Rise in PSA post RT. Opinions?

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mr bill
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Date Joined Sep 2010
Total Posts : 697
   Posted 5/17/2011 1:45 PM (GMT -6)   
Need some opinions from the forum.  Last September I had RRP at Cleveland Clinic. My PSA went to undetectable at 8 wk test.  Based on my pre-op PSA (33) and Gleason 9 the Uro Surgeon recommended Radiation.  I did have radiation of pelvic area and nodes over 39 treatments from February 22 to April 12, 2011 at Regional Cancer Center in Erie PA.  Prior to that treatment my PSA was still undetectable on Jan 20, 2011 at ACL Lab in Erie. Then went on a much needed two week vacation to my wife’s home state of Mississippi.
In preparation for follow up with Uro surgeon on May 20th I had my PSA done yesterday May 16th. Today I picked the results up and found that they had risen to .04 from <.03. 
Has anyone else had this experience?  Do labs make mistakes on a regular basis, and does this warrant a retest?  I don’t even know if this is a significant increase.  I guess my opinion is that the rise indicates something is brewing.  I would like to think it is just a minor bump, and may go back down.
Anybody have any opinion/input?

Age 66
BPH since 1996. at least three negative biopsies Erie. Uro did not Rx finasteride
2007 acute urine retention photovaporize Clev. Clinic Rx finasteride
8-9-10 PSA rose to 10.14 with finasteride positive biopsy gleason 9, cat & bone scan negative
9-8-10 RP at Cleveland. Biopsy 9 nodes 2 positive,
seminal & vas deferens +
PSA 12 week <.03, Jan 20,2011 <.03
RT started 2-17-11-4-12-2011

Steve n Dallas
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Date Joined Mar 2008
Total Posts : 4834
   Posted 5/17/2011 1:58 PM (GMT -6)   
I'd wait a few weeks and test again...

mr bill
Veteran Member


Date Joined Sep 2010
Total Posts : 697
   Posted 5/17/2011 2:42 PM (GMT -6)   
Steve,
That is what I am thinking. What bothers me is the old adage - where there is smoke there is fire. Just got off the phone with uro surgeon PA.  He indicates there are other thinks that can make the PSA rise.  I guess I should have asked what. Especially if the prostate is now in the medical waste incinerator.

Post Edited (mr bill) : 5/17/2011 2:13:54 PM (GMT-6)


Ken S
Regular Member


Date Joined Nov 2006
Total Posts : 120
   Posted 5/17/2011 3:22 PM (GMT -6)   
Bill,

I had RRP followed by IMRT five months later and my PSA's fluctuated as follows; .01 a month after surgery, .02 before radiation, .04 after radiation, .03 the year after, .01 the next year, .02 the past year. All my doctors say it's nothing to worry about.

Ken
Age 54 (2006) PSA: 2005 - 3.2, 2006 - 3.7
Biopsy 8/06, Gleason 6 (3+3), T1c
RRP 11/3/06 Post-Op Biopsy, Gleason 6 (3+3), T2c, right apical margin positive
IMRT (37 Treatments) 4/23/07 - 6/14/07
PSA: 7/10 - 0.02

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5860
   Posted 5/17/2011 4:14 PM (GMT -6)   
Its not something I would fret over at this point. I would do the 3 mos tests and see if there is a consistence and continuous rise over 3 tests counting the the last. Tho Ken S shows that it can go up and down slightly over time. The fact that is is a 9 and seminal and nodes are positive, pushes the odds to systemic, rather than local IMO. If you go rad, ask oncologist or use nomagrams for statistical chances for cure, then make YOUR call. At 66 you won't die from this. Have a nice long and productive life.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 5/17/2011 4:27 PM (GMT -6)   
Bill,

It really is hard to say. But from a positive point of view, you have gone a year and a half with small amount of rise. You also could have been at .029 the last time.

I recently went to CC again to see Dr. Stephenson, who was a developer of the MSK nomograms. I have slowly climbed to .03. He punched up his nomogram and there was 65 % chance I was cured. He is thinking the rise is due to bemign tissue.


Will see him again in July.

Good luck my friend.

Goodluck

reachout
Veteran Member


Date Joined May 2009
Total Posts : 725
   Posted 5/17/2011 6:35 PM (GMT -6)   
Bill
I'm at 0.05 18 months after surgery and my doctor told me not to worry unless it got over 0.1. But I know it's easy for them to say that, and tough for us to stop worrying. So all I can say is, don't worry :)
Age: 66
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
Post-surgery PSA:
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 and 19 month detectable .05.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/17/2011 6:38 PM (GMT -6)   
Mr. Bill,

I would do as OS suggested. If it ever hits .05 and stays or climbs above that, might be a remote reason to worry.

David
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

mr bill
Veteran Member


Date Joined Sep 2010
Total Posts : 697
   Posted 5/17/2011 6:45 PM (GMT -6)   
Thanks for all the positive input. It seems the general consensus is that it is really no big deal. Sometimes it is difficult to convince yourself of that. Dr. Stephenson also plugged my pre-op figures in and told me he could almost guarantee me 7 to 10 years, maybe 15. Then he said who knows what research will come up with by then. I hope he is right. I am already "high mileage."
Age 66
BPH since 1996. at least three negative biopsies Erie. Uro did not Rx finasteride
2007 acute urine retention photovaporize Clev. Clinic Rx finasteride
8-9-10 PSA rose to 10.14 with finasteride positive biopsy gleason 9, cat & bone scan negative
9-8-10 RP at Cleveland. Biopsy 9 nodes 2 positive,
seminal & vas deferens +
PSA 12 week <.03, Jan 20,2011 <.03
RT started 2-17-11-4-12-2011
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