Not sure ? PSA bounce?

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creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 10/15/2008 6:47 PM (GMT -6)   
Hi Everyone,
 
I thought I may as well try to get my mind settled by asking a few questions here.
 
As you can see from our signature, my husband's PSA (18 months) was due now - it came back now as 0.03. I know there can be a "bounce" at this time, and I have read (and contributed) to the posts about ultra-sensitive testing. We all have different views of the post surgery reporting of <.1 and how far it should be reported back to etc, so I understand it varies. But we have only ever had the ultrasensitive test reporting to 2 decimal places, so just work with that from 0.01 onwards...  
 
However, I have today written urgently to the nurse who I met 2 years ago when my husband was looking for a specialist (She works for the Surgeon) , asking for an immediate appointment by email now;  and my husband is down getting a referral from family doctor (GP) now,  as 6 months ago the PSA was 0.02. I hope we don't get brushed off or have to wait months for an appointment...
 
Anyway, what do you think? Is there any need to worry as much as I am worrying now?
Thanks for all veterans (and others) for your wisdom in commenting on this one. I am worrying to the max.. (maximum, that is..)  Thanks to you all once again. Lana
 
PS.  Just to repeat question:  Is a rise from 0.01 - 0.03 post surgery in 18 months a rise or a bounce or bad in any way????????? or signify the need for adjunct treatment?
Any thoughts or experiences appreciated by us.


Creed_three
 
Husband 50 yrs (49 years at diagnosis)
PSA (2002) 2.1.  PSA (2006) 3.5.  1 x (5%) core of 12 positive at biopsy. 11 cores negative. Open Radical Prostatectomy with nerve sparing April 2007. Gleeson 3 + 4 = 7.   Undetectable PSA since Surgery (< 0.1) specifically,  
June 2007: 0.01; Oct 2007: 0.02; April 2008: 0.02: October 2008: 0.03.
 

Post Edited (creed_three) : 10/17/2008 1:56:21 AM (GMT-6)


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 10/15/2008 7:05 PM (GMT -6)   
From my experience most urologists consider recurrence at .2, the fact that went from .01 to point .03 in 18 months would probably be considered a bounce. I think most doctors would monitor the PSA over the course of 3 or 4 months before jumping to conclusions. I certainly understand your concern and hope you do get medical advice as I am sure not a pro.
Please keep us posted as to what you find out.

peace and love
Dale
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
cancer in 4 of 6 cores
92%
80%
37%
28%
 


56pontiac
Regular Member


Date Joined Sep 2006
Total Posts : 234
   Posted 10/15/2008 7:30 PM (GMT -6)   
I just noticed your PSA numbers for 18 months are the same as mine were for that period and at 24 months I got 0.04. Anyway, stay cool try not to stress to much about it.
I hate what this disease does to our minds if we let it, and that we seem to get scared and anxious over these ultra sensitive test numbers. My doctor said anything under 0.10 he could care less about and not to even worry until that happens, as there are plenty of options at that point if it happens. It has been two years for me since surgery 10/12/06 and the PSA after surgery was 0.01 and then each three months it was 0.02 then 0.03 and now two years later it's 0.04. I know it's hard to not get stressed over these numbers, I sure have. It makes me not enjoy the gift of life and the blessings I have right now. I am not going to let these numbers waste my time on thinking of what horrible fate can await me and play mental what if? I am going to enjoy and live my life the best I can today.
Age 57 Diagnosed PSA 4.4
Davinci 10/12/08
Stage T1 Supposed to been ok, cancer only in the prostate so they said. Here is nice article that helped ease my mind. Enjoy your life now, don't save it for tomorrow, now is the time! God Bless You my friend.
http://www.phoenix5.org/Basics/psaPostSurgery.html

Post Edited (56pontiac) : 10/15/2008 6:36:10 PM (GMT-6)


dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 150
   Posted 10/15/2008 8:05 PM (GMT -6)   
Hi,
From what I understand You get a "bounce" after Radiation Therapy and not surgery. I wouldn't worry to much about it anyway until it reaches 0.1 which is where I am now. Your Dr. will probably continue to monitor until that point and chances are it will never reach that! That is what we will be pulling for anyway. I know all this is un-nerving because I am there now. Just stay on this site and you will get good info and compassion. Good luck!

David
Age 53
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.....


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 10/15/2008 9:52 PM (GMT -6)   
Just my opinion.....a move from .01 to .03 at 18 months would basically be just "noise" in my book. Keep getting tested as your doc recommends, but PSA can move around for no good reason. I wouldn't want to jump in and treat ANY movement in PSA before it hit .2. (Different shools of thought use a different number, but I've nenver heard a number at .03, especially with a clean path report). I kind of like the older tests post treatment that say anything under .1 is undetectable.

To answer your question, yes, you are worring too much --- you guys caught this way early, there wasn't much cancer there to begin with, your husband had successful nerve-sparing surgery, and the post-op tests have given you very good numbers. Count your blessings, chill out, and don't worry about the little movements that may or may NOT mean a thing at this point. If you have a problem down the road, they'll be plenty of time to worry and seek treatment later.

Drinving yourself nuts over little movements like that don't cure cancer --- I tried that, and it didn't work!
Sterd82
Age 47 - pre-surgery PSA 39
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
Next PSA November of 2008


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2365
   Posted 10/15/2008 10:03 PM (GMT -6)   
Given your history and good pathology report, this is doubtless just 'background noise'.

As I've posted here before, I opted for the standard PSA test in which anything less than 0.1 ng/mL (that's  100 trillionth of a gram of PSA) is below the radar. I live happier and sleep more contentedly as a result.


Age 59  PSA quadrupled in 1 yr (0.6 to 2.5) 
DRE neg  1 of 12 biopsies pos (< 5%) 
Open surgery June 06 Organ confined pT2a  Gleason 5   
Cancer-free for 2 years  PSA's undetectable  

Post Edited (TimG) : 10/16/2008 7:06:31 AM (GMT-6)


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 10/15/2008 10:04 PM (GMT -6)   
I agree. There may be some noise, lab error, a different assay being used, small amount of tissue in the prostate bed, the cowper's gland. There are other reasons for small increases following surgery that turn out to be nothing. Watching for a tend is always a wise move though. We'll hope for that! PSA bounces occur with radiation.

Swim
 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 10/15/2008 10:30 PM (GMT -6)   
Hey Creed_three, how you doing.
Terry Herbert has an excellent article on ultrasensitive testing on yananow and outlines all the pitfalls of reading too much into the very small changes that can occur. The technician doing the test, even air temperature and a myriad of other little things can affect such microscopic values. Although it's hard, (and don't I know it) take such a tiny variation with a grain of salt and just watch for a clear and consistant upward climb over a period of time before starting to think that something is going on. I have included a link to the article..........it should help to put you at a little more ease.
Bill

www.yananow.net/UltraPSA.htm
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)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/16/2008 11:47 AM (GMT -6)   

Hi Lana and CJ,

A watchful eye is what's needed here.  I echo the sentiments that say a variation as slight as this is is not enough to take action.  But a continued rise will be.  So keep a good eye on it.

I hope you guys are doing well, though.  I always read your posts and love hearing from our upside down friends. smilewinkgrin .

 

Stay well, and you know what else I will say ~ stay positive!

 

Tony


creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 10/16/2008 11:58 AM (GMT -6)   

Thanks everyone for your responses. Have read about the background "noise" and other articles and appointment scheduled next Monday to discuss results with family doctor - that's a start.

Chas, just to answer your question - in the middle of the week was in touch with someone I had not seen for 30 years (school friend). She informed me her husband and family were right on top of PSA testing and regular monitoring,  as her father-in-law had prostate cancer when he was 60 (and surgery). He is now 85 yrs old,  and still cancer-free in good health - that is 25 years of on-going recovery... credible source - some good news that 25 years is more than possible for some.

Thanks again for your reassurance everyone. Fingers crossed. I think for peace of mind we will assess the testing lab after discussion with doctor, as per Billymac's  info this week to get more info, and wait and see of course. cheers & all the best once again.


Creed_three
 
Husband 50 yrs (49 years at diagnosis)
PSA (2002) 2.1.  PSA (2006) 3.5.  1 x (5%) core of 12 positive at biopsy. 11 cores negative. Open Radical Prostatectomy with nerve sparing April 2007. Gleeson 3 + 4 = 7.   Undetectable PSA since Surgery. 
June 2007: 0.01; Oct 2007: 0.02; April 2008:0.02.
 


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 10/16/2008 1:09 PM (GMT -6)   
Hi guys! Always great to see your posts! Lana-You have always been so positive and such a source of comfort for so many! I wanted to let you know that I understand your concern, not because there is necessarily need for concern, but because as victims of this disease, we are ALWAYS going to be concerned for our loved ones. So, I hope the most recent PSA is just noise and that the next PSAs will be undetectable where they belong. Keep the faith and we will keep pulling for you both! Love to you and your family!
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 10/17/2008 2:09 AM (GMT -6)   

Chayna (Doting), Thanks for your kind words - sometimes I feel I am a bit of an intruder the way I forget that this disease is not "mine" to own. Anyway my aim next year is to teach hubby email and computer - that's a certainty. He is the one that really should be here - at least more often than myself maybe? Thanks again everyone for your advice - Glad to hear Doting, that your dad is good, little one is good, and life is good for you in general!

Feeling better today. I suppose in time, one gets use to seeing these tests in perspective. I have had this above conversation before (twice!) with Swim (another forum member), so I guess sometimes reassurance is all that is needed again (for us, over and over again it seems!!).

Once we have discussed this last PSA result with the medical officer on Monday,  I think we will be able to celebrate, as I am sure part of my problem (not husbands) is that the doctor is new (and I have not met her), reporting formats are not written (referral history) correctly (of that I am absolutely sure, but it could be easily corrected), and I am a nurse (as well as a wife),  so all this "bugs" me when I just want everyone to do it perfectly, and then we would not have to ask... anyway enough...

To end with some good news. Recent return of full pre-surgery potency without medication (at exactly 18 months) - slow and sporadic until then, with oral medications (not injections) from 4 months (his choice).  Lots of disapointments in the 18 months. Wonderered about it often, but then quite suddenly at 18 months -   No more disappointments in future. Confidence has returned etc.  Ceased medications without problems so far (2 weeks only).

Dale (livingadream) - I always love your kindness, and posts,  and thank you for your prayers - good luck with your ministry of healing. 56, DSMC, sterd82 - thanks for your reassurance - of course you are right. Thanks for understanding our anxiety over nothing. TimG, Swim and TC (Tony)- hello (Veteran) good friends - I'm glad we have you to rely on. Bill (from down under) - if you get a modified citrus pectin supplier in Australia could you let us know by email?  We also cannot find it anywhere - no local suppliers to time.

Thanks again to you all.  

I guess that was all in all, the 18 month update - panic and all, et al! turn Blessings & thanks for your warm wishes. Lana

 PS. Just edited to fix all my spelling mistakes!


Creed_three
 
Husband 50 yrs (49 years at diagnosis)
PSA (2002) 2.1.  PSA (2006) 3.5.  1 x (5%) core of 12 positive at biopsy. 11 cores negative. Open Radical Prostatectomy with nerve sparing April 2007. Gleeson 3 + 4 = 7.   Undetectable PSA since Surgery (< 0.1) specifically,  
June 2007: 0.01; Oct 2007: 0.02; April 2008: 0.02: October 2008: 0.03.
 

Post Edited (creed_three) : 10/17/2008 1:52:20 AM (GMT-6)


puget
Regular Member


Date Joined Mar 2007
Total Posts : 237
   Posted 10/18/2008 6:38 PM (GMT -6)   

I, too, have seen a rise in my PSA after my surgery in June 2007.  First test in Sept 07 was <.01, but in Mar 08 it was <.02.  Then last month it was up to .07.  Even so, my Dr said not to worry -- my path report was negative at the margins and there could be a lot of reasons for the rise other than recurrence.  I'm scheduled for another test in Jan.  I can't say I'm completely worry-free but for the moment I'm trying to follow his advice.  Thanks for the article, BillyMac.

I'm keeping my fingers crossed for all of us who have not been lucky enough to catch a consistent string of goose eggs.     


Puget
61 years old (60 at surgery)
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
Third Post-PSA Sept 08 = .07 -- now watchful waiting
98% continent
ED seemed endless, but after 15 months definite improvement and almost normal with viagra, occasionally without


M. Kat
Veteran Member


Date Joined Jul 2006
Total Posts : 715
   Posted 10/20/2008 5:51 AM (GMT -6)   
Lana, I'm glad you are feeling more positive now. Having cancer does a number on our minds (and our husband's bodies). I'm happy for you two that the ED issues are now gone. Life just feels more "normal" doesn't it? take care, kat
Husband Jeff 56 years old diagnosed July 27, 2006
PSA 6.5, 2 positive areas in biopsy, Gleason 3+3=6
Radical Retropubic Prostatectomy August 30, 2006
pathology report - all clear - cancer gone
1st post-surgery PSA test <0.1, 2nd post-surgery PSA test <0.1, 3rd PSA <0.1
no more pads Oct 12, 2006
first "real" erection with use of pump 12/16/06
3/07 - occasional dribbles and erections with Cialis and pump
8/07 - 1 yr PSA <0.1
9/1/07 - achieved erection with Viagra - no pump!
3/08 - 18 mo PSA <0.1
switched to Levitra - works much better than Viagra & Cialis - fewer side affects
summer of 2008 - have had a few erections with no drugs! yeah!!
8/08 - 2 yr PSA <0.1


creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 12/2/2008 12:59 AM (GMT -6)   
Hi Everyone,

Not sure how to change the title of this post, but I now understand that a PSA bounce may occur after radiation not surgery, so the title of this post is incorrect.

However just an update on my husband's repeat PSA today December 2. My husband had a repeat PSA to check the callibration of the machines currently used in the testing lab, and after an initial result of 0.03 in October, the result has now come back at 0.02 (late November) which means it is unchanged since April. We now have the reassurance that instructions to callibrate carefully will be written on any future referral forms due to the ultrasensitive tests used, and our desire to monitor even slight increases. Many thanks to all for the information above as it really helped at the time and doctors now on side and understand our concerns. It was worth checking the reading for us, for peace of mind if nothing else. So another undetectable result. Thankfully no more blood tests until next checkup in April 09. cheers, Lana & CJ
Creed_three
Husband 50 yrs (49 years at diagnosis)
PSA (2002) 2.1.  PSA (2006) 3.5.  1 x (5%) core of 12 positive at biopsy. 11 cores negative. Open Radical Prostatectomy with nerve sparing April 2007. Gleeson 3 + 4 = 7.   Undetectable PSA since Surgery (< 0.1) specifically,  
June 2007: 0.01; Oct 2007: 0.02; April 2008: 0.02: October 2008: 0.03: November, 2008 (repeat PSA with instructions to lab to calibrate carefully) = 0.02.
 


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 12/2/2008 1:02 AM (GMT -6)   
Hey Lana,

Great news! Rest easy for a while now...

Jim
Age 74. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
50 mg Viagra + 1000 mg L-Arginine + .03 cc Trimix = Excellent Results
PSAs from  1/3/07 - 7/17/08 0.00. 
Next PSA test on 1/28/09
Lung cancer dxed on 5/16/08.  Surgery on 6/25/08  T1N1M0 - Stage IIA  Finished 4 cycles of chemo on 11/7/08.
First CT scan on 12/2/08.
"Patience is essential, attitude is everything."


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 12/2/2008 1:20 AM (GMT -6)   
For lana and CJ:
tongue turn yeah
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)

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