Big increase in PSA

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Kevin on LI
New Member


Date Joined Jun 2010
Total Posts : 3
   Posted 6/14/2010 5:33 PM (GMT -6)   

I just received first PSA score (3 months post radiation) and it’s going the wrong way.  It was 58.  I retested to rule out an error but it’s still in 50’s.  This is way higher than it’s ever been before; pre and post treatment(s). It was 8 prior to surgery and 1 prior to radiation treatment. All MRI’s /scans prior to treatments were clear.  I’ll be calling oncologist tomorrow to see what next steps might be.

 I’ve been a lurker in the forum for past year but don’t recall seeing PSA increases like this before.  Has anyone else seen a jump like this?

To say I’m panicked is an understatement (I may have to join the Anxiety forum).

 


Age 52-DxMay 09 
-primary doc felt hardness during DRE; PSA test was 8 ; biopsy confirmed PC- Gleason 8 (4+4)
-DaVinci at NY Presbyterian Cornell - Aug 27 09
-lymph nodes clear,organ confined
-did need minor stomach surgery during procedure (cut out piece of small intestine)
-first PSA in Oct was 1.06-started 7 weeks radiation end of Dec 09-no side effects from radiation
-still using one pad per day but more for sense of security;slowly working my way off
-June 10 PSA-58
-Father has PC-diagnosed 11 years ago and is doing fine at 92 years old


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 6/14/2010 6:17 PM (GMT -6)   
Kevin on LI:
 
You will receive shortly some good responses from very knowledgeable guys who have been through radiation after surgery, but in the meantime let me get you to clarify some things that they may want to know:
 
You received a PSA reading of 58 on June 10th (last Thursday).  When were you actually tested?  Were there a test between the end of your radiation treatment and that test?  If so, what was your PSA reading from that test(s)?
 
Then you "retested to rule out an error" - when?  On June 10th?  When did you get the test results - today (the 14th)?  What was that result (I know ... "in the 50's," but where exactly in the 50's)?
 
I'll now step aside and let the big guns weigh in.
 
Good luck.
 
Zen9
 
 
 
 
 

Kevin on LI
New Member


Date Joined Jun 2010
Total Posts : 3
   Posted 6/14/2010 8:23 PM (GMT -6)   
Hi Zen9,

My first test after radiation was last Tuesday ( June 8). The results came in on Thursday at 58. The doctor asked me to come in for a retest on Thursday to make sure there wasn't a lab error. I got results of that retest this morning. It was a little lower at 53.

My last radiation treatment was Feb 25; so a little over 3 months passed before being tested.

Thanks
Age 52-DxMay 09 
-primary doc felt hardness during DRE; PSA test was 8 ; biopsy confirmed PC- Gleason 8 (4+4)
-DaVinci at NY Presbyterian Cornell - Aug 27 09
-lymph nodes clear,organ confined
-did need minor stomach surgery during procedure (cut out piece of small intestine)
-first PSA in Oct was 1.06-started 7 weeks radiation end of Dec 09-no side effects from radiation
-still using one pad per day but more for sense of security;slowly working my way off
-June 10 PSA-58
-Father has PC-diagnosed 11 years ago and is doing fine at 92 years old


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 6/14/2010 9:03 PM (GMT -6)   
OK, thanks.

I am sorry but I do not have the expertise or the personal experience to say anything meaningful about your situation. Obviously that is a large jump in PSA, but there are several potential explanations. I would suggest gathering some ideas from the guys who will respond to you here and then discussing them with a very good specialist, maybe several of them. If "LI" stands for Long Island, Dr. Peter Scardino at Memorial Sloan Kettering in NYC comes to mind, at least as a starting point, but I am sure you will get other good suggestions.

While you're waiting for responses, you might want to look at some of the signatures (the brief medical histories below the posts) of people on this board. Just look around at random. If it turns out to be relevant, know that there are people here who had PSAs much higher than yours and also people whose post-surgery radiation treatments failed but who are very much alive years later.

Your anxiety is perfectly normal. I know that doesn't help, but nevertheless ... it is.

Try to get a little rest tonight, even if you don't sleep much.

Zen9

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 6/14/2010 10:18 PM (GMT -6)   
Kevin,
With that high of a psa after both surgey and radiation it is an indication that the PC is growing in other parts of your body. You need to see a top notch oncologist that specializes in prostate cancer. I can forward a list of oncologists if you e mail me.
Good luck.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


fredlp
New Member


Date Joined Jan 2007
Total Posts : 14
   Posted 6/14/2010 11:04 PM (GMT -6)   
Hi Kevin: 
 
Here is another angle to consider.  In my case, I had a PSA in January 06 of 7.  Later in the year on retest, it came back at 38.3.  My biopsy indicated gleason 3+4=7 with 2 of 12 in one area.  about 30%.  My PSA did not match the biopsy results.  After a course of CIPRO prior to treatment, the PSA went down to 15.  I believe that there was some infection at work and possibly you have a similiar situation.  You may want to talk to the Docs. about early CIPRO to check on prostitis or other infections.  Best of Luck, it may not be as bad is it appears.
Age 71
original PSA 38.3
Pre treatment PSA 15 (after antibiotics)
Gleason: 3/4=7
Cat Scan and Bone Scan clear
Biopsy - 2 of 12 in one area malignant 30%
Proton/Photon/Lupron at Loma Linda April-June 2007
five months Lupron ending June 26 2007
first post treatment PSA September 07 0.1
second post treatment PSA April 08 0.3


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 6/15/2010 6:29 AM (GMT -6)   
Why was pice of small intesine taken?
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10  .50

Aril 10 MRI and Bone Scan show lesion on lower spine, false positive. 
 
Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July


Kevin on LI
New Member


Date Joined Jun 2010
Total Posts : 3
   Posted 6/15/2010 8:50 AM (GMT -6)   
Doctor said that when the prostate is removed, the small intestine should drop slightly.  When that didn't happen, they looked closer and saw that there parts fused together. In order to unfuse them (I don't think thats the techincal term), they had to bring in a surgeon to cut out a small piece which looked like it had been infected. Doctor said the infection could have been caused by food posioning at some point.  The piece they took was biopsied and was clear.
 
It turned my planned one night stay to a 5 night stay and 3 days without anything to eat or drink.
Age 52-DxMay 09 
-primary doc felt hardness during DRE; PSA test was 8 ; biopsy confirmed PC- Gleason 8 (4+4)
-DaVinci at NY Presbyterian Cornell - Aug 27 09
-lymph nodes clear,organ confined
-did need minor stomach surgery during procedure (cut out piece of small intestine)
-first PSA in Oct was 1.06-started 7 weeks radiation end of Dec 09-no side effects from radiation
-still using one pad per day but more for sense of security;slowly working my way off
-June 10 PSA-58
-Father has PC-diagnosed 11 years ago and is doing fine at 92 years old


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 6/15/2010 8:53 AM (GMT -6)   
My first PA was the same a pre IMRT. I see yours has decreased slightly since the Rad. I would wait for a least one more PSA test before doing anything drastic (ADT). My 2nd PSA test 6 months out after IMRT was 0.00.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable
03/02/09- 1 yr. post-op PSA .09 Undetectable
05/13/09   PSA .18 (ouch)
Started IMRT June 13, 2009
Completed 37 treatments July 31, 2009 (66.6gy)
11/23/09 Post IMRT PSA .18
2/12/10   Post IMRT PSA 0.00


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 6/15/2010 9:21 AM (GMT -6)   
Kevin

I hope the oncologist has the answers or suggestions. Frankly your stats confuse me.
It's almost as though the lab made a mix up with the earliest PSA tests.
All the best with that phone call.

Alfred
Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking of urine
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc. but...
Nov 17th 2009 PSA = 0.1
Can still get erections okay, and almost no leaking of urine, but since December 2009 I don't have orgasms, instead I just have intense pain in place where prostate used to be.
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)

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