MPSA increased to 4.31 from 3.45. Should I be worried?

thank you for your reassuring comments Tom which I found reassuring. I keep forgetting that PSA test results can be unreliable. My desire to track it by percentage increases is probably not helping me. My euro said he’s not surprised by the increase. He knows the background of my treatment. I was interested to hear you say about higher free PSA figures and mine were good. my P my FPS a this time is 0.47 ng/mL Before it was 0.40. Would you kindly explain how these figures are good. my PCA was found only in the left half of my prostate. My surgeon recommended leaving the right side alone as to MRIs and the biopsy found nothing there. my Euro has suggested an MRI which I will have. It has been one year since my last MRI so I don’t mind this. After experiencing the ups and downs since my HIFU 18 months I can understand the benefits of added certainty from RP. I was hoping to save some of my prostate and avoid the incontinence and impotence risks from RP. Onwards and upwards I guess. What is, is. Thanks again for your comments which I found reassuring and informative.

You can research free psa on the net - the higher the better. You were fortunate that the right side of the prostate showed no cancer, so that you were able to do focal treatment on the left side. You should not be using percent increase in the PSA to tell you what's going on. My PSA was up and down by a point or two on a regular basis before treatment, so some variation is not that unusual. Now, if it keeps going up in the next year, then you will have to MRI or biopsy. It's possible the PSA will just bounce around a bit. There are pros and cons to every form of treatment. Once you get to that point, if you ever, do, there are many here who can help you with that decision. You can interview different surgeons who do the different procedures for more info. They love to talk about what they do. They all seem to think that their specialty is the way to go, then you talk to another doctor and get another opinion.

To add, if I could go back I would ask to have my entire prostate ablated and not only half my prostate. At the time my surgeon said ablating half my prostate was extra cautious as I could have had only the focal piece of PCA ablated in the left half of my prostate. But this has left me with anxiety about that unablated right half of my Prostate. I guess doctors never like doing 100% of the prostate when 50% is being over cautious but this has left me with anxiety. Once you’re having an operation under aneasthetic you might as well have the entite prostate done. That’s my thinking now as I face uncertainty, further MRIs and PSA tests and a possible second HIFU

Mike,

You make a very, very good point. The doctors seem not to care about or be aware of the anxiety factor that you describe. After my first 12 core biopsy that came back positive for Gleason 6 cancer I went on active surveillance for a year and a half. I was constantly in a state of low level anxiety knowing I had the cancer and not knowing if it was increasing. Then, after my second biopsy I decided to have treatment. I chose HD Brachytherapy as it had the highest percent cure rate. Two treatment sessions. Both were very easy. Once I had the radiation my anxiety level dropped to almost nothing. There have been some side effects from the radiation - prostate swelling that lasted for about 5-6 weeks and required me to have Foley catheters, and, eventually, ED issues. RRP is also a tough operation and can cause incontinence for a year. Anyway, there are good and bad things that can happen with either treatment method. But, the constant anxiety went away.

When I was first diagnosed with the cancer I thought of HIFU but it wasn't available in the USA at that time.

Tom

Thank you Tom. The background anxiety never leaves one. My surgeon seemed keen for me to retain half my prostate and some functions. But I did not realise how much anxiety I would have. I thought after 18 months of good PSA results that I was in the clear. I guess the PSA tests are a constant for all of us but the extra MRIs are tiresome. I suffer claustrophobia so it is worse for me. Good to hear that your HDB treatment worked for you. That seemed off the agenda for me as apparently 'unnecessary'. The ED issues seem unavoidable. The anxiety is the biggest thing and more than I thought. HIFU seems a London based offering. My surgeon told me if I had lived in Wales I would’ve been offered RRP.

Mike,

Even I have some background anxiety. I had a TURP last year and the tissue samples showed no cancer - that was good. However, my PSA was 0.3 after my last test - up from 0.1 a few years ago. So, that's in the back of my mind.

I have regretted having radiation because it left my prostate in place and so I have had years of BPH issues. Had I decided to have the RRP no prostate, no BPH issues, no radiation side effects. I now have "radiation cystitis" - my bladder is very sensitive now - like overactive bladder. It wakes me up at night, so I never get a good night's sleep. Of course, had I gone for the RRP I might have have lasting incontinence - I will never know. What's done is done. It's been 6 years since my treatment and except for the 0.3 PSA I am fine as far as I know. My uro says 0.3 is "stable" and not to worry. But, like you, it's always hiding in the back of my mind.

About the ED issues - before the radiation my sex life was great - now it's gone. Who knows what would have happened with RRP. All worth considering when you decide what to do next.

Tom