I think I know where this is heading

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JayMot
Regular Member


Date Joined Feb 2016
Total Posts : 174
   Posted 3/6/2018 6:36 PM (GMT -6)   
Just got my 21 month uPSA results and it's .01. Three months ago it was .007, 6 months ago <.006. I know it's not a big move, but it's moving in the wrong direction. I guess with my pathology, I should have expected this, but like all of us, I was hoping I'd be the one that beat this outright with one treatment. It's very disheartening, to say the least.

So, I guess it's just waiting now for this to hit the magic number of around .03. Maybe I can get a good run before the next treatment(s).

Hang in there, brothers. I'll try to do the same.

-----------------------------------------------------------------------------

Age at Dx: 54 (DOB: 01/28/62)

08/31/15 PSA 2.5;
01/01/16 Urinary Frequency;
02/05/16 DRE Pos;
02/22/16 Biopsy;
02/26/16 Dx: 7-12 positive; (5) 3+3=6; (1) 3+4=7; (1) 4+3=7; T2B;
03/11/16 Bone Scan Neg;
03/23/16 CT Scan Neg;
03/31/16 Surgery Consult UPENN;
04/08/16 RT Consult/2nd Op Fox Chase CC upgrade to 4+4;
04/14/16 3TMRI "organ confined", EPE-, SV-, LN-;
06/01/16 DaVinci @ UPENN (Dr. D. Lee);
06/08/16 Catheter Out;
06/08/16 Post-Op Path: EPE+, Marg +, SV-, LN-, G7(4+3) (G4 80% - G3 20%), tumor vol 25%, T3a;
07/01/16 Start 5mg Daily Cialis, 20mg once a week on Friday's;
07/06/16 Decipher 0.56 (Average Risk), 5 Year Metastasis 7.6%, 10 Year PCa Specific Mortality 6.9%;
08/01/16 Penile rehab started (Pump);
08/31/16 uPSA <.006;
12/01/16 uPSA <.014 (? same lab);
01/30/17 Decipher GRID PORTOS: [Avg ADT Response (21%), Avg Docetaxel Sensitivity (56%),
Lower RT Response (45%), Avg Dasatinib sensitivity (38%), High Genomic Gleason Grade (81%),
High Metastasis Risk (70%), High Tumor Cell Proliferation (82%), Avg AR Activity (56%)];
03/01/17 uPSA <.006;
06/01/17 uPSA <.006;
09/01/17 uPSA <.006;
12/01/17 uPSA .007;
03/01/18 uPSA .010

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 8618
   Posted 3/6/2018 7:01 PM (GMT -6)   
Not the direction you want.

See what the next one is and you'll likely want to start a conversation with an RO then.

Till that happens - enjoy life.

Hang in there,
Andrew
I'll be in the shop.
Age 58, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17, .3 10/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

Jaybee&GG
Regular Member


Date Joined Jul 2016
Total Posts : 298
   Posted 3/6/2018 7:22 PM (GMT -6)   
Hi JayMot

I'm very sorry to see the upwards (albeit very slow) trajectory. GG had a 0.01 PSA late last year which returned to <0.01 at his subsequent test. So I guess it is possible for things to stabilise or at least move very slowly, but it would seem (to a lay person), that your pathology does indicate further tx might be required.

We are sending positive thoughts your way, for a very, VERY long remission before anything further is ever required.

Best of luck.
Jaybee&GG
Dx May 2016 age 57. PSA 23.4
DaVinci RARP 1 July 2016
G 4(50%)+3 = 7 (Grade group 3)
Large TZ Tumour (apex to base) = 10% of prostate
pT2c N0
PNI- EPE- SVI-
Lymph invasion (x 8) not identified. No positive margins.
PSA's to June 2017 = <0.01
28 June - Aug '17 = 0.01 :-(
Nov '17 = <0.01!

JayMot
Regular Member


Date Joined Feb 2016
Total Posts : 174
   Posted 3/7/2018 10:34 AM (GMT -6)   
I've just been trying to read up on the uPSA test and how much fluctuation can occur at 3 decimal places. I read a Hopkins study, but it was from long ago, that stated the PSA can be all over the place at less than .01 (.000 - .009). So, I don't know what to think. It's funny (not really) how much weight I put into a .003 rise in three months. I read another thread, not sure if I remember who's it was, but his uPSA test only measured down to 0.014. If I had been using that particular uPSA test, I'd still be at <.014 and feeling a little better.

Next uPSA test is at my 2 year post surgery mark in three months and I meet with the surgeon one last time. Then, I'm kind of on my own after that.

tennisplayer
Regular Member


Date Joined Nov 2016
Total Posts : 418
   Posted 3/7/2018 10:57 AM (GMT -6)   
Your final pathology could have been better. But stay positive. There are further treatments that can be curative. As others say, look for a good RO. Hang in there!
Age at diagnosis-66 Diagnosed 6/16
RALP 10/16 at U of Chicago, Dr. Shalhav. Experienced internal bleeding post op requiring transfusion of 2 units.
Pathology Gleason 3+4=7, tumor volume 15% Margins negative except for one focal margin, .1mm
pT2c,N0,MX,R1
PSA @ 6 wks <0.02;16 wks <0.02; 5/17 <0.02; 10/17 <0.02
My storywww.healingwell.com/community/default.aspx?f=35&m=3777359

Bobbiesan
Regular Member


Date Joined Mar 2012
Total Posts : 236
   Posted 3/7/2018 4:29 PM (GMT -6)   
JayMot said...
I read another thread, not sure if I remember who's it was, but his uPSA test only measured down to 0.014.


JayMot,

Might have been me. These are some of my uPSAs since saw my first rise last year (5 yrs after RALP):

2017/02/03: uPSA = .024
2017/04/10: uPSA = .021
2017/06/21: uPSA = .018
2017/08/16: uPSA = .017
2017/10/18: uPSA = .024
2017/11/17: uPSA = .020
2018/01/12: uPSA = .026
2018/03/05: uPSA = .032

I think you chose the right word, "disheartening". Not sure how much faith to put in the uPSA test itself. Don't want to wait so long as to decrease the benefit of secondary treatment. But also don't want to jump too soon, before seeing a definite trend. Don't know how much better SRT works starting at .05 vs .10 vs .15 vs .20. For example, is the SRT at .15 maybe 20% less effective than at .05? Not sure where that data can be found.

Seems like a lot of guys here, like Prato, are trying to puzzle this out. Vexing.

Hope your readings trend down. It sure can happen here and there.

Robert
68 now
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; up/down wildly .017-.032 since

island time
Veteran Member


Date Joined Dec 2014
Total Posts : 1492
   Posted 3/7/2018 5:03 PM (GMT -6)   
Losing the < sign has been the most difficult part of this journey (for me). When diagnosed....the goal posts were an immovable object that....once reached....meant victory.

The day I lost the < sign....was really the first time I felt the emotional effects of what it's like to be diagnosed with cancer. Real life seemed far away that day. For the first time...the goal posts were in a different location. It was discombobulating.

Suddenly....everyone has different opinions. And I'm the tie breaker.

You'll make the right calls when and if the need arises JayMot.

That jury could be deadlocked for years.

Take care man
PSA 2010 thru 2014...4.0 +/- .7
Dx 12/14 @ 56 yo...2 cores G6 <5%, 1 core G6 20%, 1 core HGPIN.
RALP 11/25/15...3+4. 3 to 5 mm surgical margin 15% involvement pT2+
PSA's....2/16-.01...4/16-.00...7/16-.00...10/16-.01...1/17-.01...4/17-.02...7/17-.02
10/17-.02...01/18-.05

JayMot
Regular Member


Date Joined Feb 2016
Total Posts : 174
   Posted 3/8/2018 10:21 AM (GMT -6)   
Bobbiesan, maybe you are bouncing around the .03 level because of "other" PSA sources?? This article, "Ultra-sensitive PSA Following Prostatectomy Reliably Identifies Patients Requiring Post-Op Radiotherapy" states in its "Discussion" that "

The capacity to measure such low values may not be necessary or valuable, as it is known that serum PSA levels ≤30 pg/mL can be produced by nonmalignant sources of PSA [13], from benign cells left at the bladder neck, urethral margin, or periurethral glands [14–19]".

The ≤30 pg/ml needs to be multiplied by 1000 to get to the .03.

I'm not sure how to post a clickable link, so just copy and paste link below.

This is the link https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527538/

J

Gunner34
Veteran Member


Date Joined Jan 2014
Total Posts : 569
   Posted 3/12/2018 3:48 PM (GMT -6)   
J
It's easy to relate to your anxiety. But you are still in a good spot and untreated currently, correct? A course of Lupron would get it back down and your life wouldn't change much. I know you're probably not even close to that point yet but it's in your arsenal as well as radiation and other treatments. You've done the research so you know wher you stand. Like I said, I get the same feeling often but I say continue to enjoy your life as is. I hope your PSA drops back down to .006 but even if it doesn't you're on top of it.

Take care J

B
Dx Jan 2013 age 46 PSA 12.4
14/14 +. T4 N1 M1b G9= 5+4
Firmagon, Taxotere - (6/13)
Etoposide/Cisplatin - (10/13)
PSA's 9/13 0.18, 12/13 0.36t
open RP 1/21/14 -7/18 nodes +
2014 & 2015<0.10 Lupron & Xtandi
5/14 -Thymectomy
IMRT 6/14
3/16 0.06
4/16 0.16
5/16 0.10
6/16 0.18
7/16 0.42
8/16 0.67 proton beam
9/16 0.57
12/16 0.68
1/17 Jevtana X 7
6/17 0!!! Start Zytiga
12/17 <0.05
2/18 <0.05??

Bobbiesan
Regular Member


Date Joined Mar 2012
Total Posts : 236
   Posted 3/12/2018 9:04 PM (GMT -6)   
JayMot,

----------------------------------------

(btw, when replying to a post there should be line of buttons

IMG URL LIST QUOTE CODE FLASH

To put a link in your posting, you press the URL button, it inserts the starter code for you, then you copy/paste or type the web link next, then press the URL button again, and it inserts the end code for a link in your post. When you submit your post, it gets converted correctly to a blue clickable link)

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Thanks for that link. I had read it some time ago but it was good to review again.

There may be some relationship between the DHT product of TRT and rising uPSA due to its effect on urethral glands or other benign sources.

This resource seems to suggest that can happen in post-prostatectomy guys, not only raising the urine PSA but also the total PSA:

/www.researchgate.net/publication/47447046_What_are_the_possible_reasons_for_urethral_PSA_varieties_after_radical_prostatectomy

Or I may have a combo of that and some uPSA from my (3 + 3 = 6) positive margin. My uPSA did trend down when I purposefully went off the TRT shots for a time last year. Need more tests over time. I may go off my TRT a few upcoming months and see if uPSA heads down again. Then I will feel more comfortable and maybe quit worrying about it.

Hope you get some good upcoming answers and results.

Robert
68 now
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; up/down wildly .017-.032 since
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