My PSA jumped 41% from 0.95 ng/mL to 1.34 ng/mL, and, interestingly, my PSA doubling time went from 10.0 months to 11.5 months using the last five readings.
Needless to say, that was a larger increase than I expected, but I’m also not surprised or panicked about it.
I’ll gather my thoughts and send an email to the urologist to seek his/her guidance. I’ll mention the canceled and rescheduled appointment; ask for their thoughts about another PSMA PET scan (or other scan); and ask, “What’s next?”
Other than that, I really don’t know what else needs to be done in this limbo period of being between one treatment and the likely next treatment.
More to follow. Be well.
Header image: Beach and Cliffs, Torrey Pines State Natural Reserve, San Diego, California
Dan's Journey through Prostate Cancer 
Hang in there ! Still quite low in reality . Check out the benefits of the PSMA-PET scan at this stage of the game . It may be worthwhile …. Praying for you my friend. James on Vancouver Island .
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Thanks, James. I’m really not at all worked up about this (a change, for sure). Not much I can do about it, so why worry.
I just sent the email to the urologist. We’ll see what the response is.
Take care and say hi to the group!
Dan
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I wish I could have your relaxed attitude. This is a great part of your personality. With my family history and my father passing away with prostate cancer about 25 years ago, it still sticks in my memory like yesterday. I myself have had the operation about six years ago and salvage radiation about 2 1/2 years ago. My PSA seems to be hovering around 0.061 to about 0.033 . It hovers in between there , for the last 2 years . The doctor say that the radiation killed off the stray cancer cells in my pelvic area as that’s why my PSA was rising, so at 0.14 PSA I had 22 sessions of radiation with no ADT. My Gleeson score was 3+4 = 7. After the operation, the surgeon told me that everything looked great and there was no sign of any cancer cells outside of the prostate and he even took a couple lymph nodes out to sample. Nothing. Yet I had some microscopic creep. The doctors now say that there could be some impossibilities of healthy prostate cells still remaining, which is pushing out some PSA at a very, very low level . They seem confident that the cancer cells have been dealt with. How would they know? Have you heard of healthy cells remaining and cancer cells being destroyed before? Anyway, I thought I would ask as you were a very knowledgable person.
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Hi James,
I can only imagine the family history adding to your concerns over time. I’m sorry that your father fell victim to this disease.
Like you, my prostate came out cleanly with negative margins, no seminal vesicle involvement, no lymph node involvement, and no extra capsular extension. So when my PSA started increasing, one of the doctors did suggest that, because of my good surgical history and because my PSA was so low, that it may be attributed to having some healthy prostate tissue left behind after the surgery. I never fully bought into that argument. I figured that, if there was, in fact, residual prostate tissue left behind and it was showing up on my PSA test (0.05), then why didn’t we see it in the earlier PSA tests? Why did it take 54 months of undetectable tests (<0.03) before it showed up if it was there all along? I never got a satisfactory answer to that question.
As far as healthy tissue surviving salvage radiation, I don't know. I suppose it's possible because the radiation oncologist goes to great lengths to not damage the surrounding tissue (e.g., bladder, rectum wall) when he's aiming his beam. I suppose, too, that it may make a difference whether they radiated just the prostate bed (as in my case) or if they radiated the whole pelvis.
It would be interesting to know when you say, "the doctors now say…" if it's your urologist/surgeon or radiation oncologist that is saying that. If it's one, you may want to ask the other for their perspective.
I'm not sure if that answered your questions or not. Sorry I couldn't be of more help.
Dan
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Wishing you the best. 🙏Blessings,Rick
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Thanks, Rick! I appreciate it.
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Seemed inappropriate to me to give it a “Like” but I do appreciate the update Dan. When I was put onto the Androgen Pathway Receptor Inhibitor Enzalutamide in November 2021 my PSA dropped to undetectable and stayed there for over 3 years. However my PSA is now on the climb again after ceasing to be “undetectable” in February of this year. In July 30th it had climbed to 0.2. So I feel I am on a bit of a parallel journey with you Dan as I watch the PSA climb – hopefully very slowly – until I need to get another PSMA PET scan which I hope will identify the location of the cancer in my body. I know that your experience with PSMA PET scans has been disappointing compared to mine. My first scan located the recurrence in the Prostate and my second scan located the recurrence in my upper body (not pelvis area) lymph nodes. That’s been really useful as I do not want to experience chemotherapy again if it can be avoided. I want me and the Oncologist to know where it is and then target treatments accordingly. If it’s one or two specific lymph nodes then spot radiotherapy becomes an option. Like you, it’s wait and see time.
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Hi Charles,
Thanks for your update. Sorry to hear that your PSA is increasing again. It’s also good to know that PSMA PET scans work for you. We’ll see what my doctor says about doing another one for me. Like you, if they do find an isolated spot or two, I’d definitely consider spot radiation.
We’ll just keep moving along in the meanwhile.
Best,
Dan
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