-dynamic therapy; PSMA. There's a part of me that says "Follow George Hardy's approach by waiting until ADT is a necessity, and then take holidays for as long as you can" But I'm really only at the start of the research mountain.

I'll obviously know more when the biopsy's done, but that'll be for a while, so could anyone tell me if a rapidly rising PSA (albeit it still in the low numbers) is indicative of an aggressive form of recurrence, and therefore demanding prompt action?

Re: How significant a factor is PSA velocity in recurring PCa?

Dave; Sorry to read that you are in this position again. It is something we all fear and something that is a real possibility. It is what we all live with.
I understand your concern as the recurrence seems very fast moving. IF it is indeed cancer again, it appears to be the aggressive sort alright, having come back at such a pace. As you said, the biopsy will give a much better idea. It could be that this is not a recurrence of the original cancer but a totally new development.(?) I have often wondered if that might be a risk of treatment that leaves "healthy" prostate tissue behind. The original tissue contracted cancer so what is to keep the healthy left-overs from developing new cancer later in life? It is probably one of those questions that there is no answer to as is so common with this disease. Maybe some of our wiser more informed brothers here can elaborate on that.

At this point I guess all that can be done is about what you are doing, taking steps to find out more and moving accordingly. As I was recently reminded by a brother in this, cherish the cancer free years one has enjoyed and proceed with life on the course that best suites your plan. I can feel your fear of the effects of whole gland treatment and they are not unwarranted - but still better than suffering/dying from this "slow moving" disease. If your apparently aggressive recurrence gets "out of the barn", options are limited and it is now free to roam. Keep us informed. We are all in this together and are pulling for you. Jon R.

Re: How significant a factor is PSA velocity in recurring PCa?

David
Everything I have read over the years suggests a doubling time of less than one year represents an aggressive recurrence.

Unfortunately you are again confronted with a series of difficult choices.

As part of your research effort you may find my online journal helpful; see http://protondon.blogspot.com/ If you decide to take a look I suggest you begin with the entry titled "To My Family, Friends and Cyberspace Buddies"

Like you:

--A PET scan indicated my recurrence is limited to my prostate gland

--Thus far I have avoided whole gland treatment because of reported outcome data.

A final note: You may find my most recent journal entry particularly interesting. It addresses the issue of whether to treat a recurrence immediately or watch, wait and monitor.

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