To update, I have been watching a mostly steady uPSA of mid .02x last eighteen months. But in recent months, since Aug., has started to tick up: .030, .034, .048 (Nov. 30). I think I was similarly hydrated, etc., for all of them.
Today (Dec. 14), I had my 12 month visit with uro --same one that did my RALP in 2012 and has had me on TRT last few years.
Here are the main things discussed with him:
(1) He said the .1 from last Fri. blood draw for his standard PSA could be anything from .051 to .149. It would still report as .1 reading! I showed him my three most recent LabCorp uPSAs, August, early Nov. and late Nov.: .030 .034 and .048. I did not know that the standard PSA only ever shows .1, .2, .3, etc. I thought once it got to .1, its lower limit, then it would show more decimals, like .12, .17, etc. Nope. He and I had quite the discussion about
PSA vs uPSA testing. We amicably agreed to disagree (ha). I continue to get my own LabCorp uPSA because I want to know and want to see the trend. He likes the standard because, over the ranges it shows, like .1 to .2, treatment wouldn’t change as a result, so why get more worrisome details. Hmmm...
(2) He said my PSA could level off at any point from now on, or I could keep seeing a rising trend. He has seen both. The former would be of no concern, and I would just outlive whatever it is. If the latter, it is most likely a local recurrence, and some form of radiation would be the next step. He did not push me one way or the other.
(3) I told him I would be just fine if it stabilized or just rose linearly at a rate I thought I could outlive. But I also told him PCa is a sensitive issue in my household. Wife’s father died of PCa with advanced brain mets; her brother just finished his primary radiation for PCa. My uncle died of PCa, and my dad died of abdominal cancer (origin unknown). He understood our feelings on this.
(4) I asked him what cut-off PSA for SRT he personally would use in a case like mine. He said there is no cut-off per se, each patient case is unique. Depends on path at surgery, current health, expected longevity, etc. He did say some think .2 is definitely BCR re SRT, but said other evidence says "the earlier the better", but said studies are not conclusive on that.
(5) He said before I went for SRT, if I do, there are two scans that might help. The Axumin would only be good for PSA .4 or higher. The PSMA would be useful at much lower levels, but (he thought), the higher the PSA at time of test, the more accurate it is. Neither test is available in my
location currently. He said the scans would help if the problem was, like in a node, so then why radiate the prostate bed? We discussed that with 3+4=7, one would not think it was micromets, and with margin+, it would probably be local to prostate bed. But who knows for sure?
(6) (edited to add) He said I could not get the Decipher tests because path tissue is only good for three years for that test...have you guys run into that??
(7) He wanted to see me again in six months, with another standard PSA just before.
(8) Oddly, the topic of TRT injections, which he has had me on since about
March 2016, did not even come up. He didn't say to stay on or go off. I myself have decided to discontinue. The injection two weeks ago was my last. When I purposefully went off my injections mid 2017 for six months, I saw a nearly 50% drop in my uPSA. And it stayed down for months until I started injects again. No explanation why. I have decided I do not need that kind of added "static" in a uPSA trend I am trying to monitor to time or even start SRT. My T tested 750 last week (his test, middle of 14 day injection cycle) and that is where (in past visits) he said he likes to keep his TRT guys. But I think, from my past tests, going off TRT I will bounce around in 300's, maybe low 400's, due to better fitness and weight-lifting. At times in past I was in mid 200’s. But am much more fit now. Will have to go cold turkey for a while, maybe forever. When I see him again in six months, he may say it was unnecessary to go off TRT, but, oh well.
So, I am in “watching PSA” limbo for a while. Aren’t we all?
Any comments on above or otherwise would be welcome. I value your ideas and experience. This is a good board and good people.
Also, looking ahead, if anyone has thoughts about
U.T. Southwestern (Dallas) or MD Anderson (Houston), esp. docs you would recommend there, please chime in.
Jan '08-'11 PSAs 2.2 2.5 2.7 2.6, DREs-
Jan '12: PSA 3.6, DRE+
Jan '12: MRI inconclusive
Feb '12: PCaDx pT2a, 4/12+ (3 @ 3+3, 1 @ 4+3); 3% tot cores; bone scan-
Apr '12: RALP; 3+4=7; pT2c pN0 pMx; 30%; 3mm r lat margin of 3+3=6 so pT2+; EPE-; PNI+; 8 LN-; SV-
TRT 03/'14-now; uPSAs: <.015 til 02/17; mostly .020-.030; then .048 on 12/1/18
Post Edited (Bobbiesan) : 12/14/2018 2:04:35 PM (GMT-7)