Question on Cancer Recurrence

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Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 8/3/2009 11:05 AM (GMT -6)   
 
This may be a stupid question but I cannot find any information on it anywhere.  If my path report which has been reviewed by 3 separate Pathologists all state the my cancer is a Gleason 8 but was contained within the prostate no sign of it getting out anywhere, margins all clear and lymph nodes all clear stage T2a.  Why would there be a possibility of the cancer recurring.  My PSA after 9 months went from 0.0 to 0.1 and all the doctors say not to worry still undetectable but why would PSA still be in my body if the cancer was contained.  I understand it is possible to have cancer in a different part of my body but not prostate cancer.  Am I right or am I missing something.  How would the PSA cancer cells get out if everyone including John Hopkins say it was all contained?  I would appreciate any insight to try and understand what I may be dealing with.
 
Thanks,
Jerry1   

Age 69
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  3+3= 6 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
6/12/09 new gleason score of 4=4
Developed stone in bladder may require surgery
 


CapnLarry
Regular Member


Date Joined Apr 2009
Total Posts : 75
   Posted 8/3/2009 11:28 AM (GMT -6)   
…”10 percent of radical prostatectomy patients whose cancer appears to be confined actually have microscopic metastases that were not detected…” (Scardino & Kelman, p. 265). So even though everything looks good in the pathology, some of the stuff may have escaped and taken up residence elsewhere.

PSA may also be generated by non-cancerous prostate cells that have been left behind.

As it was explained to me by my surgeon, while the pathology report is a useful indicator, the only way they really know that they got it all is to watch the PSA.

Good luck.
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: <0.01 at 05/09, 08/09


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 8/3/2009 11:38 AM (GMT -6)   
It is not quite right to think of PC as some sort of creeping vine that always has to be connected to its roots. Loose cancer cells can drift out of the prostate. The most likely place for them to lodge other than the lymph nodes is in the prostate bed which is why that is the most frequent target for salvage radiation.

You are correct that a good path report like yours suggests a lower probability that any cancer cells have escaped.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 8/3/2009 12:13 PM (GMT -6)   
I think I have read somewhere that there are other glands that contribute to PSA, while of course the predominate one is the prostate. That is probably why most doctors use the 0.2 as the determining factor of recurrence and other docs use the rule of thumb of three consectutive increases. So while you rose to that 0.1 mark only after 9 months, I would watch to see what it does closely to see if there will be an additional rise in the coming months.

Factors to consider if you have subsequent rise in PSA...the velocity and the doubling time along with the amount of time since surgery. Those factors can often determine if the recurrence is local or distant and what the best treatment plan should be.

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 Apr 2009 .06
                   9 month Jul  2009 .08


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 8/3/2009 12:22 PM (GMT -6)   
Gleason 8 is the other big reason. Gleason 8 ,9 and 10 ( if there is one) are particularly agressive. A couple of cells wandering around csn start a whole new colony somewhere, and apparently statistically do.

That is why many oncologists are recommending adjuvant radiation within 4 months if the gleason is 8 or above, based purely on reocurrence rates of those groups with agressive Gleasons.

I am in that class as well. Having a hard time convincing myself that radiation is worth it with a 0 PSA. I am getting rechecked every 3 months for now.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 8/3/2009 12:38 PM (GMT -6)   
 
Thanks to all of you for the information.  Like I tell my wife once you have cancer it is always there no matter what they say.  My doctors do not recommend radation at this time unless my PSA continues to rise.  I will be going again in 2 months for my 12 Month PSA and hope it stays at 0.1.
 
Jerry1
Age 69
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  3+3= 6 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
6/12/09 new gleason score of 4=4
Developed stone in bladder may require surgery
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/3/2009 1:43 PM (GMT -6)   
Jerry your current stats are much like mine, except for I am a Gleason 7, not an 8 like you. I don't want the radiation unless reaccurance is really there. Rather hold off on that "gun" until when and if it is really needed.

Good luck to you.

David in SC
Age 57, 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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, again
 
 


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 8/3/2009 2:45 PM (GMT -6)   
Since the sensitivity of the test is 0.1, a jump from 0 (or <0.1) to 0.1 could be very insignificant. If it keeps rising beyond 0.1, then you can start worrying, but not yet... I hope you will not need to... Best of luck!

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 8/3/2009 9:21 PM (GMT -6)   
Could be a dyslexic lab tech too !
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 8/3/2009 10:08 PM (GMT -6)   
Hey Jerry,

Most doctors will never profess that they have cured a PCa patient. Microscopic cells do sometimes find their way out even in a "contained" pathological situation like yours and mine.

My PSA took a little jump as well (as did Purgatory's), so I understand your concern. In my case, the doctor believes that some benign tissue was left behind. Time will tell. In addition, a good doctor will watch you carefully and help with additional treatment options if necessary.

My PSA rise really bugged me for a few weeks, but seeing the strength of many good folks I've met through this forum has really helped me.

I hope you find comfort and I wish you the best in remaining cancer free.

Kind regards,

Barry
Da Vinci LRP July 31, 2007… 54 on surgery day
PSA 4.3 Gleason 3+3=6 T2a Confined to Prostate
6th PSA 06/09 still less than 0.1


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 8/4/2009 4:44 AM (GMT -6)   
Greetings, Jerry.  Unless you are having the ultrasensitive test and it is done by a very good lab tech, small changes can simply be changes in how they do it and no actual change in your PSA.  I think you are wise to continue to monitor closely and I know I would raise the red flag if mine went up even though I know that since my doc doesn't use the ultra sensitive that most likely it is nothing.  As we all know, once you have this disease you look at that PSA test every 3 months a little differently.  Please keep us posted on how the next one goes.  David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 8/4/2009 1:57 PM (GMT -6)   
The basic problem is balancing risk. On the one hand, treating when it is not necessary and exposing the patient to the risks of treatment and additional side effects. The other side is treating too late and exposing the patient to metastasis and much less successful and more aggressive treatment and harsher side effects. Short of having a crystal ball, no doctor can advise you accurately on what to do or even the probabilities that you as an individual face.

Listen carefully, seek multiple opinions, and weigh your own preferences.

For the present -- watch your PSA and hope that you don't have to confront this.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads

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