Tag: PSA Test

Day 5,593 – PSA Surprises

On By DanIn Prostate Cancer6 Comments

I went for my PSA test Tuesday morning and came away with two surprises.

First, I was able to get my results online at 11:52 p.m., Tuesday night (yes, I’m a night owl). I’ve never had the VA turn them around that quickly before.

Second, my PSA jumped significantly to 2.52 ng/mL from 1.57 ng/mL on 1 December 2025. That gives a PSA doubling time of 10.1 months using the last 5 readings (back to January 2025).

I expected an increase, but not that much of an increase. On the positive (?) side, that should make finding lesions with my PSMA PET scan in 10 hours much easier. (It’s now 12:30 a.m., Wednesday as I’m typing this.)

I suspect it will take a week or so for my PSMA PET scan results to be posted, and I’ll update once I have them.

Time to turn out the lights and try to sleep.

Be well!

Header image: Sunset near Dateland, Arizona

Day 5,502 – PSA Results

On By DanIn Prostate CancerLeave a comment

It’s that time again. My PSA came back at 1.57 ng/mL, up from 1.34 ng/mL in September.

PSA doubling time using the last five values increased slightly from 11.5 months in September to 11.9 months now. PSA Velocity went from 0.6 to 0.8 ng/mL/yr.

My appointment to review the results is on 30 December 2025, and I’ll be sure to talk about another PSMA PET scan to see if we can determine what’s going on before we start down the androgen deprivation (hormone) therapy path.

On an unrelated note, I managed to take a little drive through the country from San Diego to visit family in southeastern Wisconsin and back last month. You can check out the full story HERE if you’re bored.

Header image: Utah canyons along I-70

Month 179 – Urologist Discussion

On By DanIn Hormone Therapy, imaging, Prostate Cancer, Radiation Therapy1 Comment

Well, that went about as I expected.

In a nutshell, we’re punting the ball another three months down the road.

The doctor commented on the continuing rise in my PSA and said after consulting with the doctor who saw me last time, said that he wanted to recheck my PSA in six months and “wait a year” for another PSMA PET scan. I should have asked for clarification on that, but I think he was referring to waiting a year after my last PSMA PET scan in March 2025 and not a year from today.

I wasn’t entirely comfortable with waiting another six months, so we agreed to test PSA again in December (three months after my September test) and go from there.

We also talked about spot radiation if anything pops up on the scan. He seemed a bit reluctant for that to be an option, and went straight to starting hormone therapy. It’s as though he was making the transition from curative options to management options, and, to be perfectly honest, I believe I made that transition in my own mind once the salvage radiation failed. That doesn’t mean that I wouldn’t try zapping a lesion or two if they popped up on the scan depending on location (no more zapping to the pelvis and risking further bowel complications).

We did talk about my experience with hormone therapy during the salvage radiation, and the timing of starting it this time around. In that discussion, he brought up the topic of bringing in a medical oncologist at some point depending on the scan results and my PSA test results.

We talked at length about my urinary frequency and some options for that. He suggested some pelvic floor therapy might be beneficial, so I said I’d be willing to give that a try.

Overall, I’m okay with where we’re at and the planned course of action for now. I’ll go for my PSA test in early December, and if there’s another significant jump, I’ll press for the PSMA PET scan to be done sooner rather than later.

My next scheduled urologist appointment is 30 December 2025.

Be well!

Header image: Sunset, Imperial Beach, California

Day 5,410 – PSA Test

On By DanIn Prostate Cancer2 Comments

I went for my PSA blood draw this morning on the day after our Labor Day holiday weekend. I thought the clinic might be packed, but I was pleasantly surprised. It took 9 minutes from checking in at the kiosk to walking out the door.

I’m guessing that I should be able to access my results online on Friday or Saturday. The trend function on my PSA tracking spreadsheet suggests that my PSA will increase from 0.95 ng/mL back in March to 1.09 ng/mL today. We’ll see if the actual results are anywhere close.

You may recall that my last urologist appointment was on 1 April 2025, and we scheduled the six-month follow-up on 30 September. A few weeks ago, the VA canceled that September appointment and the earliest re-schedule slot was on 30 December. I haven’t called to squeal about that yet because I wanted to see what the results of the PSA test are first.

If the results go from 0.95 ng/mL to 1.0 or so—even the quasi predicted 1.09 ng/mL—it doesn’t seem that urgent and I’ll just email the urologist and have a discussion as to next steps from there. I’ll also look at any changes in PSA doubling time to help determine urgency. But if the results really jump substantially, e.g., 1.4, 1.6, 2.0, etc., then I’ll work to get that 30 December appointment moved up to a much earlier date.

I suspect another PSMA PET (or other) scan may be in my future to see if we can finally determine what’s going on inside of me.

Stay tuned for the results later in the week.

Be well and enjoy this moment of Zen.

Header image: Imperial Beach, California

Day 5,256 – Doctor Visit

On By DanIn imaging, Prostate Cancer7 Comments

I had my post-PSMA PET scan visit with the urologist today, and I wasn’t really sure what to expect going into it.

The doctor (same as last time) shared the scan results saying that they’re something I should celebrate. I mentioned, though, that I have had three scans and were inconclusive despite the rising PSA numbers. He was quick to reply by saying that the scan not showing evidence of prostate cancer or metastasis was conclusive.

I understand where he’s coming from, but until we know where the cancer is, I’m going to have a difficult time accepting that perspective.

I did ask whether there was some sort of test that can determine if my cancer doesn’t express PSMA, and he said that there wasn’t. Something in my pea-sized brain tells me I need to double check him on that.

I also asked if there could be another explanation beyond the cancer that would explain my rising PSA. He ruled out the possibility of some residual prostate tissue being left behind after the surgery as being the cause based on my PSA kinetics over time.

In terms of what’s next, we’re kicking the can six months down the road for another PSA test and follow-up. I was a bit surprised that he wanted to wait six months, and suggested doing the test in three or four months. He was a bit insistent on the six month window. He felt comfortable with my current situation—the slight increase in my last PSA test from the previous one and my PSA doubling time—that waiting six months wouldn’t be a problem. He also argued that having a longer period between tests would better reflect what’s going on.

As we wrapped up, he reminded me that the scan results were good news, and I know that he’s right in that regard. I’ll work on changing my own perspective going forward (even though those little cancer bugs are still doing their thing inside me.)

My follow-up appointment is on 30 September 2025.

That’s it for today. Be well!

Header image: Cherry Blossoms, Japanese Friendship Garden, San Diego, California

Day 5,237 – PSA and PSMA PET Scan Results

On By DanIn imaging, Prostate Cancer8 Comments

I’m so over this.

Click to enlarge

On the whole, the news is good. My PSA just barely bumped up from 0.94 ng/mL in January to 0.95 ng/mL in March and, taking the last five readings, that increased my PSA doubling time from 7.7 months to 10 months.

The PSMA PET scan revealed “no evidence of prostate cancer or metastatic disease.”

So, if the news is good, why am I “so over this?”

I was really hoping that this third PSMA PET scan would bring some clarity as to where the cancer was located so we could know how to proceed—even if it meant revealing metastatic disease. It’s frustrating because we know the cancer is somewhere and because we know the PSA almost tripled between 19 January 2024 and 16 January 2025, but we don’t have enough information to do anything about it. It’s just more waiting in limbo.

Of course, having had three PSMA PET scans all turn up negative makes me question if I’m in that “lucky” category of ten percent of patients whose prostate cancer doesn’t express PSMA, making the scans useless for me. It’s something that I’ll definitely discuss with the doctor at my next appointment on 1 April 2025. I vaguely recall that there’s some sort of genomic test that may be able to assess if I really do fall into that ten percent. I’ll have to do some research on that.

Maybe, too, I’ve placed too much faith in the scan’s ability to detect anything at my PSA level. But with a PSA level hovering around 1.0 ng/mL I thought we would have a decent chance of detecting something (chart below).

Detection Rate on a Patient Basis Stratified by PSA and Region Tr indicates prostate bed only; N1, pelvic nodes only; M1, extrapelvic only. Proportion of patients with 68Ga-PSMA-11 PET positive findings were stratified by PSA range and region of disease in accordance with PROMISE. https://pubmed.ncbi.nlm.nih.gov/30920593/

Needless to say, I’m truly glad that my PSA didn’t rocket even higher and that my scan didn’t light up like Times Square. Having definitive answers, though, would be the icing on the cake.

As far as the PSMA PET scan itself, it was pretty easy and took two hours to go through the entire process. I was instructed to drink 500 ml of water starting 2 hours before the scheduled scan time, and that was the only preparation needed.

I arrived at the hospital at 8 a.m. and was brought back to a radiation-proofed exam room where the technician started and IV at around 8:15 a.m. The 68Ga tracer was ready for injection around 8:40 a.m.

Around 9:30 a.m., the technician brought me back to the scanner where I got positioned on the bed and we began the scan which took 45 minutes. The scanner was very quiet (I could have dozed off) and large enough that it wasn’t claustrophobic. I was out of there by 10:15 a.m. and on my way home. Piece of cake.

On a related note, this was the longest it’s ever taken me to get the PSA test results posted online (hence the delay in this post). I actually called the clinic to get them over the phone because they still weren’t available online today (Thursday). The nurse I spoke with was very helpful and said, “We’re facing staffing issues and, well…” stopping herself in mid-sentence, probably remembering that the call was being recorded and not wanting to make a statement about the current environment for VA employees at the moment. I fear that this may be a precursor of things to come.

Be well!

Month 172 – PSMA PET & PSA

On By DanIn imaging, Prostate CancerLeave a comment

This will be a short update, as not much has really happened in the last month.

Tomorrow, I have my third PSMA PET scan. With luck, we’ll actually find the location of the cancer with this scan. That will help us decide what’s next in this adventure. I suspect I should be able to access the results online within a week or so. If not, I have a follow-up appointment on 1 April with the urologist.

I was going to get my PSA test done next week, but I wasn’t sure what impact a potential government shutdown might have on access to the lab, so I went for the blood draw on Monday. I’m guessing that I’ll break the 1.0 ng/mL threshold with this test.

That’s it for now. More to come in the days ahead.

Header image: Sunset over the Pacific Ocean, Silver Strand State Beach, California

Day 5,214 – Doctor Visit

On By DanIn Hormone Therapy, imaging, Prostate Cancer, Radiation Therapy1 Comment

You may have overachieved when your doctor asks, “Are you a urologist?”

I had a good meeting with the real urologist this morning, and it appears that he actually read the questions I sent to him in advance. That made the discussion easier.

First on my question list was whether a PSMA PET scan was warranted. He agreed that it was, and we’re going to try to get that scheduled soon. He thought that, with my PSA at 0.94 ng/mL, there would be a better chance of actually finding something this time. The only concern is that the VA has required a bone scan ahead of the PSMA PET scan in the past, and he’s going to see if we can skip that. It may take several days for the schedulers to call me.

We did discuss the possibility of further radiation if a lesion is found away from the pelvis. I mentioned that I had had blood in my stools and mild radiation proctitis discovered (and addressed) during my recent colonoscopy. He was not keen on further radiation to the pelvis under those circumstances. Neither am I.

My next question was about the timing of beginning androgen deprivation therapy (ADT). He was pretty squishy on the timing, not knowing exactly where we’re at. I mentioned that, a year ago, the urologist told me that we’d start when my PSA hit 2.0 ng/mL, but the medical oncologist suggested holding off until metastasis. He generally agreed with the concept of starting it later so that the cancer doesn’t become resistant to it prematurely, with one caveat.

He seemed to give more weight to my PSA doubling time than did other doctors, and that’s when he asked me if I was a urologist. I had presented him my graph showing my PSA progression, and it showed my PSA doubling time. “How did you know how to calculate it?” I told him that I used the Memorial Sloan-Kettering PSA doubling time calculator. To him, my PSADT of 9 months was creeping into “concerning” territory, and might make him a little more inclined to start ADT earlier.

I asked him, “At what point do we call this metastatic disease?” and, “When should we get a medical oncologist (MO) involved?” To the first, he said that all we know is prostate cancer is somewhere in my body, but wouldn’t go so far as to call it metastatic yet. To the second, he was open to brining in a MO if the results of the PSMA PET scan warranted it.

We agreed to the following plan:

  • Get a PSMA PET scan and meet again in six weeks to review the results.
  • Get an updated PSA test before the six week review.
  • Let the results of the scan determine if we get the MO involved at that point.

I have the six-week follow-up appointment scheduled for 1 April 2025. My concern is getting the PSMA PET scan scheduled and completed before then. If I need a bone scan in advance of it, that may complicate or delay the PSMA PET scheduling further. If push comes to shove, I already had an appointment scheduled with urology on 8 May 2025, so that’s not that much of a delay if we can’t get everything scheduled before 1 April. 2025.

It was a productive meeting from my perspective, without any surprises.

More to come as we get things scheduled.

Header image: Cuyamaca Rancho State Park, California

Day 5,095 – Let the Waiting Begin

On By DanIn Prostate Cancer2 Comments

I went for my PSA test this morning, so now the waiting begins for the results to be posted online. I suspect that I’ll be able to access them late Thursday night or Friday.

I also had about four or five other tubes of blood drawn (I can’t watch 🤢) for my annual physical with my primary care physician on 4 November. While there, I also got my high-dose flu shot for old geezers and the updated COVID vaccine. All of that turned me into veritable pin cushion this morning.

As much flak as the VA Healthcare system receives, I have to admit that I’m always impressed with my local clinic. No appointment was needed for either the lab work or the vaccines, and it took just 17 minutes from the time I checked in until my lab work was completed, and another seven minutes to get the vaccines. I was in and out in 24 minutes. I challenge civilian clinics to match that.

More to come soon.

Month 167 – PSA Time

On By DanIn Prostate CancerLeave a comment

Well, it’s nearly time for the PSA roller coaster to depart the station once again. (You never get off the PSA roller coaster, you just keep riding it in never-ending loops.)

I’m not exactly sure when I’ll go to the lab—either next week (short holiday week) or the week after—but I need to get it done by the end of the month because I have an appointment with my primary care physician on 4 November, and an appointment with the urologist on 14 November. I suspect that I’ll get my seasonal flu shot while I’m at the clinic, too.

If anyone is interested, we could get a pool going to guess where the PSA test results will come in at. 😄 On 1 May 2024, it was 0.52 ng/mL. The “Trend” function on my spreadsheet has it coming in at 0.70 ng/mL using the last five PSA test results from my post-radiation nadir. My money would be on somewhere between 0.80 ng/mL and 1.0 ng/mL.

Other than that, I’m just getting ready for the palm fronds to start falling as we get deeper into autumn here in San Diego. 😂

On a fun note, I attended both of the San Diego Padres Wild Card baseball games on 1 and 2 October, and the crowd went bonkers when we clinched the best-of-three series to win a spot in the playoffs.

We’re playing our arch nemesis, the Los Angeles Dodgers, in Game 5 of the National League Division Series tonight (Friday, 11 October) to see who advances to the National League Championship Series. (We’re tied two games apiece and the winner of tonight’s game will advance. Hope I didn’t jinx ourselves by writing about this. 🤞)

Sorry for the shaky camera work. There was so much happening all over the place, it was tough to know what to focus on.

On an even funnier note, I found this perfect bed for those suffering from hot flashes while on hormone therapy.

Header image: Crepuscular rays at sunset over the Salton Sea, California while hoping to see Comet Tsuchinshan-ATLAS on 10 October 2024. (I didn’t.)