Rising Psa 1.5 years after treatment finished

Hi Skye

my husband was T3a N0 M0 Gleason 4+3. He had RT and Ht ( the latter for 18 months because he could not tolerate the side effects any longer. His PSA while on HT varied between 0.02 ans 0.04. When he stopped the ht his PSA jumped to 0.2 and a bit. ( can’t remember the ‘bit). It has remained in that range for a year - 6 monthly tests and next due in August. The oncologist told us the time for concern is 2.0 but, for some men, he would set the bar over. I did not ask him to expand on that comment but I guess it’s a question of age and quality versus quantity of life?

so, yes, your husband’s PSA is rising but these remain very small numbers now. I think if I were in your situation I would be asking the experts for their opinion - oncology, GP or prostate cancer nurse specialist. They might be able to offer you some sort of plan of action if the PSA rises further?

Sorry, you are I the situation that I dread ! I do hope the next PSA result is lower!

Hello Skye45 

i am sorry to read of your husband's rising PSA - it's normal to investigate after 3 consecutive rises or a rise above +2.

It does happen - it's happened to me - diagnosis T3aN0M0, initial PSA 182, true Gleason 9 (5+4). I had 3 years HT, came off it and after 9 months and 3 rises back on HT for another 9 months (completed in 6 weeks time).

I appreciate we are all different and it's called a biochemical recurrence and occurs in about 33% of all cases, without any signs that the cancer has spread. The plan for me is "intermittent HT" full details in my journey notes (click on my name or avatar to read).

I hope the above helps.

Best wishes - Brian.

Hi Skye45 - how old is your husband?  How is his vitality? Has his libido returned? What is his testosterone reading?  These are important factors.  If he is young at heart or in age, and all his vitality has returned, post hormone therapy, then the 0.6 figure could be due to radiotherapy “bounce”.  This happens when the cancer cells are awoken from their testosterone deprivation and as they decide to divide, they are killed off due to their DNA having been altered by radiotherapy.  A lot of people miss this point- radiotherapy only kills the cancer when they try to divide and are identified by the bodies immune system as imposters.  That’s why the 2.0 is given as the “explore further” figure. (I’m currently 1.4!, but I like to think I am high on the vitality scale). Why is vitality so important? Well, high testosterone supercharges the awakening process, especially in younger patients, who can have quite high bounces even well above 2.0.  Hope this reassures you.  AW 

Hi my husband has just turned 59. I am 48.  He is slowly becoming more active. No libido. And hasn’t had a testosterone check since two tests ago can’t remember what it was think it was 6.7 I did ask at these last results and they just said not as important to check as because psa rising it means testosterone is rising. She just said it important to get the next couple of 3 months checked psa and when it reaches 2 they will investigate. 
how quickly did it take for yours to reach 1.4. 
I suppose everyone is different and I suppose shouldn’t worry till told otherwise. 
Thank you for reply 

Hi thank you for reply 

his was T3b N0 M0. Starting Psa 30.9 he was 56 at diagnoses. Gleason 4+4

Yeah suppose he might just have to accept it maybe on and off HT he did find it a struggle so vowed never to go back on it but if that’s what they suggest and gives him a chance of surviving he will. 

Hi thank you for your reply. 
yes my husband did too struggle especially with the aberiterone but was also glad to complete the deceptyl injections as was constantly floored. Which I know can happen especially in younger males but then the bonus they have is they bounce back. Am probably although numbers are still low it’s the speed they are rising but when spoke to specialist nurse she did say they are happy with that at these last results moment but it’s the pattern I am seeing that worrying me. 
felts like this rollercoaster here Indefinetly. 
was just curious if it possible to rise and stay stable but I accept everyone different. 
am glad to hear your husband is stable 

Hi, if you skim my Bio you'll probably understand that my advice is demand further tests well before it reaches the routine >2.0. Similar original numbers and treatment to your husband. By time reached >2.0 already advanced metastatis (distant lymphs) beyond any curative attempts. 

PSMA PET is gold standard but very costly and I'm not sure that all Oncology Departments even do it. Certainly don't want to do it. Private costs c. 5 grand and even then often long wait times. 

Medics don't like to admit that low psa secreting tends to be related to aggressive and/or rare PC types, mainly i suspect because they have nothing to offer. The rate of  increase is the only indicator, not the absolute number. Ensure they investigate ASAP.

Good luck, Dave 

Sorry to read your experience. Hope you are coping? 
Yes I will maybe call them again on Monday and explain my concern of how rapidly it’s rising although appreciating it’s low but does seem a bit daft to leave it till it goes to 2. Especially with having an advanced form of it previously. 
I just fear if it continues its pattern so far and keeps doubling by then end of the year we back to square one if not worse. 
thank you for your reply 

Hello Skye45 

It's hard to work out just where your husband is with this  HT completed 2/25 and 3 rises in his PSA 0.03, 0.3 and 0.6.

IF it's going to continue to rise then yes - questions need to be asked  - it's rising, and yes doubling - but at least his team have got a handle on it so please do keep us up to speed with the next tests,

Best wishes - Brian.

I finished radiotherapy Feb 2024.

Final three month HT jab Dec 2024.

PSA undetectable till Nov 2025, then 0.2.  Jan 2026 was 0.2.  Then Apr 2026 was 1.2, then 1.4.  You need nerves of steel at this point and hope it’s bounce!

AW