Tracking my PSA

My PSA chart post primary treatments

I had my primary treatment for prostrate cancer in HUKM (Hospital University Kebangsaan Malaysia) in January 2010. I had a dual modality of external beam radiation and hormone treatments. My PSA at that time was 27 ng /ml with a gleason score of 3+4. I had 32 sessions of radiation and 36 months of Zoladex, injected in my stomach every quarter.

My last Zoladex injection was administered in February 2013 with my PSA suppressed to 0.02 ng/ml throughout my treatment. My Nadir point is 0.02 ng/ml.

By May 2013 my PSA had started to rise slowly and steadily to 0.03 ng/ml, 0.09 ng/ml, and 0.12 ng/ml at every quarter, reaching 0.18 ng/ml in August 2014. It recorded a steady rise of 0.01 ng/ml per month over 18 months.

The graph in blue (Series 1) above shows the reading values and the graph in red ( Series 2) shows the amount of increase over 18 months. Yes we see two doubling rise times, 4 consecutive rises, but with a fairly slower velocity.

I was advised to be on active surveillance until my PSA reaches Nadir point plus 2.0 ng/ml which is recognized as prostrate cancer biochemical failure for radiotherapy/ hormone treatments. It would also be difficult to scan for any cancer cells at this point of time.

 I have since requested my case to be referred to the IKN (Institute Kanser Negara) in Putrajaya for further surveillance/treatments.

At IKN I was also placed in active surveillance. My next appointment is scheduled on 02 December 2014.

I am still reading into the value and benefits of early aggressive salvage treatments vis-a-vis aggressive active surveillance for disease progression until we have a confirmation of a local or distant failure.

Tough choice.

Allen Lai