% free psa after prostetectomy

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Jmon
Regular Member


Date Joined Feb 2006
Total Posts : 82
   Posted 6/5/2008 10:32 AM (GMT -6)   
I've been searching for information regarding the significance (if any) of % FREE psa after radical prostatectomy. Can't seem to find any info. Anybody here know anything about this?
 
BTW I am 33 months out from DaVinci at City of Hope. Pre-op psa was 4.0, gleason 3+4. All went well except for a + margin. No continece or ED issues. Post-op psa's have all been <0.1. Most recently I had a more sensitive test and results came back at psa <0.03 tongue and free psa 45%. I know that free psa has diagnostic value prior to treatment, just curious as to whether it is indicative of anything after. Thanks in advance for your input.

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 6/5/2008 10:07 PM (GMT -6)   
Hey Jmon, welcome to the forum,
I think it is usually accepted that the devices that measure PSA are inaccurate at very low levels. This is why oncologists are usually not particularly interested in a figure under 0.1 and why often a lab report simply states as <0.1 undetectable.
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 <0.1 undetectable


Jmon
Regular Member


Date Joined Feb 2006
Total Posts : 82
   Posted 6/7/2008 11:13 AM (GMT -6)   

Salty_clark
Regular Member


Date Joined Apr 2008
Total Posts : 95
   Posted 6/7/2008 11:37 AM (GMT -6)   
I would like to read the responses to jmon's question about the significance of free PSA after an RP...anyone know the answer? or does anyone have a cited article or study regarding this subject?  I know free PSA is available in the blood but what does the free PSA percentage show in the case of a man who has undergone an RP.  Should it be a very low percentage figure or what...I don't know...anyone out there know...
Age 75 at DX 76 on 9 May 08
DRE positive with nodule 15 Jan 08
PSA 3.8 18 Jan 08
Biopsy 11 Mar 08 Gleason 8 (4+4) on the right 3 out of 12 positive <5%. Gleason 7 (4+3) on the left 1 out of 11 positive <5%.
Bone scan and CT scan Negative 12 Mar 08
Robot Assisted da Vinci prostectomy with Dr Fagin in Austin scheduled for 30 April 08.
- - - - - - - -
da Vinci successfully completed by Dr Fagin as scheduled.
Path Report:
Gleason downgraded to 3+4=7
Tumors confined to the prostate.
Bilateral tumor on right side 5 of 10 levels and on left side tumor present in 9 of 10 levels.
Margins Negative.
Extraprostatic Extension Negative
Seminal Vesicle Invasion Negative
Stage pT2c
As far as it goes between you, me and the fence post I am cured. But I am required to keep an eye out for the PSA due  toward the end of June.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/7/2008 1:07 PM (GMT -6)   
Hi jmon,
I can't find much on this either. In fact I did not even have a fre PSA test by CoH. Which doctor did you use? (I used Wilson).

Everything PSA I see used after is doubling time (DT). I don't think free PSA has a pronostic value after RP.

Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
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 (May 9 '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


smilingoldcoot
Regular Member


Date Joined Jan 2008
Total Posts : 338
   Posted 6/7/2008 1:16 PM (GMT -6)   
I found this, not sure it will answer your question.
 
http://www.prostate-cancer.org/education/preclin/McDermed_Using_PSA_Intelligently2.html
Retired USAF Richard & Debbie on The Shores of Toledo Bend Lake Louisiana
Biospy 1/10/08 Gleason 10, Stage T1C  8 of 12 samples positive all Less Than 5% 
U of Florida Proton Therapy Institute
5/2/2008 LUPRON & Casodex
IMRT to start 5/16/2008 for approx 4 weeks with Proton to follow for approx 4 weeks
Turn Stumbling Blocks into Steping Stones and Keep Smiling
Our Journey is on WWW.GLEASON10.COM
 


Salty_clark
Regular Member


Date Joined Apr 2008
Total Posts : 95
   Posted 6/7/2008 11:11 PM (GMT -6)   
Jmon....Only thing I could find was the following:
http://linkinghub.elsevier.com/retrieve/pii/S0022534705652871

which indicates that free PSA hasn't any significance regarding prediction of recurrent cancer. I wonder why doctors want a free PSA done anyway. I just got a prescription from my doctors office regarding my upcoming PSA test on 24 June and they ask for "free and total PSA." Its puzzling to say the least.
 

Age 75 at DX 76 on 9 May 08
DRE positive with nodule 15 Jan 08
PSA 3.8 18 Jan 08
Biopsy 11 Mar 08 Gleason 8 (4+4) on the right 3 out of 12 positive <5%. Gleason 7 (4+3) on the left 1 out of 11 positive <5%.
Bone scan and CT scan Negative 12 Mar 08
Robot Assisted da Vinci prostectomy with Dr Fagin in Austin scheduled for 30 April 08.
- - - - - - - -
da Vinci successfully completed by Dr Fagin as scheduled.
Path Report:
Gleason downgraded to 3+4=7
Tumors confined to the prostate.
Bilateral tumor on right side 5 of 10 levels and on left side tumor present in 9 of 10 levels.
Margins Negative.
Extraprostatic Extension Negative
Seminal Vesicle Invasion Negative
Stage pT2c
As far as it goes between you, me and the fence post I am cured. But I am required to keep an eye out for the PSA due  toward the end of June.

 

Modified by TC-LasVegas

Above Link Activated

Post Edited By Moderator (TC-LasVegas) : 6/8/2008 3:37:49 PM (GMT-6)


Jmon
Regular Member


Date Joined Feb 2006
Total Posts : 82
   Posted 6/8/2008 10:41 AM (GMT -6)   
Thanks for the responses. TC, my doc was Kawachi but after the initial post-op catheter out/pathology report I haven't been back. I live in Orange County so use my local gp for psa tests.
 
Since my op in '05 all of the psa tests I had gotten were not ultra-sensetive and all came back <0.1. Recently I was at another doc trying to make a plan to get my hereditary cholesterol under control and mentioned that I was due for a psa test so he threw it in with the other blood work he was requesting. Unbeknown to me it was a 2nd generation test which is sensitive down to 0.03. My results came back at <0.03 and <0.01 free psa. Needless to say I was very happy. I'm coming up on my 3 year operation anniversary in which I had positive margins. I asked Kawachi about adjuvant radiation and he said, "I wouldn't. Just go home and live your life and keep an eye on your psa." All this time I have been thinking I should be getting ultra sensitive tests in case there was a trend upward. But on the other hand I was going with "ignorance is bliss", all the while sweating that one of my tests would pop up over 0.1. So when this latest 2nd gen test got dropped on me by surprise it was like 3 years of concern just melted away.
 
Anyway back to my original question. That last test included free psa and I can't seem to find anything about the significance of post-op free psa. I've read the article you forwarded TC. It doesn't really answer the question.
 
Salty, I can't seem to open the link you sent but I'll try another way around.
 
Anyway thanks for the responses and good luck to us all as we battle this nasty b**tard.

Salty_clark
Regular Member


Date Joined Apr 2008
Total Posts : 95
   Posted 6/8/2008 3:33 PM (GMT -6)   
Sorry you couldn't open the article jmon...I just reopened it using cut and paste.
Great numbers you got on your PSA, free and total. I guess the lower the percentage in both free and total is the desired goal and you seemed to have hit it....very good.
Age 75 at DX 76 on 9 May 08
DRE positive with nodule 15 Jan 08
PSA 3.8 18 Jan 08
Biopsy 11 Mar 08 Gleason 8 (4+4) on the right 3 out of 12 positive <5%. Gleason 7 (4+3) on the left 1 out of 11 positive <5%.
Bone scan and CT scan Negative 12 Mar 08
Robot Assisted da Vinci prostectomy with Dr Fagin in Austin scheduled for 30 April 08.
- - - - - - - -
da Vinci successfully completed by Dr Fagin as scheduled.
Path Report:
Gleason downgraded to 3+4=7
Tumors confined to the prostate.
Bilateral tumor on right side 5 of 10 levels and on left side tumor present in 9 of 10 levels.
Margins Negative.
Extraprostatic Extension Negative
Seminal Vesicle Invasion Negative
Stage pT2c
As far as it goes between you, me and the fence post I am cured. But I am required to keep an eye out for the PSA due  toward the end of June.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/8/2008 3:39 PM (GMT -6)   
Jmon,
OC is my old stomping grounds. I graduated from Esparanza High School. I'm down there alot...

Salty,
I modified your post to activate your web link. Hope you don't mind.

Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
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 (May 9 '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


Jmon
Regular Member


Date Joined Feb 2006
Total Posts : 82
   Posted 6/9/2008 10:41 AM (GMT -6)   
Thanks Tony,

Yeah, I've lived here in Newport Beach and Irvine since I graduated from Cal Poly SLO in '75. Currently living in Irvine, office in Newport Center. Wife is a Cal High girl.

Salty, I was able to open your link. Sounds like the free psa % is of little to no import after the prostate is gone. I'll just be happy for the numbers I have and move on.

Shoot me an email if you're gonna be in town and I'll buy you a drink.

Keep up the fight.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/9/2008 11:08 AM (GMT -6)   
Will do,
But you'll have to shoot me one first. Your EM is disabled.

Tony
Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
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 (May 9 '08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
And at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator

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