PSA Velocity over 4 months since UTI

I want to thank all that wrote here, especially you Geoff. 

I read here that it could take the prostate 2 years to recover, so maybe that is all you need ~ time.

My husband, 72 had HIFU last year in April, which is burning out the gland and seminole vessels.  His PSA was 8. when he had treatment.  In 2.5 months his PSA went up to 13.38... 3 & 1/2 months later it went up to 16.88..... 3 months later it is now 27.22 (up 10. in 3 months)

So, I am hopeful that what your doctor says about PCa not growing that fast that quickly is true!  Especially after HIFU, burning.

Last month he had a PET scan with F-18 drink, it did not show any PCa, it did show two nodules, outside kidney and outside lung, no sign of cancer but they want to look further using MRI (next week).

Someone also mentioned that use of a hormone drug could cause the cancer to be aggressive.... he took 3 months of Casedex prior to treatment, because we went on vacation.

Again, thank you for this thread!  If anyone can offer any thoughts they are greatly appreciated.

Hi Dawnay,  When your husband had the HIFU, I guess they removed the PCa lesion(s) in the prostate, and left the healthy bits. I would imagine the remaining portion left would be VERY upset and putting out lots of PSA while it recovers. What was your husbands Gleason scores and staging? Did the Dr say what PSA to expect after the HIFU and for the next 6-12 months?

I hope your husbands MRI shows the 'hot spots' to be harmless. If not, at least they are found and can be treated.

 

I put my whole story in one post and keep updating it, rather than keep creating new posts that sort of jump about. In my case, so far so good. Everything points to protatitus after the UTI. Over the next few months, we shall map the progress of the PSA number and what the implications are. My urologist is a master class teacher of MRI, so, while his reading of my MRI says, 'you are ok', he does warn me that 20% of MRI do not show PCa in some people. The only other way of determining PCa is a biopsy. The PSA direction will define this.

Geoff

Gleason 7, staging -I don't know.  He had a MRI just prior to the HIFU, where it showed cancer in the gland and in the seminole vessels.  The doctor expected a PSA of zero, he is very disappointed, but he is in Florida and we aren't, so we don't go see him.

I think men's PSA will haunt them forever! 

But yours sounds good!

But that 20% the MRI  doesn't show is very small... and Pca grows so slowly..

The doc also wants another CT scan, that sounds like over kill to me... and too much radiation, so we'll wait to see what the MRI says.

Congrads to you though, I think you just had a UTI !

BTW, my husband also refuses water.

Hi Dawnay,

If I were your husband, I would have a 3TmpMRI of the prostate and see what is going on inside. I have seen some guys get the HIFU and their PSA still there and rising. Sometimes the PCa is close to the wall of prostate where the HIFU can't get to, meaning the PCa is still there, though, somewhat smaller. If the MRI confirms PCa there still, and he has some hot spots, radiation/chemo maybe best solution? I would have EBRT.

?Geoff  

What???  HIFU can get to all of the prostate, it can obliterate kidneys, breast cancer, seminole vessels, it is real time guided by ultrasound, with a MRI attached.  A doctor may not get it, but it isn't the HIFU machine's fault.

Oh well... we will find out!

I guess it depends what type of HIFU your husband had. They seem to come in different types. The focal type seems most common where they target the lesion(s) and leave the remining prostate intact. Then there is the total gland HIFU which removes the entire prostate, including walls. Apparently, they only use this total method on small prostates, due to the time it would take with large prostates. Before they did the HIFU on your husband, did you have a MRI so they mapped the lesions?

Yes, his entire gland was removed as the PET scan report says "On CT, prostate and seminal vesicles are surgically absent."  And yes, he had a MRI the day prior to the HIFU, doctor said he was laying it over the ultrasound.  The report said no lymph node involvement.

Yes, most times they do focal ablation.

I'm hanging on what your thread says - that rapidly rising PSA most probably means inflammation.  Especially because the doctor gave him a catheter and said he should drink a lot of water to flush the ash out, very little ash showed up in the catheter (he is so obstinate - he wouldn't drink much), so I hope the ash is creating this mess.

Very valuable info Geoff, thanks for the thread.

I was reading about the PSA and wiki says MOST elevated PSAs are NOT cancer.

They've given my husband 4 different CT & MRI tests, none show any cancer, all the way up to & including his head.  We did find he had a large (9 cm X 6 cm) mass attached to his kidney, all doctors thought it looked cancerous, so he had both removed, and it wasn't cancer.  His other kidney looked perfect so there was no fear in removing the one which had a cyst and the mass.

Hi Dawn, you are correect, most PSA rises are simply that the prostate for what ever reason is not happy and is putting out more PSA. Some of the rises are indeed PCa, but most are not. That is the problem...What is the cause? PCa is deadly, BPH is not. You have to find out which you have.

From all my research, the greatest clue for PCa, is PSA rise over time. Any doubling of PSA over a 12 month period is a clear classic danger signal.

Most UTI and prostatitus cause spikes in PSA. And of course you get the rare small cell type of prostate cancer, which is super deadly, quick and puts out virtually no PSA.

My uro said he has many patients with aggressive PCa with PSA less than 1.5. He confirmed though that all of these patients who had charted their PSA rise, had the classical incline in their base line PSA over 12 months.

My message to all readers of this forum is to get annual PSA checks so you can build a "normal" base line. Over time, it increases as we get older, but maybe by 5-10%. Some tests can show a sudden increase to cause a scare, but most are a simple infection causing the minor spike. 

My second message is don't stuff arround, get a mpMRI on a 3T machine. If a lesion demonstrated, biopsy it. If nothing, stop worrying.

Hope your husband recovered ok from his kidney op. My sister had one of her kidneys removed many years ago for a similar reason. She has since gone though a terrible round of chemo for breast cancer, and the kidney withstood the onslaught. Apparently the cancer has returned and she will have no further treatment.

Geoff

I would make the same decision as your sister has, I'm very sorry to hear about her, I imagine she is trying some alt remedies... I really think there are things that might work.  Good to hear our kidneys are so tough.

I have a theory about my husband's rapidily rising PSA, so I thought I'd see what you think:  the MRI showed "loose PSA tissue", no gland, just a small amount of tissue left after he had HIFU.  I think that tiny amount could be putting off PSA, kinda like a kitten who has lost his mommy.  Of course my doctor says it's most likely cancer which is somewhere that he can't find.  He hasn't given him another PSA test, so I don't know if it is going up still.  He's doing great., except it is hard to 'take it easy'.

Yes, I've read many times guys with a low PSA but the worst sort of PCa.

Has your husband had a 3T MRI? Has he has a PSMA PET SCAN? These are two excellent imaging modalities that can assist in identifying what may well be a cancer.

If he performs these scans and no cancer is identified by the scans then he most likely does not have cancer.

I suspect the doctor is correct. But, as you say, while there is prostate tissue still there, it will continue to put out PSA, though I would think not in big increasing amounts. Before your husband had the HIFU, did he have a mpMRI to confirm the PCa, size, location(s) and its staging? I also presume he had a biopsy to determine its aggressiveness? 

As Barney said below, When you suspect a prostate cancer may have escaped, and there is increasing PSA, then have a  PSMA PET Scan on a CT machine to determine if the prostate cancer has set up home somewhere. Apparently sometimes finding the PCa can be difficult, though the PSMA PET finds 98% of PCa outbreaks.

My sister has given up the fight and now still trying to get better from the chemo to enjoy what remains of her life. My Mother, who my sister lives with, has bladder cancer, now untreated due to her age(92) and lung condition not allowing annual cancer nodule removal. So, not a happy household.

Thanks Barney and Geoff,

Actually my husband has two doctors he is working with.  Only one said he most likely has cancer hiding.  I have no idea what kind of pet scan he had done, just that he had two different kinds, and two MRI's, three actually as one was a day prior to the HIFU treatment.  Doc said it was the best CT PET, that it is the most advanced to find PCa.  And he had a 12 needle biopsy.  Now there is nothing to biopsy. 

We both said as long as he has tissue it will put off PSA... and this is p*ssed off tissue as it was the only bit left after the cooking, maybe it was a bit burned too....  I am anxious to find out what the PSA is now.

Good luck and thanks again.

 

I suspect one of your doctors is referring to the PSMA PET CT scan. This is the one I meant.

If cancer has elscaped the prostate such a scan will often identify where it is lurking. At he same time, get a PSA test.

Months later, that scan should be repeated. As should the PSA test.

If a region is suspected I the first scan to be cancer, the second scan will show it to be brighter or duller on the scan. A brighter image in tandem with escalating PSA is a strong indicator of cancer beyond the prostate.

Makes sense!  He has an appointment in the middle of May, guess that's what the doctor will be advising.  Glad I know in advance.

Many thanks.

I wish your husband well.