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Posted 5/5/2009 10:02 PM (GMT -6)
Hello,
  I have an appt with my surgeon on 5/18.  I had my psa tested, same lab as always on 5/01 (I thought appt was on the 8th).  As one can see it continues to rise ever so slightly.  3 mo 0.11, 6 mo 0.12, 9 mo 0.13.  At 6 months DR said that we need to keep watching but did not want to pursue further treatment unless it reached 0.20.  Even though my psa is rising slowly, it is still rising.  Does psa ever rise like this then stop?
  I do a lot of lurking here and have been trying to find others with my circumstances.  It is amazing how we all have the same disease but each case seems to be different.  I know there are certain proticals which say that any psa 0.1 > post surgery should have follow-up treatment.  Others say that below 0.2 should not have follow-up treatment.  My personal thought is that if it has risen for each psa test it will continue to rise.  Why should I wait until it reaches 0.2?
  What suggestions do others have as to how I should proceed?  I have changed my diet quite a bit since surgery.  I have virtually cut out red meat and have greatly reduced the dairy.  I still love my ice cream and buttered popcorn.  I have also added pomegranite juice on a daily basis.  I have one fear that by changing my diet/pom juice is masking an even greater rise in psa.  Does this make any sense?  If salvage radiation is started what all is involved?  My wife thinks that I will have one treatment.  I told her I was fairly certain that salvage rt involed many treatments.
  As alway I appreciate any and all feedback.
  On another note,  I feel a bit guilty sometimes because I seem to be a net taker than a giver to this forum.  I truly appreciate everyone on this forum. 
 
Thanks again
 
Jon
age:  44
1st psa Apr 08 3.06
2nd psa 6/16/8 4.02,  DRE showed nothing abnormal
biopsy 7/10/08 positive 5 of 12
Da Vinci 8/04/8 Parkview Memorial in FT Wayne IN 
gleason 3 + 3 = 6
prostate 27 g, 4 x 4 x 3.1 cm
Stage:  pT2cNXMX
margins:  apical margin involved
no extraprostatic extension of tumor
seminal vesicle involvement: absent
3 month psa  0.11, 11/08
6 month psa 0.12,  2/09/0
9 month psa 0.13, 5/01/09
 
 
 

Posted 5/5/2009 10:27 PM (GMT -6)

Hi Jon,

Welcome, if that is the right greeting. No one wants to be here, but wow are we all glad we found this place. You will get a bunch of answers to your questions, and support from folks who have been where you are.

You are correct, each case is different. I know any rise in PSA is troubling.

I'll tackle the question about follow-up radiation. You are correct that it will be many sessions. I had 35 sessions (five days a week for seven weeks). It really wasn't too bad. Takes about 10 minutes, and you don't feel anything. It has side effects, includng fatigue, which may linger long after the treatmenst are done.

I had "adjuvant" radiation, which is radiation done before my PSA rose above the 0.2 threshold. Once the PSA indicates a recurrance, the same radiation is called "salvage". I opted to bombard the prostatic bed while the cancer was as small as it would ever be. It may have never returned, but I wanted it shot with every gun in my arsenal.

Ditto on the diet. No red meat, dairy or white bread here. I keep the pomegranate famers in business.

Bless you, and remember that a positive attitude is good medicine!

Rev. Bill in San Diego

Age 60 (59 when Dx) PSA 4.4
Biopsy 5/15/08 Gleason (3+3=6)
Bone scan and pelvic CT: clear
HT - 2 mo Casodex, 3 mo Trelstar
RRP Surgery 9/15/08 La Mesa California
Post-OP Gleason 3+4=7, Stage pT2c pN0 MX
Seminal vesicals, perineural margin, 18 lymph nodes, bladder neck: all carcinoma free
Perineural invasion & Distal Margin: Carcinoma present
IMRT adjuvant radiation (35 Treatments) End 1/27/09
PSA (10/13/08): <0.1
PSA (3/13/09): <0.1
 

Posted 5/5/2009 10:50 PM (GMT -6)
Hi cave88,
about 15 month after my open RP my PSA started to rise and when it reached 0.08, my Onc,, my Uro and myself, decided that it was time for further actions. You can see all this by my signature. If I were you, I would watch my PSA VERY closely and take action as soon as I'm convinced that the cancer is back. It is my understanding that the earlier one takes aggressive action, the better the chance of success.
All the best to you.

Magaboo
Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA on the 26 Jan., 09, =0.05. PSA tests now every 6 month

Posted 5/5/2009 11:02 PM (GMT -6)

Jon,

Your signature mentions "T2c" and "no extraprostatic extension", yet there is a "margin involved". Can you elaborate on what this means? With your low Gleason score, if the final pathology is T2c, then the odds are very much in your favor. A worse pathology might give more weight to "hitting it early". Any chance that a bit of prostatic tissue was left behind after surgery, contributing to the PSA?

CaPCa

Age:45 (44 when diagnosed)
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
11/04/07  First usable erection with Cialis
11/22/07  Thanksgiving - Bye-bye, pads
01/17/08  First post-surgery PSA result: < 0.008 ng/ml
03/17/08  Erection quality mostly back to pre-surgery levels with Cialis;
              have not tried without meds yet.
04/23/08  Second post-surgery PSA result: < 0.008 ng/ml
07/30/08  Third PSA: 0.01 ng/ml
11/04/08  One year PSA: 0.01
              Still taking 10mg Cialis every other day - enjoying the results
              too much to stop yet.
02/07/09  Taking 5mg Cialis every other day - having too much fun to try
              to stop for now.
03/23/09  PSA: 0.02
 

Posted 5/6/2009 4:28 AM (GMT -6)
CaPCa,
Yes, it seems as though there was some prostatic tissue left behind. There was a positive margin but no extraprostatic extension. The Dr even mentioned that the 3 month psa being 0.11 could be from tissue. My psa is rising but seems very gradual. No jump.
Thanks
age:  44
1st psa Apr 08 3.06
2nd psa 6/16/8 4.02,  DRE showed nothing abnormal
biopsy 7/10/08 positive 5 of 12
Da Vinci 8/04/8 Parkview Memorial in FT Wayne IN 
gleason 3 + 3 = 6
prostate 27 g, 4 x 4 x 3.1 cm
Stage:  pT2cNXMX
margins:  apical margin involved
no extraprostatic extension of tumor
seminal vesicle involvement: absent
3 month psa  0.11, 11/08
6 month psa 0.12,  2/09/0
9 month psa 0.13, 5/01/09
 
 
 

Posted 5/6/2009 7:59 AM (GMT -6)
Your wife is very incorrect. If you have to go through radiation as a salvage treatment, you will go through somewhere between 30 and 40 treatments, usually done Monday-Friday with the weekends to re-coup a bit, and then start all over again the following week. Hope you end up not needing to go that route.

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
 
 

Posted 5/6/2009 8:36 AM (GMT -6)
Jon...I agree with others...at your age and the doubling time of around 21 months I would look into additional treatments while the remaining cancer is at a low level for the best shot at a cure. The positive margin would indicate that the cancer is probably localized and will benefit from radiation treatment. If you wait until the psa rises above the 0.5 mark, then treatment success will begin to diminish. You have some time to think it over, as right now you will only be at the 0.26 mark in a couple of years based on your doubling time.

Personally, I wouldn't wait that long...but it is your decision. Discuss the pros and cons with salvage treatment with your doctor...there is no such thing as benign treatment when dealing with prostate cancer and you need to be informed.

Best wishes and keep us informed.
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
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06

Posted 5/6/2009 1:07 PM (GMT -6)

Jon,

My journey has been pretty much the same as yours as you can see in my signature. It seems the variation in your PSA could be just noise. I'm 2 1/2 years out and I've had PSA readings as low as less then 0.01 to as high as 0.04. the last four have settled in at 0.03.

As you can see I opted for the adjuvant radiation therapy at the urging of my urologist, oncologist and of course my radiologist because of a focally positive margin.

Ken

Age 54 (2006)
PSA: 2005 - 3.2, 2006 - 3.7
Biopsy 8/06, Gleason 6 (3+3), T1c
Radical Retropubic Prostatectomy 11/3/06 - Memorial Hospital, Pawtucket, RI
Post-Op Biopsy, Gleason 6 (3+3), T2c, right apical margin positive
CT Scan 1/07, tumor discovered on right kidney (unrelated to PCa)
Partial Nephrectomy 3/9/07 - R.I. Hospital, Providence, RI
IMRT (37 Treatments) 4/23/07 - 6/14/07
PSA: 3/09 - 0.03

Posted 5/6/2009 2:53 PM (GMT -6)
Hi Jon,
I am sorry your psa is acting like this! As you can see in my signature our rises were about the same going up 1/100the every 3 months. My surgeon/uro doc said that my doubling time was @ 15 months. With having 3 consecutive rises in as many test he wanted to check on salvage RT and the rad doc agreed. I am to see my uro at the end of this month and will have a psa drawn then. I did go by a health fair a couple of weeks ago and had one drawn and it came back @ 0.0, although it was not an ultra sensitive test I was very pleased to see it at 0.0 as opposed to 0.1 back in September when I had my last test!!!! I believe if you have 3 or 4 consecutive rises you probably have something to check on and the earlier the better for me. I wish you the very best with and will be checking to see your progress. BTW I had 38 treatments with a total of 68GY and it was no trouble at all.

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!

Posted 5/6/2009 6:43 PM (GMT -6)
Jon,
This site might help.
Posted 5/6/2009 11:27 PM (GMT -6)

Jon,

It may be my ignorance on the terms, but I don't understand how one can have a positive margin yet no extraprostatic extension - maybe someone can clarify this. If you truly have no cancer exposed on the surgical specimen removed, statistically your odds are very good of no recurrence. In other words, aggressive adjuvant treatment should be in part a function of the pathology report, I would think. As others have said, this needs to be monitored carefully. However, if the margin is truly negative, I would hesitate before opting for radiation until the 0.2-0.4 level.

CaPCa

Age:45 (44 when diagnosed)
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
11/04/07  First usable erection with Cialis
11/22/07  Thanksgiving - Bye-bye, pads
01/17/08  First post-surgery PSA result: < 0.008 ng/ml
03/17/08  Erection quality mostly back to pre-surgery levels with Cialis;
              have not tried without meds yet.
04/23/08  Second post-surgery PSA result: < 0.008 ng/ml
07/30/08  Third PSA: 0.01 ng/ml
11/04/08  One year PSA: 0.01
              Still taking 10mg Cialis every other day - enjoying the results
              too much to stop yet.
02/07/09  Taking 5mg Cialis every other day - having too much fun to try
              to stop for now.
03/23/09  PSA: 0.02
 

Posted 5/7/2009 4:40 AM (GMT -6)
Everyone,
Thank you so much. The advice/information I receive on this site is unbelievable! I have one other question. If I have the salvage rt am I allowed to be around children while I go thru treatment? I know with some rt you are not supposed to be near children. I have a 5 yr and 3 yr grandchildren who are with us everyweekend.

Thanks again jon
age:  44
1st psa Apr 08 3.06
2nd psa 6/16/8 4.02,  DRE showed nothing abnormal
biopsy 7/10/08 positive 5 of 12
Da Vinci 8/04/8 Parkview Memorial in FT Wayne IN 
gleason 3 + 3 = 6
prostate 27 g, 4 x 4 x 3.1 cm
Stage:  pT2cNXMX
margins:  apical margin involved
no extraprostatic extension of tumor
seminal vesicle involvement: absent
3 month psa  0.11, 11/08
6 month psa 0.12,  2/09/0
9 month psa 0.13, 5/01/09
 
 
 

Posted 5/7/2009 7:33 AM (GMT -6)
Jon,

No problem at all, you do not emit any radiation.

Ken
Age 54 (2006)
PSA: 2005 - 3.2, 2006 - 3.7
Biopsy 8/06, Gleason 6 (3+3), T1c
Radical Retropubic Prostatectomy 11/3/06 - Memorial Hospital, Pawtucket, RI
Post-Op Biopsy, Gleason 6 (3+3), T2c, right apical margin positive
CT Scan 1/07, tumor discovered on right kidney (unrelated to PCa)
Partial Nephrectomy 3/9/07 - R.I. Hospital, Providence, RI
IMRT (37 Treatments) 4/23/07 - 6/14/07
PSA: 3/09 - 0.03

Posted 5/7/2009 9:06 AM (GMT -6)
John,
 
Please keep in touch. I have this strange feeling I'll be following you down the radiation path.  It would help to know when I'm in for.  My email is active on this profile I think.
 
Take care.

Roger
Age: 44 (42 when diagnosed)
DRE Small Ridge on prostate, PSA 1.5
07/2007: Diagnosed cancer, T2c, Gleason 3+4=7
09/2007: Laparoscopic prostectomy @ Hamilton General, 4 hrs.
01/2008: Still working on ED.
 
 

Posted 5/7/2009 11:40 AM (GMT -6)
CaPCA said...

Jon,

It may be my ignorance on the terms, but I don't understand how one can have a positive margin yet no extraprostatic extension - maybe someone can clarify this. If you truly have no cancer exposed on the surgical specimen removed, statistically your odds are very good of no recurrence. In other words, aggressive adjuvant treatment should be in part a function of the pathology report, I would think. As others have said, this needs to be monitored carefully. However, if the margin is truly negative, I would hesitate before opting for radiation until the 0.2-0.4 level.

CaPCa

CaPCa...a positive margin means that the surgical incision cut across the membrane (capsule) for the prostate leaving some cancerous tissue behind.  It is impossible to determine at the positive margin site whether or not any EPE exists because the capsule or membrane has been compromised.  This does make staging between T2 & T3 difficult if the cross section of the positive margin area is large.
 
For those reading, a positive margin does not always mean recurrance.  In reality only 30% of those with positive margins will have a recurrance.  Most of the time the remaining cancer cells cannot survive the surgery or the environment without a prostate.   
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
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06

Posted 5/7/2009 8:39 PM (GMT -6)
Les, Roger, Ken and Squirm and others

Thanks again. It is very reassuring to hear from others who are in the same boat. Les's explanation was exactly as my Dr had stated to me about a positive margin. Ken I will keep you posted on my path.

Jon
age:  44
1st psa Apr 08 3.06
2nd psa 6/16/8 4.02,  DRE showed nothing abnormal
biopsy 7/10/08 positive 5 of 12
Da Vinci 8/04/8 Parkview Memorial in FT Wayne IN 
gleason 3 + 3 = 6
prostate 27 g, 4 x 4 x 3.1 cm
Stage:  pT2cNXMX
margins:  apical margin involved
no extraprostatic extension of tumor
seminal vesicle involvement: absent
3 month psa  0.11, 11/08
6 month psa 0.12,  2/09/0
9 month psa 0.13, 5/01/09
 
 
 

Posted 5/9/2009 9:45 AM (GMT -6)

CaPCA

hi have a look at this link about when surgical margins are positive


Age 61 at DX
Biopsy 7/2008 Positive 1 of 12 cores positive 3+4 5% To 10%
Open Radical Prostatectomy 15/10/2008
Stage pt2c
Post op staging Gleason's Score 3+4=7
apical margin is focally positive
no extraprostatic extension
Seminal vesicles and lymph nodes clear
Catheter out on the 13/11/2008
4 week PSA < 0.1
26/1/2009  < 0.1
20/4/2009 < 0.1
 
 






Post Edited (6071) : 5/10/2009 2:01:59 PM (GMT-6)

Posted 5/23/2009 8:17 PM (GMT -6)
All, my surgeon suggested that I meet with a rad oncologist who specializes in prostate cancer. I concur. Dr said that even though my numbers are close together, each subsequent has test has risen. I meet with rad oncologist on June 1st. I will keep everyone posted.


Thanks
age:  44
1st psa Apr 08 3.06
2nd psa 6/16/8 4.02,  DRE showed nothing abnormal
biopsy 7/10/08 positive 5 of 12
Da Vinci 8/04/8 Parkview Memorial in FT Wayne IN 
gleason 3 + 3 = 6
prostate 27 g, 4 x 4 x 3.1 cm
Stage:  pT2cNXMX
margins:  apical margin involved
no extraprostatic extension of tumor
seminal vesicle involvement: absent
3 month psa  0.11, 11/08
6 month psa 0.12,  2/09/0
9 month psa 0.13, 5/01/09
 
 
 

Posted 5/24/2009 9:08 AM (GMT -6)
Dear Cave88
I also had a positive margin as a result of my surgery. PSA was low until a year and then it started to rise as you can see by the signature. I opted for IMRT and will start next month. My Rad oncologist recommends adjuvant therapy for all patients with a positive margin as a precaution. Lots of guys here have been through it so you will get plenty of good advice if need be. Good luck and God bless.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable
03/02/09- 1 yr. post-op PSA .09 Undetectable
05/13/09   PSA .18 (ouch)
Start IMRT June 3, 2009

Posted 5/24/2009 11:44 AM (GMT -6)
Sorry I missed this thread earlier...

You're doing exactly what my doc told me....go consult with a radiation oncologist to get the lay of the land. .2 on PSA rise after surg. is a good line in the sand to draw, in my opinion. It COULD be just residual tissue, and I've heard of it junping around with a true recurrence. My signature tells my stats--- glad I did what I did. Good Luck!
Sterd82
Age 49 - pre-surgery PSA 39 (at age 45)
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
PSA as of November 25, 2008 undetectable
PSA as of May 22, 2009 undectable

Posted 5/24/2009 4:35 PM (GMT -6)
Hi Jon,
Good to see you back. That is a very slow climb and radiation will likely knock it out. But you might want to ask if a short stint on HT might help. Some exciting new studies are showing that RT and HT after surgery are offering the best results in these cases. And don't worry about contributing. Just by returning with an update you are helping many. I think most will agree that it's your story that helps most. Thank for being here!

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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

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