Just got my 1st post-op PSA results - not what I'd hoped for.

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glabers
Regular Member


Date Joined Nov 2008
Total Posts : 31
   Posted 12/30/2008 2:06 PM (GMT -6)   
Just got a call from my wife who just heard from the DR. Test results are 0.11; looks like I'm not in the zero club yet. Of course, the DR & nurse say they're not too concerned, but ordered another PSA test in 1 month's time to gauge a pattern. My wife isn't pleased; the DRs continually stated how good my numbers were, and how there were no need for additional tests, but it may be that they'll all be needed now.

Can anyone elaborate on this figure and what typically happens at this point?

Thanks, all
Diagnosed:  8/24/08, age-47
Father died of prostate cancer at age 72
PSA 1.5 early 2007, 4.5 mid 2008, all remedies tried & reduced to only 3.2, uh oh.
Biop - 2 positives of 20 samples
Gleason - 3+3
RRP - 11/13/08 via Da Vinci by Dr. David Samadi, Mt. Sinai Hosp. NY
Post op biopsy - 75% of samples positive for cancer, Post op Gleason 3+4
some lymph Nodes tested, all negative
all nerves spared - I'm told
Catheter in for 1 week, using 1 pad a day. 
 
 
 
 
 


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4835
   Posted 12/30/2008 2:25 PM (GMT -6)   

Think of it like money:

PSA 1.5 early 2007, 4.5 mid 2008, all remedies tried & reduced to only 3.2 said...

You were Rich in mid 2008 with four dollars and fifty cents. You're now PSA poor with only Eleven Cents in your pocket.


Age 53   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Gleason - 6
(biopsy done March 4, 2008-> 2 of 12)
 
06/25/08 - Da Vinci robotic laparoscopy
10/03/08 - 1st Quarter PSA -> less then .01
 

Surgeon - Keith A. Waguespack, M.D.

Las Colinas and Plano Offices

 


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 12/30/2008 2:40 PM (GMT -6)   
Most doctor's do not want to test PSA after surgery until the 3 month mark because there could be some residual PSA left behind. Was your lastest PSA after the 6 week mark.
 
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)
6 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is an issue


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4835
   Posted 12/30/2008 2:49 PM (GMT -6)   
His surgery was->
RRP - 11/13/08
 
As Rob mentioned, three months for the first test is the norm.
Age 53   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Gleason - 6
(biopsy done March 4, 2008-> 2 of 12)
 
06/25/08 - Da Vinci robotic laparoscopy
10/03/08 - 1st Quarter PSA -> less then .01
 

Surgeon - Keith A. Waguespack, M.D.

Las Colinas and Plano Offices

 


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2313
   Posted 12/30/2008 2:50 PM (GMT -6)   
Your PSA should fall to the undetectable range, <0.1, at the 3-month mark.  Some docs like to test earlier.
 
I didn't get my first test until 3 months, and use the standard rather than ultrasensitive test for my own peace of mind.
 


PSA quadrupled in 1 yr (0.6 to 2.5)  
DRE neg  1 of 12 biopsies pos (< 5%) 
Open surgery June 06 at age 57
Organ confined to one small area Gleason 5   
PSA's undetectable  < 0.1  


glabers
Regular Member


Date Joined Nov 2008
Total Posts : 31
   Posted 12/30/2008 2:57 PM (GMT -6)   
Steve - I like that analogy. I'll be most pleased when I'm completely pennyless :)

Rob - My surgery was on 11/13/08, my 1st post-op PSA on 12/26, or about 6 weeks. Too soon to really tell, you think?
Diagnosed:  8/24/08, age-47
Father died of prostate cancer at age 72
PSA 1.5 early 2007, 4.5 mid 2008, all remedies tried & reduced to only 3.2, uh oh.
Biop - 2 positives of 20 samples
Gleason - 3+3
RRP - 11/13/08 via Da Vinci by Dr. David Samadi, Mt. Sinai Hosp. NY
Post op biopsy - 75% of samples positive for cancer, Post op Gleason 3+4
some lymph Nodes tested, all negative
all nerves spared - I'm told
Catheter in for 1 week, using 1 pad a day. 
 
 
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/30/2008 3:25 PM (GMT -6)   
sorry to hear that, glabers, i know you wanted a fully zero at this point. when they do the next one, that will tell more i think, and hopefully it will where you want it. my surgeon i found out only this week, is a never do a post surgery psa till 3 months either kind of guy, so i have to wait till 2/9/9 to know where i stand. we are with you brother, you are still doing great.

david in sc
Age 56, 56 at DX
 
PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
 
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4
 
Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. New appt. to see dr. on 1/5/9 as result.
 
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.
 
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


Ralph Alfalfa
Regular Member


Date Joined Nov 2008
Total Posts : 469
   Posted 12/30/2008 4:13 PM (GMT -6)   
I'm curious. Did the doc start you on an antibiotic in case you had a residual infection. Blood test shoul be able to tell.
Bob
 AGE:57
 Dx: October,27(the day after my birthday)
 Psa 14.5
 Gleason:(4+3) 7
 Bone scan:Negative
 Cat scan: Negative
 Biopsy: 4 of 12 positive, left side, pre-cancerous on the right.
 Confined to prostate.
 DaVinci scheduled for Jan. 19, 2009.Dr. Scott Montgomery, KC Urology,
Shawnee Mission Med. Center. Kansas


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/30/2008 4:21 PM (GMT -6)   

Hi Glabers,

My oncologist once told me that PSA should drop at about 50% per day.  For me to drop from 20 to undetectable was supposed to be 9 days from what he told me, but he was wrong.  So when it didn't, as you can see by my PSA history below, I was really thinking that it just wasn't going to get there.  Almost 6 weeks later it did.  In the end, my experience here, and at other sites, tells me we are all different.  If it were me I would ask for another one to see if it is trending downward.  As you can see, we drew my PSA frequently after surgery.  We eventually got to where I just take it when I go in for another Lupron depot. 

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

September 17, 2008      <0.1

My next one is in January...Starting to get close!

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, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/30/2008 5:11 PM (GMT -6)   
Now psa numbers used to be thrown around by various docs and institutions claiming victory (per se) at psa levels like .2 or less (post radiations+ADT, and similar protocols)I think it was .2 for surgery also? Some definitions do vary from doc to doc, shows some inconsistency and maybe "skewing" to manufacture more 'cured' patients by their definitions. Now this was the number thrown around 3-6 yrs. ago as a key threshold, I have not studied this stuff more recently it may be a whole different ball game. The parameters for safe PSA levels in men at various ages has changed from the old numbers, old methods. Thanks to people like Dr. Strum for pointing out the issues and giving other parameters as to psa history, doubling times and other factors, the old methodology thinking has changed on psa evaluations. Although some docs might not be on top of it like Dr. Strum and alot of others, whom are more cutting edge. Like I said I don't know for sure what the so called break off point is, maybe it is not even defined like it used to be. But if it is still good data, then if you are less than .2 after major modalities as mentioned, then so far it looks very good.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/30/2008 5:29 PM (GMT -6)   
Bob,
The standard today is under 0.1. Some oncologists try for an absolute zero, which is seldom acheived, even by Strum/Myers/Lebowitz. What my oncologists doesn't like about monitoring numbers below 0.1 is the anxiety it can cause. Still other oncologists swear by finer more sensitive assays, but anything below 0.1 is fine as most oncologists won't start measuring doubling times until it is at least 0.1. And starting any salvage therapy won't usually be recommended until usually a 0.4 unless there is a compelling reason such as confirmed positive margins, SVI, or Gleason 7 (4+3) and above.

Just standards, not all urologists/oncologists are the same.

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, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 12/30/2008 6:57 PM (GMT -6)   
I'm with Tony, you may want to get another test at the 2 month mark to see if it is trending down. It might ease you mind instead of waiting another 6 weeks.
 
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)
6 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is an issue


glabers
Regular Member


Date Joined Nov 2008
Total Posts : 31
   Posted 12/30/2008 10:04 PM (GMT -6)   
All you guys are a tremendous help. You are worth hundreds of doctors as info goes. Thanks!
Diagnosed:  8/24/08, age-47
Father died of prostate cancer at age 72
PSA 1.5 early 2007, 4.5 mid 2008, all remedies tried & reduced to only 3.2, uh oh.
Biop - 2 positives of 20 samples
Gleason - 3+3
RRP - 11/13/08 via Da Vinci by Dr. David Samadi, Mt. Sinai Hosp. NY
Post op biopsy - 75% of samples positive for cancer, Post op Gleason 3+4
some lymph Nodes tested, all negative
all nerves spared - I'm told
Catheter in for 1 week, using 1 pad a day. 
 
 
 
 
 


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 12/31/2008 10:32 AM (GMT -6)   
I had my firsts post-op PSA test about a month, or shortly longer, after my surgery, and the next one just last week. Both were 0.0. I asked my Urologist/Surgeon about a more definite number, such as 0.01, etc. He told me he, and the University, consider 0.0 the benchmark, and that even if the result showed 0.2 he wouldn't be too concerned. If the result rose above 0.2, he'd want to investigate further. Each of us and our health histories is so different, it might not be good to compare our results with what others report - because to do so could be an apples-to-oranges exercise. If you have confidence in your doctors, follow their lead. Best wishes for a healthy and happy New Year!

Age:  59 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (getting better, though)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0

 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 12/31/2008 4:09 PM (GMT -6)   
My psa was 6.7 at surgery, and 8 days later had dropped to .8 (another test by my GP at my yearly check). 6 weeks after surgery it was .04 and continues to be .04 or less. Statistically Zero
James C.         Age 61
Co-Moderator- Prostate Cancer Forum
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 Nerve sparing Open Retropubic Radical Prostatectomy
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.

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