Hypersensitivy PSA testing with abnormal finding 9 1/2 yrs post surgery

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LJF
New Member


Date Joined Feb 2009
Total Posts : 14
   Posted 2/28/2009 12:10 AM (GMT -6)   
 
My then 45yo spouse had a radical prostatectomy with nerve sparing done at UCLA MC June 1999. His Gleason score was on the high side and his reg PSA was in the low 20s pre-op.  After consulting with multiple UROs, Radiation Onc etc, everyone recommended surgery so the final decision to proceed with surgical intervention was easy. The surgeon told us the cancer had made it to the edge of the prostate organ itself but had not gone beyond it. Margins were clear and no evidence found anywhere else othat it had spread.
 
Given the rapidity of the PSA rise prior to the surgery and the extremely limited life expectancy outcome data I found back in 1999 for men age 45 and under having prostate cancer, I am personally convinced prostate cancer is much more aggressive when diagnosed at a younger age. Watchful waiting isn't a realistic option.
 
Care needs to be taken in choosing what to do as a first response-once the horse is out of the barn, it can't be put back in the barn. There is a need to leave room for possible future need for treatment not already tried initially. For example, if you opt for Radiation as the first response, additional  Radiation down the road isn't an option etc.
 
He had regular PSA testing done post op from 1999 through 2007 and all were 0 or less than 0. 
A new Internist told us about the Hypersensitive PSA lab test in 2008 that apparently is only processed by Dianon Lab in CT. He had that done and it too showed a virtually undetectable level.
 
He had his 2009 Hypersensitive PSA done mid Feb. 2009  and it came back at 2.8
It has been re-drawn and we await the results to rule out any Lab error.
Our Internist tells us one can only have a PSA value if there are prostate cells floating around. A PSA value is not caused by any other source. Just because he no longer has a prostate doesn't mean a few errant cells did not "escape" prior to or at surgery and have been circulating under the radar all these years.
 
He is 4 mos shy of being 10yrs out from his 1999 surgery. He did not have any treatment for the prostate cancer other than the surgery. No trouble at all with incontinence and only minor ED issues. Recovery time was uncomplicated and he was only off work for 4 wks.  Exercises, eats well, is a believer in soy and has an overall healthy weight and life style.
 
The Hypersensitive PSA is a double edge sword. I don't know that a reg PSA blood test would have reflected this current finding. His values were fine for 9 1/2 yrs before this happened.  The real kicker will be what to do if the repeat Hypersensitive PSA value remains elevated. He will be 55 later this year. He's not done with work or life by a long shot.
 
Remain vigilant and don't ever think that when you reach the 5yr or 10yr mark post surgery that you will be permanently cured. There's a reason why PSA lab testing for men who have ever had prostate cancer will be a lifelong requirement.  In my husband's case, it identified he had prostate cancer in the first place and now it might mean that despite the 9 1/2 yr time lag he may have to contend with the orig prostate cancer having spread without being any the wiser... until now.
 
Stay safe and don't let your guard down. Comply with having PSA levels done as directed by your Uro and/or regular primary MD. If they don't order it, you make sure you say you have to have it done.
 
 

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 2/28/2009 1:43 AM (GMT -6)   
Hi LJF,
And welcoe to HealingWell.You bring up some very interesting points. My surgery did not result in a good pathology or Gleason. i am in year three and under the care of an oncologist. After my PSA went to undetectable I asked him if I could be done with this. He said no. I asked if it was because of stage and Gleason, he said no it's because it's cancer.

your suggesting that the ultrasensitive test picked up something new, but it didn't. The 2.8 reading would be found equally by the standard Bayer Assay test. What you are dealing with is a sudden rise in PSA. And if it isn't lab error, it's prostate cancer. Unfortunately, I have read many stories of relapse more than a decade after initial treatment. Your husbands age, gleason, and PSA look like mine almost. Except I was just shy of T4 after surgery.

I am not certain I agree that aggression is stronger with age, but I don't think it matters to debate it. I certainly can't use my case to.

Your last paragraph is a great one and I agree fully. My best to you both and I hope you stay with us.

Peace,

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/28/2009 10:00 AM (GMT -6)   
LJF, very good posting. You made a lot of good points. Having dealt with cancer already 4x in my life, I agree with your dr., Cancer is cancer. It has a mind and will of its own, doesn't always follow protocal and logic, doesn't always make sense, and it certainly isn't fair.

For what its worth, and I love my dr/urologisit, he is of the school that PC can be very agressive in younger men, 50's and younger, so you are not alone in those feelings.

While my post surgery pathology looks good on paper, from having dealt with cancers before, I doubt I will ever feel completely safe or clear the rest of my natural life.

I give my best to you and your husband, he has still done well this far, and since he had surgery first almost 10 years ago, he has options on the table even if the PC did come back. Keep us posted.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 2/28/2009 12:56 PM (GMT -6)   
LJF-
Welcome to HW. I am sorry you have to be here and I am hoping for a lab test error in your case. I agree with Tony, that if your husband's PSA is 2.8 that ultra-sensitive wouldn't have really made a difference. Typically the ultra-sensitive picks up noise <.1. That is my understanding anyways. You are absolutely right in the need to have regular PSA tests. Unfortunately, cancer just sucks and we will never be able to turn our back on it. The good news is that IF, you husband's PCa has returned, there are options as you said. My father had a RP, Radiation and is on HT. We are hoping this will be his last year on HT and that he will be cancer free, but...it's cancer. All the best.
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


LJF
New Member


Date Joined Feb 2009
Total Posts : 14
   Posted 3/7/2009 5:08 PM (GMT -6)   
Just to quick update to say the repeat Hypersensitve PSA value came back yesterday and is once again less than zero. Our MD was very clear the earlier value last month was Lab error. Isn't that comforting-NOT! Our Internist and another specialist have been very vocal specific to their complaints with a particular Lab company chain. Needless to say, we won't be using that Lab for anything again.

As an aside, even though told it was Lab error, we plan to repeat it again in 6 mos to make sure the value remains what it is now and that this wasn't an aberrant finding.

As always, remain vigilant.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/7/2009 6:28 PM (GMT -6)   
Being viligant is always the prudent thing to do, and thank goodness it turned out to be a lab error, when you have that next test done in six months, the proof will be in the pudding. Good luck LJF.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/8/2009 3:24 AM (GMT -6)   
LJF,
You have been delivering sage advice since you joined us. Are you in the medical field?

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


vs1vs2
Regular Member


Date Joined Dec 2008
Total Posts : 60
   Posted 3/9/2009 3:51 PM (GMT -6)   
LJF,
Your prayers were answered. Rest easy now. Sorry you had to go through that. BTW, congrats.
Tim
Age at Dx:48, currently 49
PSA May 08 2.96
referred to uro
PSA June 08 3.44
biopsy 7/25/08-29 core samples
path 7/31/08-8 of 29 PCa/10% involved L/R base and mid
high grade PIN in apex/seminal vesicles clear stage GS 3/3=6 pT2a
10/7/08 robotic at Cleveland Clinic-Dr. Kaouk
10/10/08 path GS 3/3=6 pT2c
cancer contained/neg margins
PSA Jan/09 .03


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 3/9/2009 6:46 PM (GMT -6)   
LJF- I would normally never be thrilled for a lab error, but I am thrilled for you!!! Congrats on the undetectable and sorry for the scare.  As if we don't have enough anxiety with PC as it is!?!?  Keep us posted!

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


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 3/10/2009 5:22 AM (GMT -6)   
With an error of that magnitude and with the implications such an erroneous reading carries, the lab and the technician should be brought to account. It is simply outrageous that a fully automatic test procedure could be so wrong. I would be at the lab demanding an explanation and making sure that the technician fully understood exactly what, in your circumstances, his error meant. How many others, with say a high PSA , were given incorrect results obtained at that time. Obviously the lab did not pick up they were issuing faulty results. They have a responsibility to contact all those who were tested at that time. Just goes to show you though that errors are made. Congratulations on the great new result.
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)
PSA February 09 <0.01

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