PSA above 0 after surgery

colliegirl · New User Joined: 12 Nov 2007 Posts: 1

My husband had robotic prostate surgery in June '07. He is 62. Margins were clean, lymph nodes and seminal vesicals also clean. Disease supposedly confined to 2 nodes of gland. Gleason was 6 prior to surgery. Gland was not enlarged and no tumor detectable by rectal exam. Had no symptoms other than a PSA rising from 3.8 to 4.6 in 9 months. After surgery in early Oct. had PSA test and it was .3. Doctor repeated this week (Nov. 9) and it is .2. What now? We are very frightened.

brainman · Posted: Mon Nov 12, 2007 11:18 pm Post subject: Re: PSA above 0 after surgery

Hi colliegirl, I am very sorry about your husband's cancer and current health concerns. I do not know what other sources of PSA there are. However, you are not the first person in the last several months to ask this question on the forum. I do not think they ever got an answer from the forum. I am very sorry about that. Someone aught to have the answer since the question does come up periodically. However...

I will personally do a little research on this question and post what I find if I find anything.

Best wishes.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

brainman · Posted: Tue Nov 13, 2007 12:00 am Post subject: Re: PSA above 0 after surgery

Hi again colliegirl, I did find some information for you. According to an article in the Journal of the American Medical Association, only prostate cells produce PSA. There for, your husband does still have prostate cells somewhere in his body. That is the bad news. The good news is that on average it took 8 years for the metastasis to show up and cause any problems. According to the authors of that article, your husband in consultation with his doctors has two options:

1. Begin Hormone Therapy
2. What until the cancer reappears on scans

There seems to be four factors to consider in making a decision:

1. Is the PSA above 0.2?
2. Was the original Gleason score 8 or higher?
3. Did the PSA return in less than 2 years?
4. How fast is the PSA rising? Is it doubling in less than 10 months?

All of these seem to be negative indicators, that is, depending on the answer to these questions, hormone treatment should begin soon. If I read your post correctly, he is right on the boarder of needing to start treatment now. His PSA is 0.2, but his Gleason score was 6. His PSA did return within 2 years but it has not doubled yet.

I have never been in your husband's shoes so I do not know what I would do. Nevertheless, I can understand your anxiety.

You can find more detailed information at: http://www.phoenix5.org/Basics/psaPostSurgery.html

Reference: Partin, AW; Einsenberger, MA; Chan, DW; Pearson, JD; and Walsh,PC. ''New Method to Assess Risk of Advanced Cancer After Prostate Removal,'' Journal of the American Medical Association, Vol.281, pp.1591-1597.

You and your husband are in my prayers as you try to decide what to do next.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

johnw100 · Posted: Tue Nov 13, 2007 6:40 am Post subject: Re: PSA above 0 after surgery

Usually PSA tests are not done until 6 weeks after surgery as it can take some weeks for residual PSA to be flushed from the bloodstream.

Walsh indicates waiting 3 months after surgery before testing PSA, all of which suggests that PSA numbers soon after surgery can be misleading.

sequoiaranger · Posted: Tue Nov 13, 2007 12:29 pm Post subject: PSA Going Down--That's Good!

As johnw100 said, there is residual PSA still in the system. I'm a little surprised the doctor started PSA tests so quickly, however, it does show a DROP in PSA, so it's going in the right direction. I think it is too soon to be worried, but I firmly believe in not giving cancer ANY "breaks". If I were you I would ask your doctor for some hormone therapy and re-testing for PSA in a month, then another test in another month. I think it would be worth the extra expense to be relieved that the numbers are coming down.

After my prostatectomy, I did not have a PSA test for about two months. The PSA was down to .24 from about 12 pre-surgery. I began hormone therapy ("Eligard" leuprolide) and within another 6 weeks the PSA came back "imperceptible" (less than .1).

Best of luck to you all.

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