The post RP PSA dilemna... changes below .1

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41diagnosed
Regular Member


Date Joined Jun 2007
Total Posts : 176
   Posted 2/19/2010 11:57 AM (GMT -6)   
My first PSA post RP was .04 and I was scared and angry. I wanted .00 something.

My subsequent PSAs have been .03. and I was satisfied those were good results.

A study I read said optimal outcomes on biochemical recurrence are when you have a PSA nadir post RP of less than .001 for the ultra-sensitive assays.

So here I am with a good pathology post surgery and 2.5 years out, and my PSA yesterday came back at .07. crap. That's better than a 100% increase since the last ultra-sensitive assay I had done in May last year. Not good? Well, my surgeon, William Catalona at Northwestern who is one of the father's of the PSA, is dismissive of anything below .1. I want to adopt this dismissive attitude and feel good about it being "undetectable". But reason won't allow me to do it. I'm feeling anxious and wondering if I should start the process calling radiation oncologists for salvage therapy.

My Gleason Score was 3+4, but post surgery everything was clear...clear lymph nodes, no extra-prostatic extension, self-contained in prostate. So I should be feeling good right? But I'm not.

Is there anyone out there who can tell me that they have seen up and down fluxuations in their PSA below .1? If you're out there, I'd love to hear from you. It might truly help me feel better and not feel as though I'm having a biochemical failure due to microscopic metastasis (isn't that what they call it when all else seems fine and then your PSA starts to rise again?)

I'm trying to look at the positive side...I've made it to 44 from 41 when I was first diagnosed.

Hi to all of you who supported me the first go-around. I've been absent...trying to move on past PCa. But it's always there isn't it?
 
43 yo. now
 
5/07 PSA 4.65 at routine physical
6/07 biopsy Gleason 7 (3+4)...diagnosed at 41 y.o.
6/07-9/07 manic research and interviews with physicians across the country in search of the "right" decision.  I went to Mass General in Boston, Loma Linda, University of Chicago and Northwestern.
9/17/07 - RRP at Northwestern Memorial by Dr. William Catalona.  Thankful the father of the PSA test was right here in Chicago.
Post op path report confirmed Gleason 7 (3+4). negative margins, no seminal vesicale involvement, no lymphatic or vascular invasion, bladder and urethral free and tumor volume was 5% of 27.3g.  
9/27/07 - catheter removal...let the games begin...
12/31/07 - threw out the pads (I only had used 1 pad per day for protection against minor drips)
 
I started Trimix 8 weeks after surgery with success.  I hope someday I won't need injections, but I hope more that my PSA stays at 0 forever.
 
9/17/08 One year past surgery and doing well.  PSA less than .1 and ED continues to get better and showing reasonably good results using Levitra which for a long time did nothing. 


gold horse
Regular Member


Date Joined Nov 2009
Total Posts : 340
   Posted 2/19/2010 12:37 PM (GMT -6)   
I am almost five years and psa=0.04 only one time it came 0.05.I was worryed an my doc told me it was just fine,I will not let the ultra sensitive test robed me of my serenity,we have enough to worry.mad
DIAGN=46 YEARS
GLEASON=3+3
FATHER HAD PC,THEN I THEN MY BROTHER STILL HAS TWO BROTHER PC FREE.
MARRIED,TWO CHILDREN.AGE 13 AND 8.
LAPROSCOPY SURGERY 6/2005
PATOLOGY REPORT.
GLEASON=3+3
TUMOR VOLUME=5%
LYMPHOVASCULAR INVASION=NEG
PERINEURAL INVASION=POSI
TUMOR MULTICENTRICITY=NEG
EXTRAPROSTATIC INVASION=NEG
SEMINAL VESICLES BOTH=CLEAN
MARGIN ALL=NEG
PT2ANXMX
DEVELOP SCART TISSUE AND NEEDED A SECOND SURGERY BECAUSE COULD NOT URINATE,
PSA 6/05=0.04,0.04,0.04,6/06,0.04,0.04,0.04,6/07,0.04,0.04,0.04,6/08,0.04,0.04,1/09
0.04,10/09,0.04
 


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 2/19/2010 12:49 PM (GMT -6)   
41diagnosed said...
Is there anyone out there who can tell me that they have seen up and down fluxuations in their PSA below .1? If you're out there, I'd love to hear from you. It might truly help me feel better and not feel as though I'm having a biochemical failure due to microscopic metastasis (isn't that what they call it when all else seems fine and then your PSA starts to rise again?)

Hi.  I don't have this direct experience, but have done some reading, and can provide references, that may help ease your mind. 

Some surgeons specifically tell their patients to get only the “standard” PSA test after surgery specifically to avoid what is called “PSA Anxiety.” 

As you have already pointed out, Dr Catalona is (in your words) “dismissive of anything below .1.”  Why is this?  One reason is that unilateral or bilateral nerve-sparing surgery will leave benign tissue behind which produces PSA at a level detectable by the “ultra-sensitive” PSA tests.

(reference:  http://www.prostate-cancer.org/education/preclin/McDermed_Using_PSA_Intelligently2.html)

 

Additionally, there is also normal day-to-day variation of PSA results which are evident only with the detection levels of the “ultra-sensitive” PSA test.  This article “The Downside of Ultra-Sensitive Tests” reports normal variation within the range of what you are seeing:

(reference:  http://www.phoenix5.org/Basics/psaPostSurgery.html)

 

The concluding sentence in the article reads:

''It's important that we don't assume anything or take action on a very low level of PSA. In routine practice, because of these analytical variations from day to day, if it's less than 0. 1, we assume it's the same as nondetectable, or zero.''

 

Hope that this helps ease your mind...

 

 


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 977
   Posted 2/19/2010 12:58 PM (GMT -6)   
41, I am in the same boat as you are. First 2 PSA's post RP were >.01. Then at 9 mos it hops to .07. Re-test about a week later was .05. I have got to say that I am worried, but nothing to do but wait until the next test and hope for the best. I am working to improve my diet. It makes me feel better, and a little more in control. Best of luck.
Dx with PC Dec 2008, PSA 3.4, Biopsy: T1c, Geason 7

Robotic Surgery March 2009 Hartford Hospital
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05


BoisePSABantam
Regular Member


Date Joined Apr 2009
Total Posts : 20
   Posted 2/19/2010 1:12 PM (GMT -6)   
41! My post op PSA's have been 0.07, 0.04, 0.08 etc. Any thing below .1 is considered 0.00. My GP told me that he has 12 or so patients he's refereed for surgery and ALL of us have some detectable PSA 1 - 5 - 15 years after surgery. It doesn't mean you have recurrent PCa. It's the consistent rise over time and how fast that gets their attention.
Pre-Surgery PSA: 4.92
age: 45 at DX.
DaVinci 5/07
1st PSA 0.07 8/07
2nd PSA 0.04 11/07
3rd PSA 0.04 02/08
4TH PSA 0.04 7/08
5th PSA 0.08 2/09
6th PSA 0.08 5/09
7th PSA 0.07 9/09


dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 147
   Posted 2/19/2010 1:52 PM (GMT -6)   
Hi 41,
This is probably just a glitch n the test. I had similar time frame and readings. My Doc said he would not call it recurrence until I had 3 rises, which I did in time. I understand the nerves as I am bad about that myself. I went on to do the SRT and am over a year out and am <0.04, as low as my test reads. Try not let it bug you to bad because you may be going up and down like the guys earlier in the post.

Good luck

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
05/14/09
1st PSA after SRT <0.04
12/03/09
2nd PSA after SRT <0.04


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24179
   Posted 2/19/2010 2:15 PM (GMT -6)   
Listen, my friend. There is no exact .00. Your .03, .04, and .07 are still all "zeros". You are doing great, don't let the ultra sensitivity of tests spoil what is actually a good run you have going there.

Your post surgery numbers have been great, many would love to trade places.

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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2351
   Posted 2/19/2010 2:51 PM (GMT -6)   
Hi 41,
Try not to worry. Your PSA still qualifies you as a member of the zero club. Relax, you test again in 3 months and see what happens.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11.5 months test 1/21/10 result 0.004


Ricky2
Regular Member


Date Joined Dec 2009
Total Posts : 96
   Posted 2/19/2010 3:44 PM (GMT -6)   
If your PSA rises above .1 after surgery it does not necessarily mean metastasis. There can be some cancer cell left behind in the prostrate bed which actually can stay dormant of quite awhile. That is why they do IMRT to the prostate bed when your PSA goes over .1. As I understand you then have a 50% chance of still having a cure (no recurrence)

Walsh in his book on PC does not recommend an ultra sensitive PSA test for the same reasons as cited above..

Ricky
Age 70

PSA 5/2008- 3.6, PSA 7/2009- 6.1, retested 9/2009-5.1.
Biopsy 9/2009. 4 of 12 positive. Gleason 3+4=7
CT and bone scan negative.
Robotic De Vince Surgery 10/29/2009. 1 night in hospital. No pain. Cath out on 11/6
Pathology Report: Gleason score 3+4. Margins slightly involved <.1mm to .25mm. Perineural invasion present, stage pT2c. Tumor 18%. Seminal Vesicle - absent, Lymph Nodes 0 of 6.
Continence- first 4 weeks after cath out Dry at night, rest of time, bladder held nothing. 6-7 pads per day. as of 12/30 no pads most of time. almost dry except for a few drips. I keep doing Kegels.
ED. Started VED on 12/17. 15 min every other day. 20mm cilias twice a week. No sign of life yet.


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 390
   Posted 2/19/2010 4:39 PM (GMT -6)   
41,
 
I went thru a similar situation,  but I had 2 focal point margins and was not negative margins like you.  I had a small but significant PSA rise between my 2nd and 3rd year post op to above the .1 level.  With your negative margins and still lower numbers,  I would concentrate on healty living and diet.   Try not to worry and stay positive no matter how difficult that may seem.  
 
BCR was defined as somewhere around  0.20 to 0.40 from what I had read,  but now they are also looking at 3 consectutive "rises".    With my slightly positive margins  and a trend that did seem to rise,  I opted for salvage radiation based on my DaVinci's doctors opinion along with the radiation oncologistm, my mind frame,  and some other logistics.  The current practices  seem to be opting for salvage radiation for some cases at the lower numbers now as some studies have shown better outcomes.  Thinking the PSA number was starting before 0.50...     
 
Anyway,  time for calm and maybe some additional research to help ease the unknowns...   The thing you have going for you is you have plenty of time,  still low numbers,   original clean margins,  and future alternatives.  And the technology and treatments are improving every day....  
 
I know any PSA rise it is dissappointing...  I have been there...   I thought since the prostate was gone I would never have to deal with PCa again.   Even started to forget abpout scheduling routine appointments for checkups.  I forgot that I was a "survivor" and not a person that never had PCa.  It took awhile for my mind  to switch back to a positive fight mode and constuctive thought processes...   To not let PCa control my life, but for me to  once again become informed and  in control of my life and decisions on living a quality life and as a PCa survivor.
 
God Bless,
 
pasayten (Ray)
After 3-4 years of annual PSA 4-6, biopsy recommended
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx, approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
9/10/2007 Pad free and ED at 75% with 100mg Viagra generic
6/26/2008 2nd Post-OP PSA at 14 months...  0.02 
12/2/2008 3rd Post-OP PSA at 20 months...   0.03
10/30/2009 4th Post-OP PSA at 31 months...   0.13 (moved and diff lab)
11/3/2009 Retest at my original lab...  0.11  (followup with Doc sched 11/10)
11/10/2009 Discussion indicated biochemical reccurrence and need for salvage radiation treatment. 
1/21/2010 Another PSA test at 34 months...  0.14
1/26/2010 IMRT Salvage Radiation Treatment started
                  32 sessions for 64 gys total.
2/12/2010 13 down and 19 to go...  No side effects to date except a little
                  tiredness.
 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1821
   Posted 2/19/2010 4:46 PM (GMT -6)   
41,
Firstly, it is not possible for the ultrasensitive test to give a result of .001 or lower. The lowest possible limit of detection by the latest equipment is .003 so a result below this is not possible. If PSA was not detected using this equipment the technical result would be <.003 (undetectable). But this range of detection is prone to error simply because it is so infinitesimal therefore many labs, even if using the latest equipment, will drop the third decimal place and if no PSA is detected, will post the result as <.01 (undetectable). If a lab is using earlier equipment these figures are increased 10 fold. The 2nd generation test will detect PSA down to its detection limit of .03 but this has the same percentage margin of error as the ultrasensitive test so is often simply reported as <.1 undetectable. So you see much is dependent on the equipment used. Additionally different labs in different locations may calibrate a little differently (even temperature variations can have an effect) so it is important if going ultrasensitive to use the same lab in the same place. I also make sure that the path request is marked "progress post-prostatectomy" so there is no doubt that this is not a run of the mill PSA test.
Casey's links are very good reading and you should find them reassuring.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01
PSA December 09 <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 5197
   Posted 2/19/2010 6:21 PM (GMT -6)   

This is a VERY interesting thread.

 

I know Dr. Strum really pushes for the ultrasensitive test. Part of me agrees in th sense that more information is better than less information.

 

But in this case, maybe not. My doctors are against the ultrasensitive test precisely for the reasons shown in this thread. It causes way too much aggravation/stress.

But it is not a clearcut choice, for sure!

 

Mel (10 days away from my first post-op PSA test)


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights.

Next Event: First post-op PSA on 3/1/10


Model A Vicky
Regular Member


Date Joined Aug 2008
Total Posts : 20
   Posted 2/19/2010 6:27 PM (GMT -6)   
Over the years since my RP, things sure have changed.  In '93, a 0.1 was good!  The doctor was excited with a 0.1, as that meant basically there was no detectable trace.  Then, a few years ago, equipment was developed that would go down to 0.0 something.  That second decimal point could be anything from 1 to 9, and that was still undetectyable.  Now, we are seeing 0.00 somethings, meaning it is undectable!!!  So, I'm still excited when mine comes back at 0.03, which is what my report was today.  So, as the old saying goes, don't sweat the small stuff!!!  And, I, too, get that anxious feeling a week or so prior to my annual check-up, wondering what that "undetectable" figure will be.  Just human nature to worry a little.  Just take it a month, then 3 months, then 6 month, then a year, at a time.  It'll be alright!
Doug: diagnoised age 49 (born 1943)
supporting/loving wife: Pat
1st PSA (1991): 4.0
2nd PSA (1992): 5.4
Biopsy (Nov.1992) 6 samples, all positive
Radical Prostectomy: Jan. 1993 @ age 49
Depression: Onset within 6-8 months (low testerone)
Incontenance: 6 or so weeks, with  very slight problem continuing through present
Impotence: Continues through present
Impotence Treatment:
*Viagra/Cialas/Levitra: limited success
*Testerone Treatment: So-so success (mood swings improved)
*ErectAid: Success, but bad leak-down problem
*Recent coupling of Vigra and ErectAid: Best results, but not perfect.
1993 - 2004 PSA: 0.1
Mid 2004 PSA: 0.3
Late 2004 - Late 2006: PSA fluctates 0.2 - 0.6 (cease testerone therapy)
Feb 2007: Begin Radiation
March 2007: Complete 35 Radiation Treatments
August 2007 PSA: 0.01
August 2008 PSA: 0.04 
Possible increase in PSA: Testerone Therapy???
August 2008: first (and only so far) Caverject injection--worked like it otta work, but was gone by the time we got home.  Lasted about 3 1/2 hours before completly deflated!  Had the oft mentioned ache.  Wife hasn't been as excited as I was, so no further advancement on that front.  Who knows, maybe sometime later....
 


41diagnosed
Regular Member


Date Joined Jun 2007
Total Posts : 176
   Posted 2/19/2010 6:36 PM (GMT -6)   
Healing Well and Xanax...a great cocktail for calming one's nerves from PSA anxiety.  Now onto a nice glass of red wine.  And then, since my kids are at a school overnight, I now plan to take my wife to dinner when she comes home.  It's the least I can do to make up for my emotional melt-down last night.  Isn't PCa survival a blast? :)
 
Thanks to everyone here for your encouraging words.  This continues to be a great site and I have always been greatful for finding it.
 
 
 
 
 
43 yo. now
 
5/07 PSA 4.65 at routine physical
6/07 biopsy Gleason 7 (3+4)...diagnosed at 41 y.o.
6/07-9/07 manic research and interviews with physicians across the country in search of the "right" decision.  I went to Mass General in Boston, Loma Linda, University of Chicago and Northwestern.
9/17/07 - RRP at Northwestern Memorial by Dr. William Catalona.  Thankful the father of the PSA test was right here in Chicago.
Post op path report confirmed Gleason 7 (3+4). negative margins, no seminal vesicale involvement, no lymphatic or vascular invasion, bladder and urethral free and tumor volume was 5% of 27.3g.  
9/27/07 - catheter removal...let the games begin...
12/31/07 - threw out the pads (I only had used 1 pad per day for protection against minor drips)
 
I started Trimix 8 weeks after surgery with success.  I hope someday I won't need injections, but I hope more that my PSA stays at 0 forever.
 
9/17/08 One year past surgery and doing well.  PSA less than .1 and ED continues to get better and showing reasonably good results using Levitra which for a long time did nothing. 


cpb
Regular Member


Date Joined Jul 2007
Total Posts : 34
   Posted 2/25/2010 10:40 AM (GMT -6)   
This post is most timely as I am going through a rise in PSA 2 years post op. My PSA's were undetectable through first 18 months. My next PSA test was done 27 months post op - results were 0.16. Of course, this test result brought me back to reality - I was overconfident about my consistent undetectable test results. I had another test done the following week with a different lab. Results 0.9. Then one month later - last week had another PSA with the lab that had produced the 0.16 results. This time the results were 0.1.

After much reading - research and consulting with oncologists, radiation oncologists and my surgeon, I have been left with differing opinions. The clear conclusion from both oncolgists and radiation oncologists is that once your PSA rises even to 0.05 you no longer have undetectable PSA and at some point it will rise to a level that it could metastasize whether it be 1, 3, 5, 15 years from now. And studies now show that radiation at this early stage when it is likely to be in prostate bed since PSA so low that your chances for a better outcome are greater. (Hard to argue radiation treatment with that reasoning). Even if miscrscopic in nature they believe eradicating any remnants of these cells gives you a chance for a better outcome.
My surgeon believes that if my PSA stays at 0.1 no need to do anything - only if it continues to rise should I consider radiation.
It is the oncolgists who are not necessarily radiation bias that seem to be most pursuasive when they have told me that it would be better to address a rising PSA while it is still lower to increase chances for better radiation outcome since based on my pathology it is likely that cells are still in my prostate bed.
I have gotten over my intial disappointment after my rise in my PSA and have accepted fact that this is an indolent disease that I will just have to deal with as it presents itself.
While I would like to not go through radiation and just wait to see if PSA continues to rise, if my chances in the long run are better with radiation then why not do radiation ?

Any thoughts or comments that you would like to share would be appreciated
Gleason 6 (3+3) - PSA-2.7 - T2a - Age 69
Diagnosed July 23, 2007
Da Vinci surgery - Oct 22, 2007
Doctor David Lee - Penn Health System - Philadelphia
Surgery Oct 17, 2007
Post surgery bioposy - Gleason 7 (3 =4)
No positive margins
Extracapsular extension and perineural invasion
Negative Lymph nodes
Pathologic Stage - pT3a NO Mx
Two years PSA less than 0.1
Recent PSA .16 (8 months after last PSA)


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 845
   Posted 2/25/2010 11:43 PM (GMT -6)   
I am in a similar situation but a little younger and higher Gleason.

I also have a slowly rising psa and have decided to wait until my psa hits 0.2, before radiation. And even then the probability of a "cure" is still quite low. My surgeon suggested that radiation may not even be an option for me as if there are any PCa escapees, they are no longer in the prostate bed.

He also said that he thought my rising psa may be caused by benign prostate cells left behind, but that may also be wishful thinking.

Your psa is interesting in that it has fluctuated considerably over a short time -- 0.16, 0.09, 0,10 (considering your 0.9 figure as a typo that should show as 0.09). So it's clear that at these levels we should not sweat over even large fluctuations -- so long as there are some downwards fluctuations among them.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
19-month: 0.09 (maybe)
ED:
After a learning curve, Bimix injections (0.2ml) worked well. From 14 months, occasional nocturnal erections. Have "graduated" to just the pump.


montee
Regular Member


Date Joined Mar 2007
Total Posts : 286
   Posted 3/25/2010 6:57 PM (GMT -6)   
These ultra sensitive test CAN drive you crazy.

Mine had been <0.04 for almost 2 years, then at 26 mos it was 0.05, 29 mos 0.06, then 33 mos. back to < 0.04, 36 mos <0.04 then today at 39 mos it came back as 0.07. If you go by the last test, at 36 mos does that mean it has doubled in 3 months, and why when at 0.06 did it go back down to < 0.04 for 6 months then back up to 0.07.

I feel like Barbarino "I'm so confused"
diagnosed sept 2006 @ 54 years old, live in Georgia, gleason 3+4=7, (r) lobe only

psa 4.7 (psa rose 1 point per year for 3 years, urologist said still under 4 and no concern. If I can find out about PSA velocity, why didn't he know!)

Told not to have surgery at Dana Farber as cancer had already penetrated prostate, in seminal vesicles, would have positive margins. Would only treat with radiation and HT

RP Emory Atlanta December 2006. Path-negative margin, negative lymph nodes, negative SV, both Lobes involved, 40% gland involved
multifocal perineural invasion, Gleason 3+4=7

1st psa April 2007-<0.04, 6 mos-<0.04, 9 mos <0.04, 1yr <0.04, 21 mos <0.04, 2 yr 0.04 (rising?) 26 mos-0.05, 27 mos-0.04, 29 mos 0.06 Sept 09 ,<0.04 3 year <0.04 39 mo. 0.07 (rising again)


pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 390
   Posted 3/25/2010 7:12 PM (GMT -6)   
One of the factors they look for is three consecutive rises when at the lower levels before getting more concerned about it.    Your post op pathology is another factor.
 
I just finished my SRT and will post results in a couple of months of my results.  I gave reasons for choosing SRT at a PSA of 0.11/0.13 in a post a few posts above.
 
pasayten
After 3-4 years of annual PSA 4-6, biopsy recommended
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx, approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
9/10/2007 Pad free and ED at 75% with 100mg Viagra generic
6/26/2008 2nd Post-OP PSA at 14 months...  0.02 
12/2/2008 3rd Post-OP PSA at 20 months...   0.03
10/30/2009 4th Post-OP PSA at 31 months...   0.13 (moved and diff lab)
11/3/2009 Retest at my original lab...  0.11  (followup with Doc sched 11/10)
11/10/2009 Discussion indicated biochemical reccurrence and need for salvage radiation treatment. 
1/21/2010 Another PSA test at 34 months...  0.14
1/26/2010 IMRT Salvage Radiation Treatment started
                  32 sessions for 64 gys total.
3/12/2010 Finished 32 sessions...  No side effects to date except a little
tiredness.  Slight changes in bowel movements the last week...   Would feel like I did not empty completely and get a little blood once in a while.  Also maybe aggrivated by a little constipation caused by cholesterol medicine simvastatin that I started in November and when I do not drink enough water. No change in frequency for bowel or unination though which was a blessing thru the whole process.
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2616
   Posted 3/25/2010 9:07 PM (GMT -6)   
I don't like the PSA anxiety stuff. What it really is, is a doctor doesn't want to deal with patients who are in that area where their PSA may be starting to rise. "Just wait until it is .2 or .5 then well worry about it."

I have had 9 months of <.01 readings. If I suddenly start to to see .02, or .05, you can't tell me something isn't going on. It isn't logical. If I never had a <.01, then I would agree.

I am watching my PSA, and once I see a couple months of .01 or .02 increases, I am heading for the radiologist. The sooner I act, the better chance I have of hitting it close to the protate bed. That is my reaosning and I'm sticking with it .
Goodlife
 
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 .
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)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1173
   Posted 3/25/2010 9:19 PM (GMT -6)   
The lab that does my testing can only read PSA down to 0.04. So I'm not sure if that is considered ultra sensitive or just regular testing. In any case, since my staging was T3a, the Onc and myself decided to keep a close eye on the PSA level. After about 18 month or so, the PSA level went to .04, .05, .07, and when it reached .08 we decided to proceed with SRT (3 consecutive increases). On the day before the start of SRT, the level was .1. So, in my opinion, the more sensitive test can be of benefit to determine if there is an increase in PSA so that RT can be started when its effect has the best possible chance of a positive outcome. It is my understanding that the earlier RT is stated, the better the chance of a successful outcome. Was I right in starting RT so early? Only time will tell, but thus far it looks promising. Would my PSA have stabilized at .1? I'll never know for sure, but in my own mind I have serious doubts and I'm glad that I went ahead with the SRT.
So, 41, I wish you all the best and hope that your PSA will stay at .1 or less and that you'll not require to go the SRT route.

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; JAN 10=<0.04


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 2676
   Posted 3/26/2010 12:09 AM (GMT -6)   
Not to scare you but with a pathology report like that, excellent, if you have a BCR, SRT, will probably not be much help. It is likely systemic, which is not the same as metastazed. I wont throw out percentages, but low, most here would agree with that , if not they will have info to back it up. systemic means its out there away fm radiation field, but not to bones , organs etc. that takes an avg of 8yrs to happen untreated. All dependant on gleason score I guese. So now ur talking HT and as with everything else with Pca, lot of opinions, Walsh and Scardino feel and they say studies have shown earlt HT and later HT show no significant survival advantage. They say it makes the patient feel better in the head ,cause psa is down, but the cancer that could kill you, the kind that could care less about hormones is still there and moving. Having said all that, You have nothing in those stats that indicate BCR. Im in the same boat, great Path report, but 3+4, tertiary 5. Have had only 1psa post op,0.0. however wanting to stay prepared, Im workig on a plan. I'll probably pass on radiation, be cause of side effects and loe chance of cure, and decide at some point for HT, not imediately tho. I am 66 but extremely fit,3.30 marathoner at 64so should liv a long time, but who knows. It really is an individual disease. Find out all you can about BCR, but don't over react to this psa stuff. Try and stay focused, positive and be cool. I really think watchful waiting is more relevant Post op than post diagnosis. Good luck
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
8 week psa 0,0


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 3/26/2010 12:50 AM (GMT -6)   
41diagnosed,

I would dismiss much of the last post. Although I disagree and question several things mentioned there, the "systemic" comment is not valid. Even if (and this is a BIG "if") you were on the verge of a biochemical recurrence, the fact that you have gone 2.5 years without one is a big advantage. Walsh discusses this in his book, that the longer the time to recurrence, the better the outcome with radiation due to the greater chance of localized cancer. Two years is given as a threshold, and you are past that.

In any case, I agree with most others here that you are still in the "0" club. I have had my own anxieties with the ultrasensitive test and decided to switch to the standard variety. In my opinion, the ultrasensitive test may make sense for guys whose pathology reports were not as clean as yours.

CaPCa
Age:45 (44 when diagnosed)
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
11/04/07  First usable erection with Cialis
11/22/07  Thanksgiving - Bye-bye, pads
01/17/08  First post-surgery PSA result: < 0.008 ng/ml
03/17/08  Erection quality mostly back to pre-surgery levels with Cialis;
              have not tried without meds yet.
04/23/08  Second post-surgery PSA result: < 0.008 ng/ml
07/30/08  Third PSA: 0.01 ng/ml
11/04/08  One year PSA: 0.01
              Still taking 10mg Cialis every other day - enjoying the results
              too much to stop yet.
02/07/09  Taking 5mg Cialis every other day - having too much fun to try
              to stop for now.
03/23/09  PSA: 0.02
10/19/09 PSA: < 0.1 (switched to "standard" assay)
 


creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 743
   Posted 3/26/2010 4:41 AM (GMT -6)   
41, Good luck with your future PSA's and thank you for posting your concerns. The responses have been really helpful to us especially with the range of views and experiences shared - my husband leaves all the organising, and PSA interpretation to me. Its just the way things work for us, but I too feel the extreme stress (and some responsibility) of having to eventually interpret the next ultrasensitive PSA, and so appreciate all this info given here. Now that CJ's annual PSA is due, I am avoiding having to plan it for the reasons all outlined in posts above, but when we do face the next PSA test in a few weeks, I will also be helped greatly by the information here - thanks 41, and thanks all you guys.
Creed_three (Lana) - with husband "CJ" now aged 52 yrs (49 years at diagnosis).
PSA (2002) 2.1. (2006) 3.5.  1 x 5% core of 12 positive at biopsy. Open Radical Prostatectomy with nerve sparing April 2007 Sydney, Australia. Gleeson 3 + 4 = 7. 2 small multifocal lesions. Contained. Undetectable <.1 PSA since: June 2007-0.01, Oct 2007-0.02, April 2008-0.02: Oct 2008-0.03, Nov, 2008-0.02, April 2009-0.03. Next PSA April 2010.


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2080
   Posted 3/26/2010 5:11 AM (GMT -6)   
41,

My Hospital (AVL-NKI Amsterdam The Dutch National Cancer Institute) simply do not do the sensitive tests period. (becasue of PSA anxiety etc)

For them anything that is <0.1 and stays <0.1 is okay. (Which is why my results going from 0.1 to 0.4 in three months told them that was definitley a BCR and it was time to do something else.)

These 0.02. 0.04 differences/fluctuations are very small.
PSA anxiety is not nice though.
I think it helps to think about what our test results were BEFORE treatment. If we had had a PSA level of say 12.97 one month and a level of 12.95 another and then 12.96 the difference would hardly have been noticed; we'd have thought of our PSA as being 13, but the decimal differnces are the size of what worries guys after treatment. What mattered at that stage in our lives was when the results had gone from from 4 to 7 to 9 to 13 etc.
What matters after treament is the combination of PSA level and rate of change. double from 0.02 to 0.04 is not the same as doubling from 0.2 to 0.4.
The margin of error has to relevant.

PSA in a blood sample starts to be destroyed as soon as they put the phial of blood on the desk to label it so the longer beofre it gets tested the lower the level gets.
It concerns me slightly that I do not think that (my) samples have the time they were taken on the labels with instructions to the lab to test after a standard interval has elapsed since taking the sample. (I have my samples taken in the hospital next door to the lab where they are going to be tested, but samples taken at my ordinary doctor's office get taken across the city to another lab when the nurse finishes work at the end of the morning.)

It would, I feel, be interesting to see what results someone got back it they took two samples at the same time and sent them to the lab with instructions to test one sample say one hour later and the other say five hours later. This would not have much effect on a sample where the difference came back as 12.05 or 12.03, but could surely seem significant for very tiny values such as 0.05 and 0.03.

I heard that PSA basically never goes away if you test to this degree of accuracy.
I don't want to get too off thread here but as I understand it the human body always makes very very small amounts of PSA to the extent that even women's bodies can make it. ("Wikipedia" reports a study by M. Zaviacic M. Slovak Academic Press, Bratislava 1999 called: "The human female prostate: From Vestigial Skene's Paraurethral Glands and Ducts to Woman's Functional Prostate" even found PSA and PAP (prostatic acid phosphatase ) in women's vaginal secretions! The oddest things turn up when you search the web for stuff about PSA!)

Alfred

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 2676
   Posted 3/26/2010 5:28 AM (GMT -6)   
All I said is my understanding of what I have read. for my sake if I am wrong,let me know for my sake. I dont know f I am right, I dont now if u are right, but I throw things out of my understanding. Is there a difereence tween systemic and matatazied. As I said in another post a lot is thrown out here, with out backup. I,m not an expert, help me where I am wrong. Please dont dismiss me and let me go down a wrong path and say oh well, he'll find out, the hard way. We are all in this together, lets help each other thru this jungle, Bless us all everyone!
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
8 week psa 0,0

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