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psa creep

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Posted 3/7/2018 10:03 AM (GMT -8)
I have been around this site for almost 12 years. Biopsy in 2006, surgery in 2007 radiation in 2015. After salvage radiation (no HT) in November 2015 my PSA of about .2 (+-) has not decrease but not increased. It has gone up and down between .179 to .240 during this time. My radiation doc and oncology doc both said that while not "usual" it might be normal for me. Both docs order psa tests and the ultra sensitive tests are always lower, even one from the same blood draw in 2016..don't know why. They both agreed that additional treatment was not called for, but we should continue monitoring.

My PSA test this week shows an increase to .339, up from .245 six months ago. This is the first real upward trend in over 5 years. I have an appointment with my PO next week. Based on our earlier conversations, he will probably suggest HT or maybe continued monitoring. HT might be the answer, but I wonder what "new" therapies might be out there. I have not followed newer treatment and I am horrified by their financially destructive costs.

I would like some input into some of these possibilities and any other observations you might have about the progression of my disease. I will soon be 78 and in pretty good health, some early kidney disease and controlled blood pressure. Thank you all for the years of good advice and guidance
Posted 3/7/2018 1:12 PM (GMT -8)
At 78 and even if it was ...horrors of horrors... a 1.0...me... Id live my life...if I ever got confirmed advanced cancer..{.this you do not have}.... I would get surgically castrated{maybe...I could give the devil his lb of flesh}...and go about my merry way...counting my blessings instead of sheep...but now that you see who the post is from...im sure you are not surprised...others will come by with other advice you should listen...then you should turn unto wisdom and lo...
Posted 3/7/2018 3:59 PM (GMT -8)
Thanks logo

Just noticed I was math challenged...77 not 78 this year.

I am disappointed that my post has mostly been ignored. I hoped to get some real opinions...Oh well I guess the board quality is slipping.. nono
Posted 3/7/2018 4:07 PM (GMT -8)
lifeguyd,

I just wanted to pop in to provide a little moral support. As a 70 yr old who had both surgery and radiation, I am probably not the best to discuss further treatment with. I let my PSA get to 94 and then 145 before I spent some time on ADT.

My best to you and I hope you get some meaningful feedback on your questions.

Sonny
Posted 3/7/2018 4:18 PM (GMT -8)
The board has slow days sometimes, patience... when a poster asks for medical advice, not (just) moral support, I try to be like Mr Ed and not speak unless I have something to say... (Sonny, right away you showed your heart, jumping in the pool to give lifeguyd a boost)... lifeguyd, we’re all rooting for you. Give the Wise Ones more time, please, I’m sure they’ll chime in soon.
Posted 3/7/2018 4:28 PM (GMT -8)
In your case, I wouldn't be rushing into new treatments without good cause. Monitoring and seeing where it goes seems like a good idea to me.

Hang in there,
Andrew
Posted 3/7/2018 6:19 PM (GMT -8)
What is your PSADT?
Posted 3/7/2018 8:07 PM (GMT -8)
Since the end of radiation, my psa has waffled around +- .2 which my oncologist suggested was not typical. The .2 number is the same that it was at before radiation.

Over the past 27 months (since the end of radiation) it has almost doubled from my lowest reading( .179). Most of that movement has been during the past 6 months.

As I mentioned in my post, I always got a lower number when using an ultra sensitive test. For example in 2016 a single blood draw was run through both a regular and an ultra sensitive screenings. The ultra tested at .179 and the regular tested at .19. Not a big deal, but no one seems to know why.

Just trying to determine if I really need treatment.
Posted 3/7/2018 10:09 PM (GMT -8)
You might want to use this calculator to calculate PSADT:

/www.mskcc.org/nomograms/prostate/psa_doubling_time

If it is below 9 months, you should consider starting ADT sooner than later.
Posted 3/8/2018 9:52 AM (GMT -8)
lifguyd...to your point about "board quality"...and I realize{love that word much better than recognize...a waft of hubris...in the latter} both our thoughts are personal observations....I observe a more enveloping and geometric affect to the posters responses...you may remember...back in your day...the responses were more linear i.e. ... more structured to the point...for lack of a better word...less soul...yes advice was given and taken...support always there...condolences given and received...as time progressed...better said as we progressed...and this is true...outside of the forum in most venues of life...in spite of/because of...a very real rudeness that exists...in the Polis...any where and with anyone...if you engage another human being as an individual and in caring manner{only the most harden will not respond to genuine smile plus...tho beware there are wolves out there...utilize your gift of discernment}...er..where was I...oh yes...that person will respond in genuine joy to those efforts?[hardly an effort...non?...oui?} I see where you might make a statement as you did...I get cranky too in this crazy world...I wish you the best...and I know that you know I'm a big believer in wishes...logo
" a wish is a dream your heart makes " Yiminy Cricket to the Child in all of us...

wink
Posted 3/8/2018 10:08 AM (GMT -8)
Keep coming back to the title of this thread, "psa creep"

you know, PSA can be a creep, a jerk, and a generally horrible person. It could be nicer you know.
Posted 3/8/2018 10:21 AM (GMT -8)
Yep, what the others said. If it’s moving slowly, wouldn’t there be some time to watch, especially because you have seen fluctuations before? That’s not based on any expertise but trying to sift through what you’ve said.

lifeguyd, we’re of an age, but my EPE and persistent psa means immediate ADT & RT.

On psa assays, is the ultrasensitive always to thousandths? I thought I was getting the ultra but reports are only to two decimal places.
Posted 3/8/2018 1:40 PM (GMT -8)
Progressing...they have ultras that are 2 decimal points and 3 decimal points and probably working on 4...of course if that happens a raison de etre is sure to follow{lead maybe???} and they will come... yes they will come...clump...clump...clump...I'm bad...I know turn
Posted 3/8/2018 6:57 PM (GMT -8)
Thanks folks..I admit to being a bit grumpy at times..

It is mostly curiosity about the difference between my ultra sensitive and regular psa tests results. The ultra has always been 3 decimal points and the regular 2 decimal points. All of the blood draws were at the same place and the tests sent to the same lab.

As I said before, in 2016 I had one blood draw that gave two different results. ( rechecked for accuracy) ultra was .178 and the regular was .19. The ultra sensitive has always been lower. I get both results because different Docs ordered different tests.

No one at the lab can explain the difference. It makes you wonder about the accuracy.
Posted 3/8/2018 7:13 PM (GMT -8)
Ok to be definitive...I am 100% positive...no doubts...that a .19 is a 2 decimal ultra psa test...a std psa test would round that up to a .2...if it was .14 ultra it would be reported as .1 on a std as it is rounded down...now this next point I am not entirely sure of...if an 2 decimal ultra was a .09 I'm thimk it would be reported as that lil open ended carat toward the number or less than .1... I used to know this stuff cold...but that is true of a lot of stuff......again lifeguyd ..... may ye be longin heaven before the devil knows your dead...I used to know that one cold too...so it goes...
Posted 3/8/2018 7:20 PM (GMT -8)

lifeguyd said...
It is mostly curiosity about the difference between my ultra sensitive and regular psa tests results. The ultra has always been 3 decimal points and the regular 2 decimal points. All of the blood draws were at the same place and the tests sent to the same lab. As I said before, in 2016 I had one blood draw that gave two different results. ( rechecked for accuracy) ultra was .178 and the regular was .19. The ultra sensitive has always been lower. I get both results because different Docs ordered different tests. No one at the lab can explain the difference. It makes you wonder about the accuracy.


I'm with you there, lifeguyd. It's maddening (see my signature). That's why clear trends established over time matter so much more than any particular result.
Btw, now you can see, perhaps, why DWI defense lawyers (I was one, for a short while) pull their hair out when a judge or jury unquestioningly accepts a BAC result marginally over the .08 limit with slim assurance of its accuracy, and when state laws restrict defendants' access to equipment maintenance records etc.
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