Interpreting Post-Op PSA...

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Kark60
Regular Member


Date Joined Jun 2008
Total Posts : 91
   Posted 6/30/2008 9:50 AM (GMT -6)   
I had RRP on May 28 and the blood draw for my "four-week" PSA last Wednesday. Today, the nurse told me over the phone the score was "0.1" and that it was "good."

Given others' experiences, will I have another PSA at six weeks to see if the number is decreasing? What other things should I be aware of (or ask the doctor about) with a verbal report of a 0.1 at four-weeks post-surgery. Any help or insight is appreciated. Thanks...
Husband and father of two (current ages 4 and 6).
Age when diagnosed: 47 (current)
Biopsy showed cancer only on left side.
Pre-surgery PSA: 13.7
Pre-surgery Gleason: 4+3=7
Pre-surgery Staging: T2
CT Scan, Bone Scan, PET Scan: Clear
Robotic Surgery on May 28, 2008, at Barnes Hospital in St. Louis.
Right nerve bundle spared; left bundle removed.
Catheter for 8 days with infrequent "stress" leaking since. Now use one or two pads during the day and none at night.
POST-SURGERY PATH REPORT:
Gleason: 4+3=7
some perineural invasion noted.
no lymph node involvement.
margins clear.


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 6/30/2008 10:30 AM (GMT -6)   
i had a psa at 4 weeks and then 6 weeks. next one is at the 3 month mark. there have been a lot of threads about when should you have your first psa. some say 3 months. they say you may have some residual psa left in your system after a month. my psa was the same at 1 month and 6 weeks.

did your doctor schedule another follow-up for your next psa test? if not, you may want to call and schedule and see when he wants to see you again.
 
Age 48
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
decision - surgery (robotic)
surgery may 9, 2008 - houston, tx
pathology report -gleason 8
margins clear
4 week and 6 week PSA .04 (undetectible)
continence ok during day - 1 pad
night time different story
kegel's twice a day 20 reps


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 6/30/2008 6:09 PM (GMT -6)   
Kark, my husband has RALP in March 2008. First PSA was 4 weeks post op and it was 0.1. Urogologist said the next one (8 weeks post op) would be zero ... and he was dead on. A PSA of 0.1 4 weeks after surgery is very good news...congratulations. I am sure that your next PSA will be one big goose egg!

DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 6/30/2008 7:56 PM (GMT -6)   

kark,

the number to look for depends upon the equipment used.

some go no lower than 0.1, others go to 0.04, etc.......


Danman Bob, Born 1951
Nerve-sparing, open prostate surgery November 13, 2007
Gleason score 9, PSA 14; Biopsy result - 9 of 12 sticks showed cancer
Post-op pathology stated that cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (fraction of a pad a day as of late April 2008)
100 MG Viagra 3 times a week beginning December 2007
Osbon Erec-Aid Esteem manual pump for therapy beginning mid-February 2008
30 MG papaverine/1 MG phentolamine bimix injections beginning late April 2008
Five week post-op PSA 0.2, five month post-op PSA 0.1, next test August 2008


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 6/30/2008 11:13 PM (GMT -6)   
Kark,
First thing is to make sure you get a written PSA result as well as the full pathology report following your surgery and keep your own records. As DanmanBob said there are different analyzing machines with differing sensitivities used to determine PSA:
Generation 1 gives a figure to 1 decimal place ........... i.e. 0.1
Generation 2 gives a figure to 2 decimal places...........i.e. 0.01
Generation 3 gives a figure to 3 decimal places.......... i.e. 0.001
but these figures in Gen 3 can be pretty inaccurate at such very low levels so usually urologists and oncologists are only interested in a result that says PSA is undetectable .........i.e. <0.1 (undetectable)
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


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 6/30/2008 11:27 PM (GMT -6)   
Hi Kark60,
 
Typically a nurse can only pass on the diagnosis from the doctor.  When the nurse says "good," I expect that is what the doctor is passing on through the nurse to you.
 
In addition, as others have said, there are two other factors in your case (1) you're only 4 weeks out of surgery and (2) we don't know the sensitivity of the tests that your doctor uses.  Many doctors wait 6-8 weeks for the first PSA and also say, "don't worry about the first one," since your PSA level in the blood may not have stabilized.
 
I truly believe you're just fine right now.  Also you have all the license in the world to call back and ask the nurse to pass questions on to the doctor if you are concerned.  You are in the driver's seat.  Get the answers you want from your health care professionals.
 
All the best,


Barry ~ (a.k.a. "Idaho") - Prostate Cancer Forum Moderator

 

Da Vinci Surgery July 31, 2007… 54 on surgery day
PSA 4.3  Gleason 3+3=6  T2a  Confined to Prostate

1st PSA  09/11/2007  <0.04 (undetectable)

2nd PSA 12/10/2007  <0.04

3rd PSA  03/17/2008  <0.04

4th PSA  06/17/2008  <0.04

My web site: http://pca-info.blogspot.com


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 7/1/2008 8:36 AM (GMT -6)   
At surgery, my psa was 6.7.  I had a regular doctors visit and blood work 2 weeks later and the psa was down to .8.  4 weeks later, at the urologist it was .04, where it has remained for another test at 6 months.

James C.
Co-Moderator- Prostate Cancer Forum

Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
10/15/07 ED- begin 50mg Viagra and Vacurect pump nightly, Fully continent
1/14/08 Caverject started/stopped, aching. 2/24/08 .5ml Bimix started-success
5/7/08 ED- Viagra, pump, no response- Trimix .075ml continues
Post Surgery PSA's:  3 mts-0, 6 mts.-0


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/1/2008 11:13 AM (GMT -6)   

Kark,
Below is my PSA history.  I am an interesting case that after the initial PSA test, have never had a climb in PSA.  But I do have advanced disease so we did a lot of testing right after surgery.  I believe my PSA histogram pretty well shows how the PSA drops after surgery. yeah

My PSA History

October 3, 2006 19.8

October 10, 2006 18.9

November 27, 2006 13.9

Surgery February 16, 2007

February 28, 2007 0.9

March 12, 2007 0.1

March 23, 2007 <0.1

May 16, 2007 <0.1

July 18, 2007 <0.1

September 19, 2007 <0.1

January 29, 2008 <0.1

May 9, 2008 <0.1

 

Tony


Age 46 (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


Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 7/2/2008 8:10 PM (GMT -6)   
Just to echo what has been said already.
 
I had a six week PSA and now a 4 month.  My first was local community Generation 1 test 0.1 accuracy. University Doc wants only Generation II testing 0.05 and took the 4 month at the Big Hosp.
 
I have heard on this site many times that the 4 or six week is not done by all Docs because of residual levels.  Those like my Doc want to see how fast it goes down for gauging and such.  I think they like to see how it goes down.  I am not a Doc but 0.1 dont sound bad.
 
I had a a bad margin and seeing it go undetectable in six weeks is evidence that there was no gross cancer left behind.
 
All the best,
 
Frank
Diagnosed 01-08-08 @ 53 years old 
DRE normal - High PSA for 5 or more years
2004 Biospy negative - 2008 Biopsy positive (01-08-08)
10 cores, 1 positive and at 1% of that one core
Current PSA 6 - Bone and Ct scans negative
clinicalg Staged at T1C - Gleason 3+3 = 6
Robotic Da Vinci performed March 27th, 2008
University of Chicago,5 hour surgery , 3 hour recovery
Unexpected Cardiac issues appear and disappear?
Hospital stay 30 hours - Catheter out in 7 days  normaly expected leakage - Erectile funtion back on line 9 days 
Post Pathology T2C, Gleason 7, 10 % of both portions of prostate, Seminal vessels clear, fat tissue clear,Tumor on top of prostate distal from apex. 1 positve margin at urethra and bladder.
Six week PSA < 0.05 Ya Ba Da Ba Dooooooooooo.  Put a steak on the grill Wilma!!!!
Oncologist to discuss case with Urologist and Radiation Oncologist to consider radiation.
 

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