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Posted 3/30/2008 9:09 AM (GMT -6)
I just got the results of my third PSA test, 6 months after my Sept. 07 Da Vinci surgery. First two readings (6 weeks post op and 3 mos post op) showed non-detectable PSA. This week it came in at .06. Now that's a very low level of PSA, to be sure, but it's the velocity of the increase that has me wondering what it all means. My doctor was out on Friday and so I've not been able to discuss the result or my questions with anyone. Have any of you had similar experience? Normal? Abnormal?
Posted 3/30/2008 10:41 AM (GMT -6)

Marty G

You didn't list your post surgical pathology report on your signature line.  As you can see by my line, I had postiive margins and my PSA did about the same as yours.  That's why I had additional therapy - the hormones I'm continuing today.  If you had negative margins and everything was "contained", it could just be a testing issue, and your doctor will just want you to have it retested.  Wait until you see your doctor and stay calm.

Age 57 at diagnosis,  PSA 4.7 (up from 3.2 one year ago)
Biopsy November 8, 2006 1 of 10 cores positive 5% LEFT Side Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology Stage T3a, Gleason 3+4, positive margins and capsular penetration RIGHT Side
Post Surgery PSA:  March 5:  0.01
5 month PSA, June 13, 2007:  0.08
Adjuvant therapy began June 26 with Zoladex injection
Radiation began August 23, ended October 8
First post radiation PSA, December 18, 2007:  0
 
 

Posted 3/30/2008 10:45 AM (GMT -6)

Hi Marty, Welcome to the board.

I would guess that you have been reading stuff on this board before now.   If you do a search, you will find that some small PSA variations are not uncommon.

My tests showed a small increase, but the doctor said that it probably was nothing. He will not react unless it shows a pattern of increase above .1

I'm sure others will give you the same advice. 

Good luck

biopsy 10/16/06
T2A,  PSA 4.7
Gleason  4+4=8  right side
DaVinci Surgery  1/16/07
Post op confirms gleason 4+4=8
no extension or invasion found
no continence problems
PSA 90 day -.01  , 6 month -.01 , 9 month +.02 , 1 year +.02
Ed problems continue
Caverject/viagra /discomfort
02/28/08  start Bi-Mix Rx
 

Posted 3/30/2008 12:39 PM (GMT -6)

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Posted 3/30/2008 12:39 PM (GMT -6)

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Posted 3/30/2008 12:49 PM (GMT -6)
Hi Marty,
Welcome to HealingWell. Some things are not clear about your experience and the members can better respond with more information about your experience. If you don't mind, go back to your control panel and update your signature with you surgical information. One thing that pops out to me is that you stated that your first test was undetectable but you do not use a number. For me <0.1 is undetectable using standard PSA assay test. If your first test was using that test then undetectable you still are. Because you are two decimal points out that second test was the ultrafine PSA assay. Thus it can detect a smaller number. But most oncologists consider <0.1 to be acceptable enough to call it undetectable. Your body has other ways of generating PSA, ie adrenal glands, etc. So yes, talk to your doctor. But he may just say you are fine. That we shall be Hopeful for. God Bless and welcome to the best site I could find on the 'net for patient to patient interaction...

Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator

Posted 3/30/2008 1:14 PM (GMT -6)

Ok, thanks for your help and kind replies guys. I've posted some of my vital stats. I'll update it with even more details when I have a minute to dig through my file.  

Age: 54
Diagnosed July 2007, age 53
Gleason 3+4
 
DaVinci, U of Chicago, Dr. Arieh Shalhav, Sept 27, 2007
Post Op Gleason 4+3
No evidence of tumor in margins, lymph nodes, or seminal vescicles. There was perinueral invasion and there was evidence of cancer cells in the fatty tissue surrounding the prostate, but no evidence it penetrated the fatty membrane.
 
PSA Nov. 07, less than 0.05 (non-detectable)
PSA Jan 08, less than 0.05 (non-detectable)
PSA March 27 08, 0.06
 

Posted 3/30/2008 2:14 PM (GMT -6)
Well, I was hopeful I had it. I am very sorry you have to wait until your doctor can reply your question. I too am a 4+3, and unfortunately I had a poor pathology. We will be using the ultrafine PSA and PAP tests on my next visit. BTW, My oncologist used to head the oncology department at UoC. A very strong facility, indeed. I hope you are just dealing with a fluctuation, but you do need to ask. There would be no harm in requesting another test. Why wait? If it is a valid increase, you need to monitor it closely. And probably start looking into adjuvant/salvage therapies. I have had that experience. Be well, and God Bless you. You have found some great support...

Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (1/08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator

Posted 4/1/2008 8:23 AM (GMT -6)
Marty G,

Just went through the same thing my PSA had been holding at .04 for way over a year after surgery. The last PSA came back at .07, which really floored me, simply because I was not expecting it. I finally got to see my Oncologist and he insist that I am overreacting and basically refuses to retest for 90 days. He is a great Doctor by reputation. He told me there are so many things that can cause a fluctuation in PSA and thats why he wanted 90 days to give any infection or current condition to subside. I strongly disagreed and made a emergency appointment with my PCP and got to see him yesterday. I explained I wanted to know immediately if my PSA was on the rise so I could begin treatment. To my dismay he agreed 100% with the Oncologist and also refused to retest.

While I still disagree, and think it is very easy for them to say I am worrying over nothing, they both have excellent reputations. Let me state that I am a VA patient, so I have no leverage over these guys and while I can refuse advice, I would then have to hire private doctors and not even a rich man could pay for the proceedures I have had done. It is going to be one of the longest 90 days of my life.

I sure hope you have a positive outcome and please let me know how its going.
Prostate Cancer, Removed by Da Vincie Robotic
in Aug. 2006 
Poorly Differentiated Adenocarcinoma involving Left and Right Lobes involving 80% of the Specimens
Gleason 4+4=8
Pathologic Stage T2C No Mx
Age at Diag. 51
1 year PSA .02
DES Stent Placement on 12/31/07

Posted 4/1/2008 8:35 AM (GMT -6)
Prostate cancer experts consider anything less than 0.1 as non-detectable (zero). I understand your anxiety about a possible rise in PSA necessitating treatment.

The the reason I opted for the regular PSA test, which is sensitive to the nearest 0.1 ng/mL, is because I did not want to be overly concerned with changes in values below 0.1. I'm happier not knowing and go with the expert opinion that less than 0.1 is not a cause for concern.

Age 59  PSA velocity quadrupled in 1 yr (0.6 to 2.6) 
1 of 12 biopsies positive (5%) 
Open surgery June 2006 
Cancer confined to one small area Gleason 5 
PSA's undetectable
 

Posted 4/1/2008 10:57 PM (GMT -6)
My 9 month test showed an increase from less than .01 to .02. I panicked, but my uro told me that fluctuations in this range are meaningless and in light of my post-op pathology, I had nothing to worry about. He won't test again until next September. Sounds to me like you have nothing to worry about, either.
Puget
60 years old
Dx March 2007
Pre-Surgery Gleason 3+3 = 6
Clinical Stage: T1c
Biopsy: 1 in 10 positive
Da Vinci: June 7, 2007 
Post-Surgery Gleason 3+3 = 6
   Clear at margins
First Post-PSA Sept 07 = <.01 (Hooray!!)
Second Post-PSA March 08 = 0.02

Posted 4/2/2008 4:13 PM (GMT -6)
Thanks for the feedback guys. GREAT NEWS! Retook the PSA test Tuesday, results today came in at less than 0.05, essentially undetectable again! That is where my two previous readings were, so we're thinking we had a lab error. Will test every 3 mos for the rest of the year to be sure, but as you can imagine I'm feeling very relieved.
Age: 54
Diagnosed July 2007, age 53
Gleason 3+4
 
DaVinci, U of Chicago, Dr. Arieh Shalhav, Sept 27, 2007
Post Op Gleason 4+3
No evidence of tumor in margins, lymph nodes, or seminal vescicles. There was perinueral invasion and there was evidence of cancer cells in the fatty tissue surrounding the prostate, but no evidence it penetrated the fatty membrane.
 
PSA Nov. 07, less than 0.05 (non-detectable)
PSA Jan 08, less than 0.05 (non-detectable)
PSA March 27 08, 0.06
 

Posted 4/2/2008 4:21 PM (GMT -6)
Good news, Marty!  Yes, labs do make errors, and the ultrasensitive is especially prone to test variation at low levels...Tim
Age 59  PSA velocity quadrupled in 1 yr (0.6 to 2.6) 
1 of 12 biopsies positive (5%) 
Open surgery June 2006 
Cancer confined to one small area Gleason 5 
PSA's undetectable
 

Posted 4/2/2008 6:10 PM (GMT -6)
Thanks Tim. By the way, you've got a great path report. Mine's not bad, but I'd take yours if I could choose.
Age: 54
Diagnosed July 2007, age 53
Gleason 3+4
 
DaVinci, U of Chicago, Dr. Arieh Shalhav, Sept 27, 2007
Post Op Gleason 4+3
No evidence of tumor in margins, lymph nodes, or seminal vescicles. There was perinueral invasion and there was evidence of cancer cells in the fatty tissue surrounding the prostate, but no evidence it penetrated the fatty membrane.
 
PSA Nov. 07, less than 0.05 (non-detectable)
PSA Jan 08, less than 0.05 (non-detectable)
PSA March 27 08, 0.06
 

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