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Thread: PSA frequency after rrp

  1. #1
    Regular User
    Join Date
    Jun 2010
    Central Louisiana

    PSA frequency after rrp

    I did a quick search and didn't find what I was looking for. For those of you who have had RRP, how often did your urologist obtain your psa data after your surgery? Especially for the first year. monthly? quarterly?

    Dx June,2010, age 57. psa 3.07, fpsa 18%, DRE +, gleason 4+5=9.
    7 cores from <5% to 60% ( out of 18 )
    began casodex 50 on June 25.
    rrp surgery 7/21/10
    PCa contained within capsule - neg lymph node, neg seminal vesicle -WHEW !
    pT2C N0 MX
    Catheter out 8/5
    Currently 99% continent, (9/8/10)
    First post surg psa on 9/3 - nondetect !

  2. #2
    Senior User
    Join Date
    Oct 2009

    PSA Monitoring after Radical Prostatectomy

    Hi Bently, - The frequency of ROUTINE PSA monitoring following Radical Prostatectomy (RP) is the same, whether it is an RRP, RALP, LRP, or PRP but, he schedule varies by Urologist and/or Institution. A COMMON one is Quarterly the first year, Semi-annually in the second year and Annually thereafter. Dr Catalona at Northwestern University Medical Center states that he prefers a schedule of Quarterly tests for 2 years, before changing the sequence. These schedules assume consistently "undetectable" PSA results on each sequential occasion, which is Clinically considered to be anything "Less than" 0.1 ng/ml, reported as <0.1 ng/ml on the Standard PSA assay.

    The STANDARD PSA assay reports readings to one/tenth of a nanogram per milliliter of blood is still used at most leading Cancer institutions (Mayo Clinic, Johns Hopkins and Memorial Sloan-Kettering for instance) and are considered perfectly adequate, in fact preferable, for routine post-surgical monitoring.

    There are individual situations where either the Physician, or often the Patient, may ask that either Hyper- or Ultra- sensitive assays may be requested to be performed. These reportedly can measure PSA levels to one/100th or one/1000th (0.01 to 0.001) of ng/ml. A Nanogram (1.0 ng/ml) is one BILLIONTH of a gram, so these are minute (my-noot) levels of PSA being measured by such extra-sensitive assay materials. As sensitivity increases, so do the potential for meaningless non-biochemical deviations from test to test. Such "bouncing around" of PSA results at these sensitivity levels are RARELY clinically meaningful unless they portray an unending, steadily rising PSA over several tests. Therefore they can lead to unwarranted concern and worry, needlessly increasing "PSA anxiety" for no valid reason.

    If they are to be used for routine post-surgical monitoring, you as a responsible Patient, should make absolutely certain that you fully understand the significance, or more often the LACK thereof, in such clinically meaningless variations. There are appropriate situations for their use, such as with an Oncologist monitoring ADVANCED PCa where these tiny variations, when consistently moving upward or NOT moving down when under continuing treatment, MAY signal appropriate changes in the protocol or the level of intervention, but these are the exceptions and unless in such specific instances, MOST responsible Physicians are not going to act on such flimsy evidence as PSA changes at total levels below 0.1 ng/ml and more likely 0.2, when considering any aggressive intervention.

    I hope this helps your understanding, but if not, I will be happy to respond to specific questions or make clarifications. - John@newPCa.org (aka) az4peaks

  3. #3
    Senior User
    Join Date
    Sep 2008
    East TN
    I'm not sure if I will directly address the question or not, but would pose a follow-up question of my own. I had DaVinci prostatectomy in Sept, 08, first PSA in October, next in January, 09. My PSA started rising again, so it was off to radiation land after a second opinion. I finished radiation in May, 09 and had my next PSA drawn in August (IIRC). It was <0.06. So, I was re-tested in December, still <0.06 and now again in July, still good. I'm not sure WHEN I want that next PSA, simply because as that time draws near, it's almost all I can think about. There are times that I think the THOUGHT of cancer is much worse than the cancer itself. Because I feel strongly about quality of life issues, I'm not planning on a tertiary, palliative treatment, should my cancer return. They either got it with surg/radiation, or they didn't and that, as they say, is that. So, why bother with another PSA???

    Sure wish we could have a discussion about quality of life issues surrounding our cancer.... Pardon my rambling, it's the heat...

    PSA 6.48, biopsy Gleason 3+4, robotic prostatectomy 9/17/08, pathology Gleason 4+5, pathologic stage T2c, positive margins, SRT completed May 22, 2009. 1st post-radiation PSA, 8-4-09, <0.06. 2nd post-radiation PSA 12-22-09 <0.06. PSA, July 23, 2010: <0.06. PSA, January 10, 2012: 13.90. Re-test, February 6, 2012: 16.47. April 6, 2012: 25.6. PSA, May 2, 2012: 37.74. PSA, May 27, 2012: 37.4. PSA, June 17, 2012: 51. PSA, Sept 27, 2012: 110.24. PSA, January 28, 155. May, 2013, Well, you get the idea...

  4. #4
    My uro requires PSA tests every 3 months for 2 years. After that, I think we have to negotiate whether it's annually or semi-annually.

  5. #5
    Experienced User
    Join Date
    Apr 2008
    Bentley, the frequency of PSA testing after RP depends on what the surgical path report showed and the final stage of the disease. In my husband's case, the surgeon handed him a sheet of general information about what to expect after surgery including follow-up. Generally (and I stress the word generally), PSA is checked every 3 months for the first year, every 6 months years 2 through 4, then annually thereafter. In my husband's case, since his final stage was T3a, the surgeon said we're going to monitor PSA every 3 months for the first 2 years. In March of 2010, my husband hit the two year mark and received another undetectable on his PSA. He has graduated to a PSA every 6 months (the next one is in September). As an FYI, the urologist and my husband's "regular" MD use the standard PSA test. We have discussed the use of an ultrasensitive test with both of them as well as with a radiation oncologist we met last Fall...none of them feels that the ultrasensitive test yields any pertinent information. This is often a big bone of contention not only among doctors but among PCa patients.


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