Rising PSA 4 years on.

Hello James p 

A warm welcome to the Macmillan online Prostate Community. I am so sorry to read of your rising PSA.

Your GP and Consultant are just following the standard protocol for rising PSA and taking no action unless your PSA is above 2 or you have 3 blood tests showing consecutive increases. (PSA "bounce" or various activities such as sex or exercise prior to a test can give false readings hence the 3 rises).

At 0.07 the cancer would show up on a PSMA-PET scan and treatment could begin - you could try telling your team the wait and the rise and lack of treatment is causing anxiety - it may work, but as I said above, they are following standard practice.

I hope the above helps - if I can do anything else for you please let me know. Please do let us know how you get on.

Best wishes - Brian.

Hi James

I'm sorry to hear that the small rise in your PSA is causing you some anxiety. I had 20 sessions of RT back in 2018 as well as 3 years of HT. During the HT my PSA was undetectable (my NHS trust only measured to <0.1) and rose to 0.2 over the year following the end of treatment. I contacted my CNS and he explained that "As I still had the remnants of a prostate, a PSA of 0.2 was of no concern. But, if it rose above 2.0 they would take action".

Now, more than three years after my last Prostap injection, it is still stable at 0.2 and I have been moved to annual PSA tests.

I hope that helps.

Thanks for your note and reassurance. 

Hello James p .

We all watch the PSA like a hawk for signs of a recurrence after treatment - my husband has had 3 since he was diagnosed in 2020 with advanced metastatic prostate cancer. We have been told that individual increases are not necessarily of concern, the experts look more at the trend over a period of time and the rate or velocity of the increase. The standard protocol for action after EBRT is when the PSA reaches 2 unless the velocity indicates further investigation earlier for which the gold standard at the moment is the PSMA PET CT which can pick up activity when the PSA is as low as 0.2, but is more accurate at 0.5. There is a school of thought that if a recurrence is confirmed then hitting it hard and fast has better outcomes in keeping men on the curable pathway and preferably before the PSA reaches 2.0. For some men the rise stabilises at a new level or may go back down (a bounce which can occur around 18 months after coming off HT) and so you are spot on at increasing the frequency of testing at the moment.

Please come back with any questions but try and relax for now.