Low level PSA after surgery

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opie
New Member


Date Joined Jul 2006
Total Posts : 18
   Posted 4/27/2007 8:32 AM (GMT -6)   
Thanks to everyone who posts here. I have been "lurking" here for the last year and a half. I've learned so much from all of you who are so willing to share.
Background: Husband diagnosed at 48. Radical prostatectomy in July 2005 at Mayo Clinic. Gleason 7. 5% left and 40% right involved. Negative surgical margins, lymph nodes and vesicles. 16 weeks of Casodex due to close proximity to urethra. DNA anaploid(sp.)Fully continent and just minor issues with e.d. Husband is in great shape, exercises, eats well, does have daily headaches, high stress job but a great support system if I do say so myself!
3 months PSA:<.01
6months :<.04
9months: <.04
15 months :.06 (new software)
18 months: .07
21 months:.07


We were advised that the low level PSA could be due to :
1. PSA is naturally occurring in the body
2.Could be from benign prostate cells left behind
3. Prostate cells beyond the surgical margins.

Are there any other explanations for the low level PSA? Any ideas on the probabilities of the above three scenarios?

Thanks so much for your help.

eglman
New Member


Date Joined Apr 2007
Total Posts : 5
   Posted 4/28/2007 1:12 PM (GMT -6)   
Opie,
I've had similar questions on PSA and posted them on another thread within this site. But the research I've been doing had dug this up:

I've discovered more information on post surgery PSA with regards to Nerve Sparing Surgery (NSS). I've read on other sites from patient posts and one medical publication that Nerve Sparing Surgery (which I had) results in slightly higher post surgery PSA values. As explained in these posts, this is due to prostate tissue that remains after surgery attached to the nerve bundle. My doctor also told me that PSA below 0.1 is "in the noise", meaning that the test is so ultra sensitive that other natural body functions influence the reading. Doctor explained that this is why below 0.1 is considered "undetectable". Only worry when there are several readings above PSA 0.1. Not sure I fully agree with the Doc on this (since some studies show the PSA trend below 0.1 is important), but that's what they told me at UCSD medical center.

My post surgery PSA: RP NSS; 3m 0.05, 6m 0.09, 6m + 1wk (waiting for retest results)


52, Biopsy 8/06, Stage T2b, PSA 7.2, Free PSA 17% Gleason 5 (3+2) [20% in 2/7 cores], negative DRE and bone scan. RP with DiVinci robot 10/06. Neg Margins, Neg Seminal invasion, Post Surgery Pathology Gleason 6 (3+3).

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 4/28/2007 8:41 PM (GMT -6)   

Hi ~ Opie,

 

Our welcome letter will follow but I wanted this posting to be under eglman's...  

 

Quote from Opie’s posting above:

3 months PSA:<.01
6months :<.04
9months: <.04
15 months :.06 (new software)
18 months: .07
21 months:.07

We were advised that the low level PSA could be due to :
1. PSA is naturally occurring in the body
2.Could be from benign prostate cells left behind
3. Prostate cells beyond the surgical margins.

Are there any other explanations for the low level PSA? Any ideas on the probabilities of the above three scenarios?

 

I found the answers for 1,2,3 in the books listed below.  In reference to low level PSA… as long as it’s undetectable… that’s what we are looking for.  The fluctuation stated above in the excerpt gives credence to this scenario.  And that’s the rule we will be following as we move forward in “Our Journey” after RRP. 

 

I had a hard time trying to understand the PSA results when reading some post…  So ~ I had Buddy sit down with me to give me a visual!!!  This is a personal view on the PSA information… The information I provide below is specific to “Our Journey ~ RRP” and our lab.  

I hope this helps you to understand a little more about your results.

 

Our lab uses <0.1 as their scale.  So when we got our 1st and 2nd call from the nurse she stated that our PSA was <0.1 undetectable  which ='s a Woo~Hoo!!

Many labs classify anything  <0.1 (10 pennies) as undetectable

 

Here’s a question that we would get answered by inquiring of the lab or your urologist.

What results do I have to be within to still be in the “undetectable” range with your testing procedure?

Based on the lab results I’ve received (2 different programs used) are they classified as being undetectable?

 

Here’s a scale that helped me to understand our scale with having Retropubic Radical Prostatectomy:

(green is in the undetectable range for our lab)

<0.01 (no pennies)

0.01 =     1 penny

0.06 =     6 pennies

0.07 =     7 pennies

0.09 =     9 pennies

0.1  =   10 pennies

At this point we would start monitoring.

0.11 =   11 pennies

0.12 =   12 pennies

0.20 =   20 pennies

0.50 =   50 pennies

1.6      =  160 pennies

2.0     =  200 pennies

2.5   =  250 pennies

 

* Excerpt: PSA Anxiety…  The Downside of Ultra-Sensitive Tests

            You’ve had the radical prostatectomy, but deep down, you’re terrified that it didn’t work.  So here you are, a grown man, living in fear of a simple blood test, scared to death that the PSA—an enzyme made only by prostate cells, but all of your prostate cells are supposed to be gone—will come back.  Six months ago, the number was 0.01.  This time, it was 0.02.

You have PSA anxiety.  You are not alone

This is the bane of the hypersensitive PSA test:  Sometimes, there is such a thing as too much information.  Daniel W. Chan, Ph.D., is professor of pathology, oncology, urology, and radiology, and director of Clinical Chemistry at Johns Hopkins.  He is also an internationally recognized authority on biochemical tumor markers such as PSA, and on immunoassay tests such as the PSA test.  This is some of what he has to say on the subject of PSA anxiety:

  The only thing that really matters, he says, is, “At what PSA levels does the concentration indicate that the patient has had a recurrence of cancer?”  For Chan, and the scientists and physicians at Hopkins, the number to take seriously is 0.2 nanogram/milliliter.  (20 pennies my italics)   “That’s something we call biochemical recurrence.  But even this doesn’t mean that a man has symptoms yet.  People need to understand that it might take months or even years before there is any clinical, physical evidence.” 

            On a technical level, in the laboratory, Chan trusts the sensitivity of assays down to 0.1, or slightly less that that.  “You cannot reliably detect such a small amount as 0.01,” he explains.  “From day to day, the results could vary—it could be 0.03, or maybe even 0.05”—and these “analytical” variations may not mean a thing.  “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.”

 

 

*Dr. Walsh’s Guide to Surviving Prostate Cancer (2001)

Chapter 10 How Successful is Treatment?

Within this chapter there are many questions answered.

What Should I Do if My PSA Comes Back after Surgery?

Cancer Control after Radiation Therapy

What Happens if PSA Comes Back Again, or If I have Distant Metastases?

 

 

Dr. Peter Scardino’s Prostate Book (2006)

Chapter 20  Rising PSA after Surgery or Radiation Therapy

Read this chapter to learn:

Why do some prostate cancers recur?

Does a rising PSA always mean cancer?

What can be done about a rising PSA after surgery or radiation?

 

Our thoughts are with you both…as you continue to move forward in your journey.  It sounds like you’ve got a great support group!!  Thanks for allowing us to walk with you.

In Friendship ~ Lee & Buddy


mama bluebird - Lee & Buddy… from North Carolina

 

v          We invite you to visit our personal thread:  Click Here:  “Our Journey” ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

4th PSA 2-13-2008 (23 months) Less than 0.1 Non-Detectable :)

Post Edited (bluebird) : 3/4/2008 7:31:43 PM (GMT-7)


stkitt
Forum Moderator


Date Joined Apr 2007
Total Posts : 32602
   Posted 4/28/2007 9:48 PM (GMT -6)   

Hello Opie,

Welcome to Healing Well and I am Kitt.

All three of the scenarios you posted may be right.

Since PSA is produced by both normal and cancer cells in the prostate, if all prostate cells have been removed at the operation, then the level of PSA ought to fall to almost zero, or less than 0.1 ng/ml. The time taken for the PSA to drop to this level after surgery depends on how high it was before the operation; however, in most cases, it should be undetectable at 3 months after surgery.

Most surgeons recommend measuring the PSA once every 3 - 4 months after surgery for the first 2 years and then 4 - 6 monthly for 2 - 5 years. After this, the risk of the cancer returning is small. Annual testing is then recommended. Your doctor may suggest a different testing program, however. It very much depends on the nature of your cancer.

Keep posting, we are here to support you.  Again Welcome. :-)


 
Respectfully
 
Kitt
 
Depression 25 years, Husband Crohns Disease 30 years
__________________________________________________ 
"If you doubt you can accomplish something, then you can’t accomplish it. You have to have confidence in your ability, and then be tough enough to follow through.”
Rosalyn Carter
 


opie
New Member


Date Joined Jul 2006
Total Posts : 18
   Posted 5/9/2007 5:33 PM (GMT -6)   
Thanks so much to those of you who posted replies. Kitt, eglman, and mama bluebird, I appreciate your help in answering my questions regarding a low level. but rising PSA following surgery. Your explanations made a lot of sense and brought us some peace of mind. My husband likes to know "why" and your posts made a lot of sense. Thank you. Bluebird, thank you for your analogies and I am waiting for a hug! Sorry it took me so long to reply. We've got graduations, a 15 year old with a torn ACL scheduled for surgery next week(8 months after her 18 year old brother had his ACL surgery)and just everyday "stuff".

On another topic, I came across the Ted Koppel and Discovery Channel program, Living With Cancer the other night. I thought it was a great program and provided me more insight as to how cancer can continue to affect a person even after "successful treatment". It can and does stay with you. In good and in not so good ways.
Thanks again. This is a great site.
Opie



Husband 48 at diagnosis. RRP on July 29, 2005. Gleason 7.
16 weeks of Casodex.
PSA:
3 m. <.01
6m. <.04
9 m. <.04
15 m. <.06
18 m. <.07
21 m. <.07

bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 6/7/2007 6:36 PM (GMT -6)   

Hi ~ Opie & Loved Ones

 

Caring Enough to Share….. 

 

     A   “Special”  Warm Welcome  to  You!   yeah   

 

This is truly a great forum!!! ~ “You” have joined! You are now part of our forum family ~ a group of wonderful individuals who are so willing to share their journey. 

Thank you for joining all of us on this road to HealingWell…..

 

KNOWLEDGE IS POWER... and POWER conquers fear

 

Keeping you Extra Close in our thoughts and prayers.

In New…Friendship ~ Lee & Buddy

 

“God Bless You” 

It's a little prayer  ~  "God Bless You"  ...but it means so much each day,

It means may angels guard you and guide you on your  way

 

(Direct Link ~ just click on the title below and a new window will open!  

Reminder … click on the REFRESH icon once you get there)

Helpful Hints ~ & ~ Direct Links to Important Topic Threads ~ Hope this helps you!! :)

 


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 6/7/2007 6:44 PM (GMT -6)   

Hey ~ Opie,

 

As they say ~ better late than never!!!  I’m even longer than you!!! responding sad eeekkkk!!!

I can just imagine your schedule!!!  I’m just happy our information was helpful to you.

Hope things went well with the ACL surgery.

 

smurf  This  “Hugs”  for  you!!!   tongue   

 

In Friendship ~ Lee & Buddy

 

P.S. Hope you continue to stay with us!!!

 


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 7/31/2007 5:45 PM (GMT -6)   

Quote from 2nd thread titled No Subject re-names Opie's Update (deleted and moved here)

Hi Gang:
Trying not to worry too much. Husband's latest PSA has gone up again slightly. Went from .07 to .11. Doc says not to worry yet but easier said than done!
Opie

Husband 48 at diagnosis. RRP on July 29, 2005. Gleason 7.
16 weeks of Casodex.
PSA:
3 m. <.01
6m. <.04
9 m. <.04
15 m. .06
18 m. .07
21 m. .07
24 m. .11

 

 

Hi ~ Opie,

 

I’ve placed your information from your 2nd thread here ~ so it stays together.

This way we can continue to walk with you as you both continue to move forward.

I’m so glad you’ve reached out again ~ we will “all”ways be here for you!!  Even if you just need to talk it through.

 

Worry ~ oh yes… it’s part of the process… but it truly doesn’t get us anywhere and it drains us of any positive energy!!!  That’s where knowing what’s next is the best way to “relieve” the fear…  Knowledge is Power. 

What number did your doctor say it would have to reach before he would move to the next step in treatment??

 

Continue to hold on to all of us ~ Okay!!

Keeping you close in thoughts and prayers.

In Friendship ~ Lee & Buddy

Post Edited (bluebird) : 9/30/2007 8:48:45 PM (GMT-6)


myman
Veteran Member


Date Joined Feb 2007
Total Posts : 862
   Posted 7/31/2007 7:13 PM (GMT -6)   
Hi Opie,

Well, you're scared. I've been there and probably will be again...it's a completely normal place for you to be right now.

"What number did your doctor say it would have to reach before he would move to the next step in treatment??" (Bluebird's words) If he didn't discuss this with you call him and ask.

When you can look ahead a little bit and check what some of your options are, that may help you. My husband doesn't do that but I have to, you know?

For me, knowing sheds some light and lessens the fear.

I did watch the program you mentioned and agree with you...it was good. As you could see there are other things that factor into a person's outcome. Their outlook on life, faith, people around who love them, good medical care, etc. That says to me it's more than numbers or statistics. I hold onto that and hope you can, too.

Please come here to talk and ask questions (we have a bunch of smarties here) because in doing so you help us also.

All the best to you both,
Susan
Husband Diagnosed 11/17/05 Age: 63 No Symptoms
PSA: 7.96, Positive DRE
Biopsy Right: 6 of 6 Cores Positive Biopsy Left: 1 of 6 Cores Positive
Gleason: 4+3 = 7 Stage: T2B N0 MX
3 mo. PSA Post Surgery: 11.8, 12.9, 13.9 Bone scan, CT scan, Endorectal MRI, Chest XR - neg.
9/06/06: 6 mo. PSA: 18.8 Distant lymph node involvement Start HT Lupron 3 mo. shots
12/06/06: PSA 0.8
03/07/07: PSA 0.3
06/06/07: PSA 0.1


opie
New Member


Date Joined Jul 2006
Total Posts : 18
   Posted 8/1/2007 2:51 PM (GMT -6)   
Thank you for your kind words Susan and Bluebird.
Susan, you are absolutely right when you mention factors such as faith, positive surroundings, and life outlook. I had shared with a friend whose husband was recently diagnosed at 45 with colon cancer, that there are blessings to be found amongst a cancer diagnosis, if you but look for them. I do have a heart full of gratitude for everyone who has taken the time to listen, offer words of encouragement, share their stories and their knowledge. We are blessed with the gifts of faith, family, friends, insurance(!), and living at this time and place.
Thank you again,
Opie

AEG
Regular Member


Date Joined Nov 2005
Total Posts : 154
   Posted 8/3/2007 12:05 AM (GMT -6)   
Hi Opie,

I just wanted to send you a prayer that your husband should be well and that his psa should drop with the next reading. I feel for what you're going through.
Please keep us posted.

Best of luck to you.

A.
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