Active surveillance - increasing PSA

My husband was diagnosed with prostate cancer over 2 years ago following an operation for prostatitis with a gleason score of 3+4 and is on active surveillance which he was happy about. He has always had a very low PSA score both before and after the operation but over the last year it has increased from 0.48 to 0.56 over 3 months which is very low but is a significant increase for him. We know that PSA can increase for all sorts of reasons but are concerned that his consultant does not want to take any action until the PSA score reaches 3.  The discussion was very rushed, abrupt and there was little or no  appetite to answer our questions. There has been no explanation  for this figure of 3  and my husband's visit to the GP following a further increase just resulted in a reiteration of the consultant's view.  

We have had 2 close friends die of prostate cancer and want to be informed and involved in decisions but do not know how to find out more information or have a reasonable discussion with someone. We do not want to take up NHS time unecessarily but also know of people whose concerns about cancer were brushed off by NHS personnel and then died - the family of one gained a very large pay out from the NHS - the death was avoidable and there was negligence. So we do not want to be complacent either.

Any advice or information about research would be welcome. 

  • Hi Guinness. I'm different to you, prostate Cancer gone to lymph nodes, spine, ribs, pelvis and a lung stage 4 gleason 8 psa 1581 when diagnosed in Feb 2016 had cemo and on hormone therapy. Psa went to 0.03 last year now rising slowly oncologist wants to give more cemo when it gets to 20,. Hopefully [@telemando]‍ and [@woodworm]‍ will pop over shortly we've all had different treatments so if you want to know anything hopefully we'll be able to help. Best wishes........ Billy 

  • Hi Billy - thanks for your prompt reply.

    It sounds as if you've gone through a lot  - but your PSA is thankfully now very low even though it is rising. It's interesting that your oncologist has a cut off of 20. It would be useful to know how they come to these decisions -I know it is individual but they must have some parameters. 

    It would just be good fo have a little more information so any contributions would be welcome.

    G

     

  • Hi Guinness if [@woodworm]‍ and [@telemando]‍ can get here they could give a lot more information with having different treatments, I'm afraid i can't help with having a high psa treatment is completely different as well as symptoms. Hopefully others will pop over soon. Best wishes..... Billy 

  • Hi Guiness.  I thought I'd sent a reply to you yesterday, but it's not been posted. I must have forgotten to click send.

    I am not a doctor and I have no medical qualifications. 

    I had surgery for early prostate cancer back in 2010, and I'm still here to tell the tale. At its highest, my PSA was 5.6, but I know many men who've had successful treatment with higher PSAs.  In general, a PSA under 10 at diagnosis is regarded as low risk. Clearly, even if your husband's PSA reaches 3 before treatment, he will still be in the low risk category. 

    Assuming that this rise in PSA isn't just a blip, his PSA doubling time is 13 months. If it continues at this rate, it will take around 2 years to reach a value of 2.0.  There is certainly no need for immediate or precipitate action; your husband has the luxury of some time to think about the best way to handle this situation.

    I think that if I were in your husband's shoes, I would continue to monitor my PSA every 3 months.  When it looks like it's getting close to 2.0 then I would start pressing the consultant to consider suitable treatment options, which I would expect to produce a cure. 

  • Hi

    Thanks for this - some useful informationn and something to ponder on.......

    G