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Thread: PSA creeping up after Da Vinci surgery

  1. #1
    Senior User
    Join Date
    Apr 2014
    Posts
    127

    Question PSA creeping up after Da Vinci surgery

    1 month after surgery 0.06, 2 months 0.07 and now 3 months 0.08. meeting with my doctor in 2 weeks to see the plan of action. would like a little input from members that had similar results. my doctor has talked of radiation, clinical trial or drugs. january i had psa of 10.6, gleason 4+4 and staged at T3b, surgery in feb. 64yo in good shape and no symptons of prostate troubles, no ed but i do have it now. i go on medicare in october and retiree insurance secondary till the end of the year. now i get the good news the company i worked for 43 years is carving me and my wife out as of 1-1-2015. confused when i read on here about <0.10 as considered 0 or undetectable. some input would be helpful, seems like everything is moving to fast. thanks.

  2. #2
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
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    7,232
    Hi,

    Welcome to the forum, but also sorry you need to be here.

    Yes, anything less than 0.1 is considered zero. That is the standard for undetectable.

    Can you give us more details from your pathology report? Did you have any positive margins? If the cancer is still there -- and still around the prostate bed -- salvage radiation is possible. Salvage radiation is intended as a way to finish the cure that was started by the surgery.

    If your doctor's first option is to do radiation, that would hopefully mean that the cancer truly is still around the area where the prostate was -- and not elsewhere.

    In the meantime, more info from your post-op pathology will help us get a better idea of what your situation might be, such as the condition of the lymph nodes, extraprostatic tissue, seminal vesicles, etc.

    Stay tuned as others chime in with thoughts & advice.

    Good luck!
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Eight annual post-op exams 2012 through 2019: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  3. #3
    There are two types of PSA test, Standard and Ultra-sensitive..You are getting the ultra-sensitive test which can produce a lot of PSA anxiety..You may have other issues going on back-stage (insurance) so that may be playing a part in treatment recommendations. Radiation treatment is very expensive.. So waiting until October to start that is not unreasonable..if your PSA continues to rise, they can clamp it and prepare you for radiation treatment by starting adjunct ADT now..At some point you need to consult with a Radiation Oncologist and get his thoughts....
    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. 1/2015 PSA 0.106. 4/15. 0.4, 9/15 1.4, 3/16 Zytiga, 0.04, 5/17 1.4 may switch to Xtandi. 3/1/2018. PSA now 54, chemo will begin next month. 7/19, PSA 2000 starting Lu-177 tomorrow..77 years old now..

  4. #4
    When it comes to PSA testing after surgery, it can be confusing because different testing lab uses different machine with different sensitivity (resolution), some has sensitivity of .1, others .01, etc. What you should look for is the < sign in front of the PSA number, for example, if the machine sensitivity is .1, anything less than .1 is considered undetectable, < .1, = 0. Your tests were done with an ultra sensitive machine and there were no < sign in front of the PSA numbers meaning your PSA were not 0.

    Does it means your cancer is back? Not necessarily. Sometimes, some benign tissues were left behind and so the PSA was not 0. There were a few posters on this site had this happened to them. However, in those cases, PSA stabilized to a small number and stayed there. That is also why the medical community considers recurrence only after three successive number of > .1 and PSA reaches .2 or greater.

    My advice is to watch your PSA carefully and start to prepare for plan B just in case, i.e., prepare for the worst but hope for the best. Plan B should include consultation with an oncologist and a radiation oncologist as Fairwind stated.

    Good luck.
    PCa Dx 2010 at 65. PSA increased from 2.5 in 2000 to 10.7 in 2010. Four biopsies in 6 years. Final biopsy in 2010: 1 of 12 cores 5% cancer, G6
    CT, bone scans & MRI all negative
    Da Vinci 8/10; nerve sparing, catheter out in 7 days; no incontinence, no ED
    Post Op Pathology pT2N0Mx: organ confined; negative margins; lymph nodes & seminal vesicle not involved but PNI present; cancer extensive within prostate, multifocal G 3+3 and tertiary G 4
    Infected lymphocele diagnosed and treated in 2014, 4 yrs after RALP
    PSA <.1 for the past 6 years.

  5. #5
    I noticed your cancer was G(4+4) and staged T3b meaning your cancer was aggressive and had spread to the seminal vesicles. So you are considered a high risk case. However, not all high risk cases resulted in recurrence and even if recur can be cured with radiation and hormone therapy. There are quite a few posters in similar situation as you and I hope they can chime in and help out.

    Take care.

  6. #6
    Experienced User BeeMan's Avatar
    Join Date
    May 2012
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    79
    I have a friend that had a prostatectomy in 2000 and his PSA has continued to rise over the years. He now has a PSA of 1.8. He just came into town to meet with my radiation oncologist and is planning to have adjuvant radiation therapy in Sept. after the MRI and bone scan. The prognosis looks good because it most likely is confined to the
    "prostate bed".

    BeeMan

  7. #7
    That's a very modest change, and many people wouldn't consider that to necessarily be failure as above; nevertheless, the goal PSA after surgery is zero. Two main options include continued monitoring or radiation (due to it being Gleason 8, some people would use hormone therapy for 6 months around radiation). How's the recovery of continence going? The radiation doctors often prefer to allow maximum recovery of urinary continence before going with radiation.

  8. #8
    Quote Originally Posted by timeshifter View Post
    That's a very modest change, and many people wouldn't consider that to necessarily be failure as above; nevertheless, the goal PSA after surgery is zero. Two main options include continued monitoring or radiation (due to it being Gleason 8, some people would use hormone therapy for 6 months around radiation). How's the recovery of continence going? The radiation doctors often prefer to allow maximum recovery of urinary continence before going with radiation.
    I respectfully disagree that a reading of 1.8 PSA following a prostatectomy is "modest". If fact, any reading exceeding 0.2 PSA sets off flashing red lights and bells and loud whistles in my urologist's office.
    Three years after my Da Vinci prostatectomy in Nov., 2010, my PSA has inched back up to 0.16 while doubling in less than one year. After consultations with my urologist and an oncology radiologist, last summer I received 40 treatments of radiation to the prostate bed area. This was followed 3 months later by my first ever true 0.00 PSA reading.
    It's worth noting that the $240,000 worth of radiation was approved by Medicare even though my PSA reading was less than 10% of Beeman's friend's reading.
    If the OP can wait until his October Medicare coverage kicks in, he may find less resistance in seeking out insurance payments for services that may be needed.

  9. #9
    Quote Originally Posted by Jim215 View Post
    I respectfully disagree that a reading of 1.8 PSA following a prostatectomy is "modest". If fact, any reading exceeding 0.2 PSA sets off flashing red lights and bells and loud whistles in my urologist's office.
    I was replying to the original poster with a PSA that went from 0.06 to 0.08, not about the case with PSA 1.8.

  10. #10
    My results were similar, although they classified me as zero for 10 months post surgery, on the 12th month I was .08 then 3 months later I was .12. I told my doctor I wanted radiation and had 33 rounds. Seven months after radiation my PSA is 0.0.
    Good Luck
    B

 

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