Rising PSA Levels After Surgery

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Milton1
New Member


Date Joined Oct 2009
Total Posts : 4
   Posted 10/9/2009 1:22 PM (GMT -6)   
I am an otherwise healthy 59 year old who had a radical prostatectomy on June 5, 2008. The surgery was deemed successful with no cancer cells detected in the margins. Subsequent PSA readings post surgery at my follow up visits have been 0, 0, 0.02, 0.04 and on Monday of this week (October 5, 2009) the reading was 0.07. As a result, my urologist/surgeon is suggesting follow-up, external beam radiation therapy. Has anyone else seen rising PSA scores post surgery and if so, was external beam radiation therapy suggested or conducted and if so, was the therapy successful. I am concerned with the rising PSA levels but equally concerned that the radiation treatment is a fairly aggressive response to fractional PSA levels.  Any thoughts would be helpful. Thanks.
 
Milton1 

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 10/9/2009 1:51 PM (GMT -6)   
Milton if I may ask, what were your pathology results? I am interested in knowing your pre surgery PSA, your gleason scores, etc

I would like to comment on this for you however I would also like to have the complete puzzle before doing so.

Peace and love
Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01

Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23847
   Posted 10/9/2009 3:44 PM (GMT -6)   
Milton, would have to see some of your stats to even begin to answer that. Even though it has risen to .07, that is still a zero in anyone's book. Would depend on so many factors. I am in the midst of salvage radiation right now, as I had post surgery psa rising.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2589
   Posted 10/9/2009 5:18 PM (GMT -6)   
I am glad your URO is on top of the situation. From what little we see, you have a little time to make the best decsion/

Good luck and let us know how this progresses.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)


Milton1
New Member


Date Joined Oct 2009
Total Posts : 4
   Posted 10/9/2009 8:56 PM (GMT -6)   
Thanks to every one who has replied thus far, but all of you have far more recorded data than I do. I feel like a neophyte amongst professionals. Based on what each of you have requested....PSA levels were as follows 11/06 - 2.1, 11/07 - 4.2, 01/08 - 5.1, 03/08 - 5.7. The results of the  prostate biopsy performed in March of 08 displayed 3 of 6 samples were positive for cancer, but it was a slow groing or appeared to be a slow groing variety. Radical prostatectomy performed on 06/05/08. I do not have any pathology results other than the fact that my urologist indicated that the cancer was confined to the prostate and the margins were clear. The lymph nodes were also clear. As I suggested, I have no clear data top support the conversation that I had with the urologist although I can obviously ask for those results. I imagine that is something that I should do. anything else that I need to know?
 
As I indicated previously, my cirrent PSA level of 0.07 seems minor although I am concerned about the progression from a zero level after the surgery. I just don't know if radiation beam therapy is necessary now or ever.
 
Milton1

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 10/9/2009 9:00 PM (GMT -6)   
A rising PSA is never a good sign but yours are still low. I have read that many docs think that .2 is where to pull the trigger but I would recommend a second opinion, probably with a prostate oncologist. You are fairly young and have to take the long view about both treatment and side effects.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


Milton1
New Member


Date Joined Oct 2009
Total Posts : 4
   Posted 10/9/2009 11:01 PM (GMT -6)   
Geezer99,
Thank you for your recommendation. I am going to schedule a consultation with a prostate oncologist to get a second opinion. My consult appointment with the radiation oncologist  is scheduled for October 26th, but I am fairly certain that he is going to recommend some form of radiation treatment. I will keep you all informed of how that goes as well as my second opinion consultation, but any added suggestions or insight would be appreciated.
 
Milton1

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1250
   Posted 10/9/2009 11:53 PM (GMT -6)   
Milton1 --- I had to smile when you said you were fairly sure the radiation oncologist was going to recommend some form of radiation.

The only thing for sure about PCa is that surgeons will suggest surgery, radiation people radiation, hifu doctors hifu, watch and wait believers watch and wait, etc., so I bet you're right!

Good luck, and please, report back in.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09  0.02
Oct 1st 09 -- dry at night, during day some stress issues, but better every week.    


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1779
   Posted 10/10/2009 7:58 AM (GMT -6)   
Milton, don't be too sure that the rad oncologist will recommend SRT. When John and I first met our rad onc (John's latest PSA was 0.3 - 18 months after surgery), she asked us "so Dr. [name] is recommending radiation at this time?" The answer to her question was no; the urologist/surgeon suggested that this might be a good time to start exploring SRT and to meet with one or two rad oncs in the process. Most doctors will look for a rise over 3 consecutive tests and the ones we've spoken too seem to look at
the PSA rounded up or down. Our urologist reported my husband's PSA after surgery as 0.0 (for 17 months), 0.1 and then 0.3. The radiation oncologist also said that she doesn't look at every number but rather just the one to the left and right of the decimal point because of the so-called "background noise" inherent in the tests.

In my humble, layman's opinion, your current PSA doesn't appear to warrant action but, certainly, it wouldn't hurt to explore your options. You have a way to go before you hit the magic number which seems to be anywhere between 0.2 and 1.0, depending on who you ask!

Please keep us posted!
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (extraprostectic extension in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Gleason 3+4 (no change from biopsy). PSA results: April 2008 0.1; May 2008 0.0; August 2008 0.0; November 0.0; February 2009 0.0; May 2009 0.0; August 2009 0.1; September 2009 0.3. Met with radiation oncologist and began process for salvage radiation. CT scan and bone scan done on October 8 (bone scan clean!).


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 23847
   Posted 10/10/2009 8:05 AM (GMT -6)   
I agree with Sephie here. Not pretending to be your doctor nor have access to your medical data and history, but with the pathology report you shared and the psa readings post surgery, doesn't appear to be in any kind of range for salvage radiation in my opinion. Sephie is quite right, it would take 3 consecutive rises before most doctors would accept it as re-occurance in the first place.

Definitely a time to start mapping out a strategy for future action if needed. I am hoping you won't need to go down the salvage route.

David in sC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1173
   Posted 10/10/2009 12:31 PM (GMT -6)   
Hello Milton1,

Sorry to hear about your rising PSA. If you look at my stats you can see that I was in a similar position about 10 month ago. I've decided that my increase in PSA signaled a recurrence and that the next step in my battle was SRT. It is my understanding that SRT works best when started early. When radiation started the PSA had increased to 0.1. Side effects from radiation were minimal except for some anal discomfort and some bleeding. Now, 10 month later, I'm almost back to pre radiation and the PSA level last July was <0.04. My next test is due in Jan 10, but thus far it looks promising.
I'm hoping that your journey into SRT land will be uneventful and totally successful.
All the best to you.

Magaboo
Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA in Jan., 09, = 0.05; July 09, <0.04


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3620
   Posted 10/10/2009 1:32 PM (GMT -6)   
Milton,
It's good that you are getting an opinon from a prostate oncologist. I have found that both surgeons and radiologists are mechanics that understand well the mechanics of their treatments, but don't understand the biology of PC and how it manifests at different stages. Even though my surgeon and radiologist were very good in their fields my surgeon completely underestimated my PC and my radiologist overestimated it; both becouse they really didn't understand PC at the cell level or how to properly stage it. It took a phone conversation from my oncologist to explain the exact staging to my radiologist.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 10/10/2009 4:24 PM (GMT -6)   
Great advice from everyone Milton. I personally think that you should have another PSA testing to see where it is and if it is truly rising. I do believe in jumping on the enemy quick if the enemy is truly present. The positive thing is that you are asking questions and getting involved in your health care. We have to be our own best advocates and it sounds like you are. Keep us posted on your progress and please know I care deeply about you and pray that you will be a zero for years to come.

peace and love
Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01

Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


Milton1
New Member


Date Joined Oct 2009
Total Posts : 4
   Posted 10/10/2009 6:35 PM (GMT -6)   
Sleepless09, Sephia, Purgatory, Magaboo, John T, Livinadream, Geezer99, Goodlife,
 
I can't thank you enough for sharing your thoughts, your insights, knowledge and concern with me. This is my first experience with a support group and; quite frankly, I never expected to receive the level of support that you have provided. Your willingness to share your health and medical experience and condition is quite......well, let's just say it is far more appreciated than you could imagine. Thank you for your help and assistance, I feel better for just knowing that you are out there. Thanks...I will keep you informed of progress either way. God bless each and every one of you.
 
Milton1   

dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 147
   Posted 10/10/2009 6:41 PM (GMT -6)   
Hi Milton,
As my bio reads my case was nearly the same as Magaboo with the 4 consecutive rises. I wanted to get it early as most of the latest ideas suggest the earlier the better. My side effects were minimal and had little trouble. I will have my next psa in November. You are on a very good site for information. Just gather all the info you can to make an educated decision! Good luck to you and I will be keeping a lookout on your journey.

David
Age 54
Pre-op PSA 4.3
Surgery Feb. 17 2005
Post-op Path : Gleason 3+3=6
Right pelvic lymph nodes: negative for metastatic carcinoma
Left pelvic lymph nodes: negative for metastatic carcinoma
extent: right lobe 40% left lobe 10%
capsular penetration: Absent
Seminal vesicles and vasa differentia: Uninvolved
Prostate: 26 grams
Post-op PSA's <0.04 for 3 years
Feb. 08: 0.07, March 08: 0.08, June 08: 0.09 and Sept. 08: 0.1
IGRT scheduled.....November 17th....
FINISHED 01/14/09 YEA!
05/14/09
1st PSA after Salvage RT <0.04..... Another YEA!

New Topic Post Reply Printable Version
Forum Information
Currently it is Wednesday, July 23, 2014 4:49 AM (GMT -6)
There are a total of 2,177,537 posts in 242,126 threads.
View Active Threads


Who's Online
This forum has 153451 registered members. Please welcome our newest member, Elisag.
284 Guest(s), 6 Registered Member(s) are currently online.  Details
freewheelin76, linc497, getting by, gavin92, xy123, 1039smooth


Follow HealingWell.com on Facebook  Follow HealingWell.com on Twitter  Follow HealingWell.com on Pinterest  Follow HealingWell.com on YouTube
Advertisement
Advertisement

©1996-2014 HealingWell.com LLC  All rights reserved.

Advertise | Privacy Policy & Disclaimer