PSA and its relavance to post operative outcomes

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Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 1/15/2009 2:12 PM (GMT -6)   
We acknowledge and celebrate zero's and of course any one knows that a zero is certainly better than the alternaitive.  But my question is what do they mean .
 
A zero PSA at 6 weeks, is it an indicator that improves the overall prognosis or simply that you are going in the right direction.?
 
A zero PSA at a year,  what does that mean to the overall curative picture?
 
Has anyone heard of studies that provide a goal for our very special zeros.  Like zero's at 5 years, 10 years etc. how does this effect the end game.  What about any nannograms or diagnositic tools for post op PSA histories ?
 
Oh boy, I hope I'm not getting the PSA jitters.... Just slap me if I am, go ahead slap me.  Ouch! who was that?
 
I could be suffering from P.I.S.S ( PSA Interval Stress Syndrome)
 
Thanks Guys and Gals.
 
Frank
 
 
 
Age 54
DRE normal , 2004 Biospy negative - 2008 Biopsy positive (01-08-08)
10 cores, 1 positive and at 1% of that one core
PSA @ surgery 6 
Bone and Ct scans negative
clinicaly Staged at T1C - Gleason 3+3 = 6
Robotic Da Vinci performed March 27th, 2008, University of Chicago.
Catheter out in 7 days normaly expected leakage
Post Pathology T2C, Gleason 7, (3+4) 10 % of both portions of prostate
Seminal vessels clear, fat tissue clear, single positve margin at apex measuring less than 1/2mm. 
PSA Six week < 0.1 4 month PSA <.05 6 month PSA<0.01,9 month<0.01
Watching PSA @ 3 months for 2 years,  will do salvage radiation if necessary.
Fair to Good results with Viagra,  side effects are bothersome at times. 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25372
   Posted 1/15/2009 2:20 PM (GMT -6)   
Frank,

Based on your signature, your post surgery psa's are all excellent, and should be reason enough to rejoice.
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. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - Had operation St. Francis - removed blockage, put in Cath #5, suppose to be removed 1/19/9
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
 
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 1/15/2009 2:42 PM (GMT -6)   
Frank, I think that the numbers of zeros is positive towards the ultimate of being 10 years free progression. My understanding that if you don't have any recurrence after 10 years then you can say "I'm Cured". But because recurrance can happen at time after primary treatment, it goes that the longer the period of time of having zeros the more likely you will remain disease free. Thus joining the zero club and staying there is what everyone is trying to get to. BTW recurrence in most cases is equal or greater than 0.2 psa for us surgery guys. So with a <0.01 you are in great shape.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25372
   Posted 1/15/2009 3:32 PM (GMT -6)   
Les, the 10 year mark is what my dr has often used as a reference point, he said if there were no reaccurance by then, probably wouldn't happen, but not guaranteeing it of course. With the other rare cancer I had 3x, 8 - 10 years was the magic number, this March I will 9 years out on that one too.
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. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - Had operation St. Francis - removed blockage, put in Cath #5, suppose to be removed 1/19/9
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
 
 


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 1/15/2009 4:37 PM (GMT -6)   

Curt:  Here is a nanogram that takes into account your pre-op PSA but also your amount of time after surgery with no recurrence.

http://www.mskcc.org/mskcc/html/10088.cfm

Your good without question.

David

P.S. Put the wet stuff on the red stuff.


 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/15/2009 4:40 PM (GMT -6)   
Some treaments are claiming victory or cure at around 10 years with certain psa numbers depending upon treatments. Like www.rcog.com is claiming cures at 10 yrs. with psa at .2 or lower, remember this is radiation and you still have a prostate in you, maybe this is why it is .2 vs. .1 or lower. Now I always question everything, compare it to other radiations that have claims or abstracts written on this.

With PCa you always have to monitor and be vigilant is important, or you can drink tequilla and fo-get-about it and some people do. (-:

Bob
 


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 1/15/2009 5:02 PM (GMT -6)   

Bob:

I'm considering the tequila approach it sounds like more fun.

 

David


 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 


dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 149
   Posted 1/15/2009 5:26 PM (GMT -6)   
You never know...............
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.....November 17th....
FINISHED 01/14/09 YEA!


Todd1963
Veteran Member


Date Joined Oct 2008
Total Posts : 3211
   Posted 1/15/2009 5:27 PM (GMT -6)   
You know frank the only problem w/conduit is that you have to pull the wires when your done. When I remodeled an old house I killed the juice at the box and I was wrapped up in wire big time up in the attic when my ex wife came home and wondered why the lights didn't work. She had no idea I was up there when she fired up the mains. I will keep to the pipefitting. I would rather be waterboarded than electricuted when someone opens up the current. Todd LOLOLOL
dx:06/03/06
Age at dx: 42 age now 45
Treated for sciatic nerve pain 6 months prior to dx.
Heavy amount of blood in urine Unable to urinate 
Lung x-ray for pnumonia revealed multiple lesions in each lung
P.S.A. at time of dx. 3216.14
Began lupron and casodex
Cat scan showed large mass in the pelvic area affecting the bladder multiple nodules in both lungs and lymph node envolvement.
Bone scan revealed possible bone involvment in the pelvic area
Biopsy 12 of 12 cores positive gleason 3+4=7
P.S.A.s since lupron 2946, 1274, 532, 5.01 1.23, .09
Begining jan 08 psa .o9, .25, .44, .86, .73, 1.34, 1.49. Doubling time is a little over 3 months
Cat Scan 12/12/08 Prostate normal size and shape. No tumors detected. Left lung clear of all nodules right lung showing only benign scar tissue. Lymph nodes normal
Bone Scan 12/24/08. Clean!!!


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/15/2009 7:13 PM (GMT -6)   
Hey is that P.I.S.S. in the PCa glossary and terminology dictionary (Frank 1205) just coined a new PCa term!!! Tony add that one on the list asap, maybe the doctors will start using it soon.

PSA Interval Stress Syndrome (PISS) hope you don't mind if I abuse it and use that somewhere else.

   |
   l l
   l l
 ( )( ) (leaning tower of Pissa) (Penil-colony) (vigra building)

Use your imagination. Apparently a few years of drug therapy helps your creative mind, better living through chemistry or some such jargon.

Z-Bob


 


Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 1/15/2009 8:00 PM (GMT -6)   

Thanks All.

I appreciate all the great input.  Dont get me wrong I am not feeling sorry for myself, geez I am doing great I feel so fortunate.  I some times second guess my decision not to radiate that positive margin.

David thanks for the nomogram,  never saw that one.  Very happy with the numbers. Thats about where I was clinically before surgery and the bad margin.  Thanks a million. Its going to be around 20 below zero tonight.  Me and living1963 got this pipe subject going.  I will see more broken pipes once it gets above freezing than you can shake a stick at.  It will be a great year for plumbers and sprinkler fitters this year.  Ever see what happens when you shoot a hose in the air when its -20 degrees.  Yup comes back huge chunks of ice.  Teaches the Newbees to keep their helmuts on.  

zufus, go ahead and abuse the acronyn P.I.S.S. all you want, it won't p_ _ _ me off.

Living1963 I am glad your O.K. but your "you got voltage" is hilarious.  You have a fine woman there.  I have never known one,  not that there aren't many now,  that know where the main is let alone give it a throw.  She's a keeper.

dsmc, thank you very much for your input.  I wish you the very best with the completion of your treatment.

Purgatory, thank you for your comments I appreciate them.

Tony your the best always.

O.K. now the important questions, What do I do with this worm I got in this bottle?

Frank

 

 


Age 54
DRE normal , 2004 Biospy negative - 2008 Biopsy positive (01-08-08)
10 cores, 1 positive and at 1% of that one core
PSA @ surgery 6 
Bone and Ct scans negative
clinicaly Staged at T1C - Gleason 3+3 = 6
Robotic Da Vinci performed March 27th, 2008, University of Chicago.
Catheter out in 7 days normaly expected leakage
Post Pathology T2C, Gleason 7, (3+4) 10 % of both portions of prostate
Seminal vessels clear, fat tissue clear, single positve margin at apex measuring less than 1/2mm. 
PSA Six week < 0.1 4 month PSA <.05 6 month PSA<0.01,9 month<0.01
Watching PSA @ 3 months for 2 years,  will do salvage radiation if necessary.
Fair to Good results with Viagra,  side effects are bothersome at times. 
 


Ripandburn
Regular Member


Date Joined Aug 2007
Total Posts : 125
   Posted 1/16/2009 6:18 AM (GMT -6)   
This whole thread made me smile.... Thanks I needed that. Also, David, thanks for the link to the nanogram. That also reduced some of the anxiety I am feeling.
53 years old
T1c 3+3=6
DaVinci July 16, 2007
largest cancer .2mm
Bladder Sling installed during prostate removal
nerve sparing with both nerve bundles intact
all cancer contained within prostate nothing near margins
11 weeks post-op - no more pads
5 PSA's all < .1 - Undetectable


Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 1/16/2009 7:47 AM (GMT -6)   

zufus,

I'm sorry.  I didn't see the ex-wife words in your story.  Forget the keeper thing I said. I have to ask though, is the reason she is an ex-wife got to do with the little matter of electrocution?

Frank


sandstorm
Regular Member


Date Joined Dec 2008
Total Posts : 194
   Posted 1/16/2009 9:00 AM (GMT -6)   
Frank1205,

It is my understanding that a zero PSA at the end of ten years means, the "Doctors" will consider you Prostate Cancer free, and thus cured.

P. S. I've set back the timetable for putting in that waterline from the well, on your advise. Thanks!
Age at DX 57
5-18-07 PSA 7.7
5-06-08 PSA 4.6  8% free psa, but stable
10-23-08 PSA 5.65 4% free psa
11-04-08 biopsy
11-11-08 2 of 12 cores positive
Gleason 3+3  6  stage t1c / post-op 3+4  7  stage t2c
CT and Bone scan negative
Da Vinci RRP 01-09-09
Catheter removed 1-15-09


Frank1205
Regular Member


Date Joined Feb 2008
Total Posts : 308
   Posted 1/16/2009 11:41 AM (GMT -6)   
Sandstrom,

Glad to here that. Too many brothers here especially DaVinci guys with hernias. You dont need that problem for sure. Good luck on your recovery. Walk and walk some more.
Frank
Age 54
DRE normal , 2004 Biospy negative - 2008 Biopsy positive (01-08-08)
10 cores, 1 positive and at 1% of that one core
PSA @ surgery 6 
Bone and Ct scans negative
clinicaly Staged at T1C - Gleason 3+3 = 6
Robotic Da Vinci performed March 27th, 2008, University of Chicago.
Catheter out in 7 days normaly expected leakage
Post Pathology T2C, Gleason 7, (3+4) 10 % of both portions of prostate
Seminal vessels clear, fat tissue clear, single positve margin at apex measuring less than 1/2mm. 
PSA Six week < 0.1 4 month PSA <.05 6 month PSA<0.01,9 month<0.01
Watching PSA @ 3 months for 2 years,  will do salvage radiation if necessary.
Fair to Good results with Viagra,  side effects are bothersome at times. 
 


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 1/16/2009 6:46 PM (GMT -6)   
you guys are to funny, heck I am glad I have PCa just to share a life with my friends here at HW. ok I know that is taking it a bit to far. Zero's are good, but please never let your guard down. This demon can crop up at anytime.

peace to you
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
PSA Dec 16th, 2008 is .06
Testosterone keeps rising, the current number is 156, up from 57 in May
cancer in 4 of 6 cores
92%
80%
37%
28%
 

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