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Thread: Question about psa level

  1. #1

    Question about psa level

    Hello everyone. My husband had a radical prostatectomy on February 21, 2011, the cancer was a 7 (3+4), the margins were negative. He had his first psa done today and it was a 1. I am so concerned, the doctor did not remove lymph nodes because the margins were negative and the cancer was determined to be confined to the prostate. Can someone please tell me how long does it take for psa to drop to a safe level after a radical prostatectomy. The doctor is going to test him again in a month and if the cancer is still there what would be his options, my husband is 61 years old and in very good health, the cancer was discovered Dec 2010. Thank you so much for your help.

  2. #2
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    PSA 1.0 is not good..That's called "Persistant PSA" when it occurs after surgery..Are you sure it's 1.0 and not .1 or .01 ? I suspect the doctors will review your husbands case carefully, making sure no errors were made in the paperwork surrounding the surgery and the post-surgical biopsy.

    Your options are somewhat limited..With the clean margins, there is little point in radiation treatment, but I'm not a doctor or a PC expert, so they may recommend salvage radiation anyway, hoping, somehow, it's still localized..Hormone Treatment is a certainty, it's just a matter of when they want to start it..I would start getting a PSA test every 2 or 3 months and watch the trend closely to get a better idea of what's going on..Don't start any treatment on the basis of just one test...Unfortunately, there are no rules with prostate cancer..

    Best of luck to you..
    PSA at age 55: 3.5, DRE negative.
    65: 8.5, DRE " normal", biopsy, 12 core, negative...
    66 9.0 DRE "normal", BPH, (Proscar)
    67 4.5 DRE "normal" second biopsy, negative.
    67.5 5.6, DRE "normal" U-doc worried..
    age 68, 7.0, third biopsy (June 2010) positive for cancer in 4 cores, 2 cores Gleason 6, one core Gleason 7. one core Gleason 9. RALP on Sept. 3, 2010, Positive margin, post-op PSA. 0.9, SRT , HT. Feb.2011 PSA <0.1 Oct 2011 <0.1 Feb 2012 <0.01 Sept 2012 0.8 June 2013 1.1, Casodex added, PSA 0.04 10/2013. PSA 0.32 1/14. On 6/14 PSA 0.4, "T"-5. 10/14 PSA 0.6, T-11

  3. #3
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    Sounds like its been 2+ months since operation. My guess is that it would reflect the real number by now. I think they sometimes wait 3 months.
    Something around zero is desired.
    If it is actually 1.0 then it would mean the cancer is in the system and it might have spread prior to the operation.
    Good luck to you both.
    DOB Sept. 1947. Prostate cancer Gleason 7 (3+4), PSA 5 in Oct 2010. Cryoablation Jan. 2011. Had some complications.
    Experienced nocturia, irritable bladder summer 2011. "Agent Orange"compensation from VA Oct 2011.
    PSA .05 01/26/2012, .06 6/26/2012, .04 12/24/2012, PSA .04 6/26/13, PSA .05 1/27/14
    I am eating vegan mostly plus a little fish. Take some supplements.
    (Any advice given is the personal opinion of a layman and is not intended to replace the advice of a health professional.)

  4. #4
    Thank you for responding, I am so grateful for your help in understanding all of this. Before biopsy his psa was a 3.9. Prior to surgery his psa was 2.9, Can someone help me understand the pathology report? The pathology report stated 1. prostate/vesical junction cauterized fragment of smooth muscle with no malignancy identified 2. urethral/prostatic margin cauterized fragment of smooth muscle with no malignancy identified, the lymph nodes were not removed from my husband, primary patttern grade 3, secondary pattern 4 total gleason 7/10, tumor present approximately 40% of the prostate gland, pathologic staging pT2c.
    Prostate Analysis: the apical margin is first trimmed from the specimen and serially sectioned. The apex section demonstrated the presence of an infiltrating adenocarcinoma, but multiple step sections demonstrate the absence of carcinoma at the apical margin. The base margin is serially sectioned and examined and demonstrates no evidence of malignancy. The remainder of the prostate gland is examined and demonstrates diffused adenocarcinoma with areas of tumor present within virtually every section examined. The tumor is composed of a Gleason's pattern 3 and fused gland pattern 4, which is present bilaterally. The tumor is not present at the inked capsular surface ofthe prostate and does not extend into the seminal vesicles. Also Surgical Margins- uninvolved in invasive carcinoma, with this info do you think it has spread?

  5. #5
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    That pathology report is generally pretty good..Many less fortunate men, including me, would be glad to have it..It would INDICATE the cancer was completely contained in the gland and that all of it was removed...Eight weeks out, his PSA should be 0.0 But it's not...

    The only negative part of the report was the 40% involvement and " The remainder of the prostate gland is examined and demonstrates diffused adenocarcinoma with areas of tumor present within virtually every section examined." That sentence is not the greatest news..."Clean Margins" is a good sign but it's not a guarantee his cancer has been cured..

    That part of your journey is history..It's over...Now you have to play the hand you have just been dealt..Your insurance companies willingness to pay for radiation treatment may or may not become a factor..Hopefully his doctors will make that decision, not the insurance company..It's still a little early to label the surgery a failure, they will want to monitor his PSA for a few more months before beginning a new round of treatment..

  6. #6
    Experienced User eyetat's Avatar
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    My team would not take a PSA reading till the four month mark and now six months latter. At four months it was 0.01 so now it is a watch and wait if any jump and we will revisit options. Thats my story and Iam sticking to it.I hope.
    Age 55
    PSA
    11/08-3
    12/09-3.5
    7/10-4.75
    8/1-4.6
    Gleason score 6
    lt lobe 2 of 5 C
    rt lobe 4 of 5 C
    tc2

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    Dear "concerned wife".....it seems that we are members of the same "club". My husband, also 61, was diagnosed at age 57 (seems way too young for such a diagnosis, but it is what it is) He underwent prostate surgery, then salvage radiation 2 years later. Now, 3 years later, it appears that there may be an indication of recurrance (again). All the numbers are so confusing....especially when they are running through your head while sleeping. It seems my husband is more "at peace" with this than I am. He is keeping a positive attitude because he is blessed with no sense of "decimals" I do not know if radiation is an option for him but I would like to encourage you by saying that it was not a negative experience for my husband. He had MINIMAL side effects. I wish the two of you good luck and good health! Have you been informed about any of the natural methods of slowing the progression of PC (ex: pomegranate, etc) ? I know these are not a cure but I have heard interesting remarks regarding these products.

  8. #8
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    my husband has a psa of 143 -- no not a typo -it was found after he got a swollen supra clavicle lymph node- we live in canada where health care may be cheap but you get what you pay for- he has several lymph nodes involved -surprisingly all left side -dre was not alarming- they did a blood test and found this psa of 143- he has stage 4 cancer and in canada they only do hormone therapy - no chemo no radiation - just a chemical castration

    and he is 53

  9. #9
    Experienced User eyetat's Avatar
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    I am not trying to be a a## but I never asked what it cost, I wanted the best I could find. I never asked what the co pay would be, It is my life at stake I am happy so far with the results and feel I have had very good health care. I wish all people coud have the same.RCB.
    Age 55
    PSA
    11/08-3
    12/09-3.5
    7/10-4.75
    8/1-4.6
    Gleason score 6
    lt lobe 2 of 5 C
    rt lobe 4 of 5 C
    tc2

  10. #10
    Hello everyone, it me again and I am still so concerned about my husband. He will have get his 2nd psa results on Thursday. Its been about 3 months and 3 weeks since the radical prostatectomy was done. I am feeling very anxious about the results because the 1st psa after surgery was taken about a month ago and it was a 1. I would like to know if anyone can give me suggestions on what we should be asking the doctor if the psa has not gone down. Also I would like to know if anyone knows a good oncologist in the Pensacola, FL area.

  11. #11
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    With a 3+4=7 Gleason and a pre-surgery PSA of 2.9, a case like you have presented is very rare...So lets look at the bright side..

    1) The first test was incorrect. Mistakes happen..
    2) The surgeon left some benign prostate tissue behind. The PSA number will remain stable. Harmless..
    3) Your husband is the 1 in a 1000 with a low-grade PC that has metastasized very early in its development...
    4) The pathology report is wrong, the surgical margins were NOT negative as claimed...

    I can't think of any other reason for your husbands persistent PSA..But I am NOT a doctor...However, the following paragraph WAS written by a doctor..

    "Defining a PSA recurrence seems pretty obvious at first glance. After all, PSA after prostatectomy should be 0. Any other number is considered a PSA recurrence. In reality, things are not that simple. First, we have to differentiate PSA recurrence from PSA persistence. A first PSA test obtained 1-3 months after prostatectomy should be 0. However, any PSA value other than 0 is not considered a PSA recurrence at this time. The reason for this is that the PSA has not recurred but, rather, has persisted. Although this difference in terminology may seem like nothing more than semantics, it makes a tremendous difference in terms of prognosis and understanding the status of the prostate cancer. Patient who have a persistent PSA after prostatectomy almost always have metastatic disease. While imaging tests like a bone scan or CT scan may be negative, a persistent PSA indicates that some cancer cells are lurking somewhere in the body that are simply too small to identify on imaging tests. These cells are then labeled micrometastatic disease. Unfortunately, patients in this situation can no longer be considered curable. Instead, they often get palliative hormonal therapy which, fortunately, can often keep those few micrometastatic cancer cells from significantly growing for many years. These patients may also qualify for clinical trials."

    You can read his blog here. The paragraph above was from his April 2, 2011 blog..

    http://myprostatedoc.blogspot.com/se...&max-results=7

  12. #12
    I just want to say, Thanks Fairwind and everyone else for all the info that you have provided to me. I really appreciate the opportunity to come into this forum and read all the information and feel the support that you provide not only to me but to so many others. Everyone here is so great with providing info and sharing their personal stories to help and encourage each other. Lots of Love and Prayers to All of You! My husband got his second psa result today since is radical prostatectomy in February and it was a 0.2, this is down since the 1st one which was 1. I really wanted it to be 0, but I am grateful that is has dropped. Now we just have to wait and see how everthing goes.

  13. #13
    Experienced User eyetat's Avatar
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    You now have a five year journey to go through ,to be concidered cancer free. At least that is what I am told.
    Age 55
    PSA
    11/08-3
    12/09-3.5
    7/10-4.75
    8/1-4.6
    Gleason score 6
    lt lobe 2 of 5 C
    rt lobe 4 of 5 C
    tc2

 
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