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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.

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

my dr. said watch the alk phos and glucose after the cancer as become androgen independent (not feeding off testosterone) -mine is both now out of range.. James

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

Hi James,
Sorry - could you just explain "alk phos" and glucose. And what do you mean by 'out of range'? Sorry if I'm being a bit dim!

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

First of all let me explain what my background is--i am a retired senior scientist (with a lot of time on my hands) spent most of my adult life researching possible cures for cancer and other cures of many other diseases around the world (let me say I have not found a cure for sure) i have however found and developed many products to suppress cancer such as hormone blockers (testosterone suppression ) to stop feeding --along with products to allow men with urination issues to urinate without Catheterization along with other types of products to suppress Malaria and to remove parasites from the blood stream.. enough said about me.. as for as your question concerning Alkaline Phosphatase --it is simply and enzyme in the blood stream that is a key number (concerning prostate cancer Metastasis in the bone structure)--I have never seen a case involving a man where the prostate cancer has moved into the bone structure that died from this and where the alk phos was never outside of the lab ranges--typically Alk phos has to reach very high numbers before a man will die from androgen independent cancerous cells ( i have seen it in the range of 300 up to 2000) remember we are not talking about PSA here.. we are talking about Alk Phos levels--Alk phos is a key number to watch once the cancer moves from androgen dependent (feeds off testosterone) to androgen independent (where it feeds off of the body) mainly the bone structure-Psa appears to be, for the most part irrelevant once the cancer becomes androgen independent and hormone blockers are no longer effective as a hormone blocker is designed to address androgen dependent cancerous cells only..As for as your question concerning glucose levels--glucose levels are very important once the cancer begins to move into the bone structure (simply put) cancer love sugar and will raise glucose levels.. as a rule there are 3 things to look at when things are looking really serious--# 1- very elevated Alk phos--# very elevated Glucose levels and last but not least #3- elevated PSA. and by this time there is always pain issues to deal (from the stage 4 cancer) when all 3 of the above takes place. hope this helps--Remember I am NOT a medical DR. this info above is strictly for observation (not treatment) thru so many yrs of seeing all stages of differnet cancers in my line of work . ----James

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

sorry David-- answer to your question about range (this is the numbers that labs use to detect any possible unusual activity (meaning numbers out of range) --if your numbers are in range then there is not likely any concerns your dr would have..same way with glucose levels.. James

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