How high can the PSA safely go post surgery before further action

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oceanwave
New Member


Date Joined Mar 2009
Total Posts : 4
   Posted 3/18/2009 11:34 AM (GMT -6)   
My husband had a PSA of .07 four months after surgery. Four months later it had risen to .1; 3 months after that to .12. How high is it safe to go before further action such as radiation is taken? I have read that .2 is the cutoff point although doubling time is also looked at. Needless to say, we are concerned.
 
 Any shared personal experiences or Dr. opinions would be greatly appreciated!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 3/18/2009 12:02 PM (GMT -6)   
Hello and welcome here, Oceanwave. Glad you found us and now a part of us. What would help would be if you could post some of your husbands stats related to his Prostate Cancer, make a signature at the bottom of your post. What was his post surgery pathology report like? What was his final Gleason score and tumor designation?

Some doctors, after PC surgery, would use .1 as the point to consider a second treatment, but others would still watch and see if it went higher yet. Some more information here would help with the opinons.

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
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 3/18/2009 4:38 PM (GMT -6)   
I've read a couple of studies that indicated the sooner a 2nd treatment was started the better the outcome. I believe this was related to ADT3 and not radiation or another salvage method, but I think it would make sense for all secondary treatment options. You want to stop the cancer when it's at its weakest.
JohnT

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

JohnT


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4088
   Posted 3/18/2009 5:34 PM (GMT -6)   

Dear Oceanwave:

I can understand your concern.  I understand that .2 is the "cutoff" but, as you say, doubling time is an essential issue.  I have posted a couple of links below that may be helpful as you examine your options:

http://www.communityoncology.net/journal/articles/0304191.pdf

http://www.phoenix5.org/Basics/psaPostSurgery.html

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 3/6/09.

carver
Regular Member


Date Joined Jan 2009
Total Posts : 27
   Posted 3/18/2009 6:40 PM (GMT -6)   
My psa post RP has risen from less than 0.1 to 0.6 over the last 12 years. My Gleason was 2+1. (Lower than the average psa of 3+3) I have not had any further treatment so far. (advice from two urologists) A friend who had a rise post RP from 0.5 to 0.8 in 3 months (Gleason 3+4) after 5 years post RP just had a prostascint scan which indicated a nodule in the prostatic bed. He is now undergoing radiation treatments. Check the prostascint scan information with a web search. You will find out that the scan is more definitive when the psa is above 0.5. My friend felt relief that the cancer was identified in the prostatic bed.(Local recurrence) The scan did not show any other possible cancer sites in his body. Keeping a close watch by graphing the psa has help me deal with the recurrence.  Best wishes,Al

hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 3/18/2009 6:57 PM (GMT -6)   
Oceanwave
I started additional therapy 6 months after surgery, when my PSA had risen to .08.  Even before the rise, my surgeon and oncologist had suggested this, due to my positive margins.  As others have mentioned, looking at the pathology report is one key, and discussing this with your surgeon is another. 
Good luck
Age 57 at diagnosis (2006),  PSA 4.7 (up from 3.2 one year previous)
Biopsy November 8, 2006 1 of 10 cores positive 5% LEFT Side Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology Stage T3a, Gleason 3+4, positive margins and capsular penetration RIGHT Side
Post Surgery PSA:  March 5, 2007:  0.01    5 month PSA  0.08
Adjuvant therapy began June 26, 2007 with Zoladex injection
Radiation began August 23, 2007, ended October 8
First post radiation PSA, December 18, 2007:  0;  March 2008 - still 0;  July 2008 - 0; Sept. 2008 - 0;  Dec 2008 - 0;  March 2009 - 0;  Final Zoladex injection!
 
 


dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 149
   Posted 3/18/2009 8:31 PM (GMT -6)   
Hi Oceanwave,
My psa stayed good, <0.04, until my 3 year point and then it was 0.07 and rose to 0.1 back in September. It was rising .01 every 3 months which comes out to a 15 month doubling time. My surgeon referred me to my Radiation Oncologist and he advised to start with salvage IGRT. He said, and I have read several studies that confirm, the earlier the better with the Radiation. I finished mine 1/14/09 with very little side effects. Now all I have to do is wait and see if it was successful! If I were in your place I would have a radiation consult. I know all of this is a crapshoot but I want to be in the game. Good luck to you and be proactive.

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.....November 17th....
FINISHED 01/14/09 YEA!


stxdave
Regular Member


Date Joined Nov 2008
Total Posts : 65
   Posted 3/18/2009 9:12 PM (GMT -6)   
Hi Oceanwave,

The magic number is usually determined by the individual physician. I am sure it is probably based on PSA level at time of diagnosis, post surgical Gleason scores, and the extent to which the cancer had spread, if any. Obviously, if the cancer seemed to be aggressive, you would want to start subsequent treatment as soon as possible. It is imperative to make sure you and your physician are on the same page so he will be as aggressive as you want to be.
Best Wishes,
Dave
Dx'd 1999, Age 60, PSA 43, Gleason (3+4=7), T3c
42-3d EBRT w/Lupron/Casodex for 24 months and PSA remaining to be <0.1 for the entire 24 month period.
July 2001 - 2nd opinion required to go intermittent ADT.
MDAnderson biopsy revised Gleason (4+5=9).
Intermittent ADT, Lupron only, with PSA threshhold established at 1.0.
March 2007 - Diminishing returns with Lupron, conferred with MDA urologist for bilateral orchiectomy. Uro asked for biopsy of prostate again. Biopsy resulted in tumors found with Gleason (5+4=9).
August 2007 - RRP and bilateral orchiectomy. PSA <0.1
99% continent immediately
September 2008 - PSA 0.45
November 2008 - PSA 0.67
December 2008 - Resume Casodex
December 2008 - Stricture in bladder neck requiring surgical removal. 99% incontinent immediately.


Life is not waiting for the storm to pass, it's learning to dance in the rain.


justus1292
Regular Member


Date Joined Feb 2009
Total Posts : 63
   Posted 3/25/2009 8:24 AM (GMT -6)   
My uro said as long as PSA in < 0, not to worry.  Before you start kemo or radiation, get a second or third opinion.
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