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Thread: psa after rp

  1. #1
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    psa after rp

    Well here goes. I was diagnosed in Oct. of 06. 3+4 before surgery 3+3 after surgery. Divinci in Memphis. Psa never went to 2. something at 3 months. It stopped about 2yrs. ago at 6.7 and then a couple of weeks ago 6.3. I have had prostascint, bone scans, nothing ever found. I was sent to a doctor warner in Nashville who is supposed to be a good doctor. He just told me that it cost ten thousand dollars a year for hormone therapy so it would be no problem for him to snip my testicles off there in his office and I could go back to gardening.
    My delema is should I just watch and wait-have radiation or what since my psa is staying basically the same. Could it all of a sudden just go crazy?

  2. #2
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    How old are you? What was your PSA BEFORE the surgery?

    But with the limited information you provided, as long as your PSA velocity stays at zero, I would hold off on further treatment. Your Gleason 6 cancer could very well be indolent and never cause you any further problems..The fact that your 3+4=7 was downgraded after the prostate was removed means the initial pathology was not very well done and may have led to unnecessary treatment.. But now, 6 years later, it's all water under the bridge..

    The HT drugs are a Gold-mine for everyone involved with them..But there are choices..I am on Eligard, good for 6 months, list price is around $1800-$2000 a pop. So that's $4000/year if you have no insurance...If you fall into the "low-income" category, the drug companies will often provide the drugs at little or no cost..

    At this point, you need to consult with a Medical Oncologist who specializes in treating Prostate Cancer. Urologists and Surgeons don't have the skills or training to treat your case now...

    Welcome to the forum and the 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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    Welcome. Sometimes in prostate surgery, there were positive margins, which means some cancer cells were left behind. Also, sometimes the surgeon left some benign prostate tissues behind. In both cases, the post surgery PSA either does not go to undetectable or starts rising after surgery. I personally know of a case similar to yours and his PSA has been stable since 2004.

    You did not mention your full stats so it is hard to figure out your situation. Perhaps you can tell us what your post surgery pathology report said.

    I am not a doctor, so it is just my speculation:

    From reading your post I gather your PSA never went below 2 after surgery? If that is the case, very likely your surgeon left some prostate tissues behind. The question then is whether they are benign or cancerous?

    If your PSA is currently stable, I would not rush into any treatment. Very likely, even if cancer cells were left behind, it is indolent (your G6 indicated they were not aggressive). You just have to monitor your PSA regularly and if it goes up rather rapidly (cancer cells mutate and get aggressive) then you can seek treatment.

    From what I read, side effects of hormone therapy can be quite bad so do not rush into it unless absolutely have to. I also suggest you get a second opinion from another doctor before making any decision.

    Best of luck to you.

  4. #4
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    Welcome, I think newporter summed up the situation very well. I'm wondering if you have health insurance because if you do the cost should be mostly covered for hormone or radiation. The choice of removing the testicles is tricky because no matter what side effects occur, there is nothing the doctor can do, but with hormone therapy he can adjust or go to a different drug. I'm not qualified to give medical advice but here is my own experience, hope it contains some info you can use.

    In Sept 2011, had RRP and was told that one margin was positive and a lymph node that was removed had cancer in it. The surgeon was optimistic that there was either a very small residual cancer or the margin would be "false positive" which he said happens in 70% of cases (???). He was wrong on the second part.

    After my followup PSA test (3 months post surgery) PSA was 2.9 and no question in my doctor's mind that I should get going with oncology as soon as he determined I was fully healed. But he assured me that I would likely have both hormone and radiation.

    Radiation Oncologist had Open MRI and Prostascint scans done and revealed a small residual cancer near my rectum and in a dangerous place which is likely why the surgeon stopped short. I am now on hormone therapy with 6 month Eligard and 14 days of Casodex. And the oncologist has me scheduled for IMRT in March.

    Hormone therapy has been tolerable with mostly hot flashes and some muscle changes/soreness. I have so much going on that I may be just not noticing but so far tolerable is best I can say.

    Good luck whatever you decide to do.

    PS (added): My primary care physician found the problem, I had two surgeons perform the RRP and a very experienced oncologist, and all of them have said, "We are gonna beat this thing."
    Last edited by BigNate; 01-31-2012 at 06:53 PM. Reason: Add PS
    Prim: Sep/10 PSA 3.6/DRE OK, Mar/11 PSA 5.9/DRE lump
    Urol: Jun/11 PSA 16.2/DRE lump, Jun/11 put on Cipro
    Jul/11 Pos Biopsy, Jul/11 Staged T2c
    Sep/11 RRP, prostate, seminal vesicals, part bladder+ 12 nodes.
    Path: Pos margin, 1 pos node, Gleason 5+4, 4+4
    Nov/11 PSA 2.9
    Dec/11 Refer Onco, MRI pos node@rectum.
    Jan/12 HDT begins, 6 mon Eligard shot, Casodex/14 days
    Jan/12 Pee blood, xray >1/2 inch kidney stone
    Jan/12 Lithotripsy, pain, EMT to ER, given Dilaudid>respiratory arrest.

 
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