High PSA after Prostectomy

ftpolkmp · New User Joined: 02 Nov 2009 Posts: 2

Well had my surgery and as far as the surgery goes it went well. Had my first psa test in June and it was .4 had my second on the 20th of October and it was .5. My doctor called and told me it was high and said he wanted to monitor it for 4 months if it continued to rise he wanted me to start radiation. "Surprise" I told him about it was .4 in June and he had to go check it out to confirm it. This after having seen him 2 days before. So now what. My PSA are considered high for having a prostectomy but no one seems to know what to expect from here. I called the Fox Chase Cancer center in Philadelphia and a nurse there said that that just may be my number. If it had started below .1 then they would be concerned but because it was .4 and has only gone to .5 they say I should wait a few months and take the test again. My questions are

1. knowing that the PSA with a Prostectomy are only an indictator of the possibility of Cancer and is not a definitive then what should I expect.
2. If it's a microscopic piece of Prostate cell then how will they determine if it ever becomes cancer.
3. At what point should I start to worry about it being Prostate cancer?

Anyone out there ever have something like this?

srtimmons · Posted: Tue Nov 03, 2009 12:29 am Post subject: don't wait

I would not want to wait a few months for another PSA test. I'd get a second opinion quickly from an oncologist specializing in PCa. If it is spread, best start the radiation sooner rather than later. If second guy says wait, then you wait.

I always recommend being agressive with PCa as my brother died from it this February. He had a rare variant that does not cause a high PSA. But it quickly spread to his spine.
_________________
Age 58
Dx 6/15/2009; PSA 7.1; 7/12 cores positive; Gleason 6 (3+3) and 7 (3+4); PNI observed. Bone Scan and CT scan negative. Robotic RP 7/20/2009

Path report 8/11/2009 - clean margins, negative lymph nodes, negative seminal vesicles, Gleason 3+4, Stage T2c; 15% of prostate involved; NoMx.

Post-RRP PSA: 9/09: .006

az4peaks · Regular Joined: 23 Oct 2009 Posts: 17

Hi ftpolkmp, - You have every right to be concerned about a 0.5 ng/ml PSA following Prostate Cancer (PCa) surgery, having risen from 0.4 just 4 months earlier.

Can't reliably tell you much more, however, without additional information.

(1) Are you in the Army?

(2) What is your age?

(3) What was your PSA at diagnosis?

(4)What was your full Biopsy pathology Gleason SCORE ie: Primary Gleason GRADE + Secondary Gleason GRADE = Gleason SCORE (example: (3+3)=6

(5) What was the clinical (pre-op) STAGE assigned your disease?

(6) What were your post-op Pathology Report results? Such as: Pathological Gleason Score? PCa capsule contained? Margin Status? Pathological STAGE assigned?, etc., etc,

All this, would likely help better identify your true situation and assist in determining your next step. - John@newPCa.org (aka) az4peaks

ftpolkmp · New User Joined: 02 Nov 2009 Posts: 2

No longer in the Army, retired 2001. At the ripe old age of 46 (I am now 47) I was diagnosed in April 09 with a low grade (gleason 3+3 for a score of 6 with less than 5% on the right apex) Prostate Cancer. My last 3 PSA's were 2.5, 2.68, and 3.14.
When the Prostate was removed the post operative biopsy found another spot on the left center that was also less then 5%. The cancer was contained within the capsule of the prostate. I believe my clinical was T2c. Your question #6 i do not know all the answers to but will see if I can find out. My clinical doctor has a list of questions for my Urologist that I am waiting for an answer too.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 744

I would not rely upon the telephone advice of a nurse in place of that of a radiation oncologist.

Should you need radiation, the sooner you start, the better. You definitely want to start below 1.0. Optimal results are at 0.5 or below.

The nurse's comments notwithstanding, if a prostatectomy is successful, PSA should fall to 0.1 or below and stay there. That's what Patrick Walsh says.

I have written a one page guide to what is known about salvage radiation and the likelihood for success at:
http://knol.google.com/k/galileo/salvage-radiation-for-prostate-cancer/2n1ogr0gu40lx/3

I recommend going to a good radiation oncologist as soon as you can. If you have access to a medical oncologist who specializes in prostate cancer, that would be another person to add to your team.

Time is not your friend at this point. If you wait, by the time you get your next PSA results, realize you need radiation, start looking for a doctor, get an appointment, go through the planning, etc...you might miss your second chance at a cure.

You and I are the same age, by the way. We don't have the "luxury" that some older men do, of simply sitting out the battle knowing that something else will get us first.

John (aka az4peaks) is a great source of information. I would pay close attention to his postings. They are the carefully considered words of someone who has helped many, many men through this.

All the best wishes.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

az4peaks · Regular Joined: 23 Oct 2009 Posts: 17

Hi again Ftpolkmp, - Thanks for the update of information, it helps a lot. It appears from your Biopsy findings that it was thought that you had early stage, MODERATE grade Prostate Cancer (PCa) in one lobe. Those were favorable numbers going into treatment. With that said, I would tell you that all of that means little now, and you can essentially forget that information, as defining your disease.

Now that you have had surgery, you have available the far more reliably accurate, and far more meaningful, information contained in the post-operative Pathology Report. I would strongly suggest that you obtain a copy of that document for your records. The information it contains, combined with your post-op PSA monitoring results, are where your attention should be concentrated now. If you would like me to review it for you, and comment on the potential significance of the contents, I would be happy to do so.

I am NOT a physician, but I consider myself to be a well-informed layman with 30 years of first-line involvement in the American Medical Care System. I always encourage patients, with whom I have interaction, to share the information I convey with their professional advisors, for their comment and, hopefully, affirmation.

Although not unheard of, having a detectable PSA 3 months following surgery is not the norm and is NOT the desired result. The question then is, why does this relatively high residual PSA exist? The fact that the PSA did not remain stable from the first to the second Post-op test and never reached undetectable status are unfavorable considerations.

My friend, Replicant, has accurately indicated the statistical benefit of beginning Salvage Radiation, if appropriate, early in the PSA progression. Radiation, as with ALL secondary attempts at "cure", is only effective against localized or "regionalized" (locally extended) PCa. Unfortunately, this cannot always be determined with reasonable certainty.

Systemic disease, which can eventually lead to distant metastases, is considered incurable and, therefore, the treatment goal changes from one of attempted "cure" to one attempting to "control" disease progression and morbidity (side effects). Treatment options at the systemic stage become quite limited, usually initiating under some form of the "Hormonal Therapy" umbrella.

Since you are no longer the typical PCa patient, I would suggest that you attempt to get an appointment, as soon as possible, at the nearest University Medical Center or, if practical, one of the number of institutions recognized as "centers of excellence".

Such facilities as Mayo Clinic, Cleveland Clinic, and the members of the National Comprehensive Cancer Network (nccn.com), all meet such criteria and have the multiple medical/surgical specialties and ancillary services available to fully evaluate your personal situation.

I will be happy to try and answer any specific questions you may have. If you will E-mail me, I will furnish you my telephone number here in Scottsdale, AZ, if you wish to talk. Good luck! - John@newPCa.org (aka) az4peaks

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