Ultra-sensitive PSA - tendency to bounce up after surgery even with no eventual recurrence?

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CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 5/13/2009 4:07 PM (GMT -6)   
I have noticed, after following a number of signatures from other members, that the lowest ultra-sensitive level is achieved on the first test after surgery. This assumes that sufficient time has elapsed to to allow for the prostate-generated PSA to decay away. Some men eventually experience a biochemical recurrence, reaching 0.2ng/ml. However, this seems to be true for many men who probably will never have a recurrence. Levels seem to go up a bit from the post-surgery test, plateau, or move back down. Some men are lucky and see a steady sequence of levels over time. However, I don't think I have EVER seen a decay down from the first test, e.g. 0.04, 0.02. 0.01, etc.
 
This is by no means a scientific observation. I was wondering if anyone else has noticed this and whether there is a medical explanation. I know of the "bounce" from radiation treatment, but I have not heard of a "bounce" described for surgery. I thought I had read a one time that the prostate not only produces PSA but absorbs some of it as well. This might explain explain why the loss of a prostate lets other minute sources of PSA (Cowper's gland, etc.) become more apparent over time. Thoughts?
 
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
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/13/2009 4:10 PM (GMT -6)   
CapCA,

I hope that is true in my case too when they retest me in 5 1/2 weeks. The first one was .05 and now this one was .10. I keep hoping it was some kind of testing bounce, seems so soon if it is a real rise after only being 6 months out of surgery with a very clean post surgery pathology report.
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, 5/9 .10 doubled in 3 months, new test in six weeks, then possibly off for salvage radiation
 
 


cave88
Regular Member


Date Joined Jul 2008
Total Posts : 76
   Posted 5/13/2009 8:21 PM (GMT -6)   
CaPCa,
Good question. I was wondering the same. As you can see from my signature my psa is rising ever so slowly but rising. What would cause the psa to start going down?
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
 
 
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 5/14/2009 7:53 AM (GMT -6)   
CaPCa...great question and you are right...I hadn't noticed before...good observation. Will watch this thread to see what becomes of it.

Cave88...your post PSA tests are higher than what would be expected for surgery...are you considering any followup treatment?
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


Pelahatchie
Regular Member


Date Joined Jul 2007
Total Posts : 86
   Posted 5/14/2009 2:47 PM (GMT -6)   
It seems to me if you are lucky enough to achieve <.01 at six weeks after surgery then you are in very good shape and will stay that way.  Anything above that seems to be a crap shoot which leads me to the theory that in alot of these cases there was prostate tissue left behind, not necessarily cancerous.  I believe the big downside to robotic or other nerve sparing surgeries is the tendancy to leave tissue behind in order to spare the nerves which is great for your sex life but problematic for future psa testing.
Age 45 at DX
 
DX 8/05 Gleason 5, Mayo clinic Second Opinion Gleason 6, PSA 2.8
 
Da Vinci surgery Dr. Dasari, Centennial Nashville 9/24/05
 
Pathology Report Gleason 6, 15 % on left side only very near to the edge of capsule, too close to call on margins, doc's said to watch it very closely, final decision T2A
 
PSA's have basically ranged from <.04 to .05 for two years.
 
no E.D. and no Incontinence, feel very blessed
 
PSA Nov 07 = .06
 
PSA Dec 10th 07 =.07
 
PSA Jan 4th 2008= .1
 
Started Guided IMRT on January 7th, 2008 to treat prostate bed and lymph nodes, completed on March 6th, 2008
 
PSA April 18th 2008 =.03
 
PSA August 18th 2008 = .01 or less, test only goes down to .01


CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 5/15/2009 10:04 AM (GMT -6)   
Dr Scardino's book has a line (I'm quoting from memory) to the effect that only half of the men who reach 0.2 ever actually have a clinical recurrence. Sorry, I don't have the book with me.
Larry Shick
Personal homepage incl. PCa story: www.sv-moira.com.
01/09: Diagnosed (age 60) biopsy PSA 4.4, free PSA 9%, T2c stage, Gleason 7 (3+4), 7 of 14 cores; 6'2", 200 lbs.
03/09: Robotic surgery (Dr. Kawachi, City of Hope) 47 gms, 10% involved, staging/Gleason unchanged (pT2cNXMX), margins clear, no ECE/sem ves involvement, fully continent from day 1, some success w/Viagra 50mg/day.
Followup: 05/09 0.006


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 5/15/2009 11:05 AM (GMT -6)   
My father's first post op PSA was .07 and his second one a few weeks later went down to .05. However, they were done at two different labs, so it is possible the differences in labs resulted in the difference in PSA . Of course, I am hoping it was because his PSA went down because he was not even 12 weeks post op. He started radiation and HT shortly after, so we don't know what the third would have shown. Interesting topic. I am also interested in the timing of the first post op PSA's and whether the 6 week vs. 12 week post op PSA's really make a difference.
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


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 5/15/2009 10:41 PM (GMT -6)   

In the medical papers and abstracts I have read, a distinction is made between "biochemical recurrence" (BR), "local recurrence" (LR) and "distant metastasis" (DM). LR and DM are a subset of BR. I believe BR is generally defined as a post-surgical PSA of 0.2 or greater. Clearly then, the medical community has identified that BR does not always result in LR or DM. I assume that the cases of BR that do not progress are identified by a PSA which stabilizes or drops at the 0.2 level. This would be consistent with what Larry reports from Dr. Scardino's book.

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
 


laughingagain
New Member


Date Joined Oct 2009
Total Posts : 12
   Posted 9/29/2010 3:50 PM (GMT -6)   
CapCa:
 
Wondering how your psa is today?  I am very worried about my dad. My dad's post surgical psa reading have been similar to yours.  His post surgery psa was <.01 until 18 months after surgery.  At that point it was .01.  Stayed there for 6 months until 5/10 at which point it was .02.  He is being re-tested in the next couple of weeks, but my anxiety is high.  The oncologist thinks it may be a recurrence - his surgeon disagrees.  I am praying that your psa has remained  stable. 
 
Laughing Again.
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