Results of the dreaded Nine Month PSA test

I was suppose to call my dr later today for the results, but the person at the lab that read it called me directly right around 0800, kind of surprised me.  It rose over the course of 71/2 weeks from .11 to .16.   That is a rise of .05.

I still have an appt. I kept open till I got the results with a Dr. Duncan, the Radiation Oncologist I was suppose to meet originally some weeks back, but was unavailable at the time.  I guess the wise thing is to keep the appt with him this Friday afternoon.

Its looking more and more like reaccurance to me. :(

Until they can fix my blockage problems, can't move on ahead with radiation anyhow.

So, guys, give me your gut and off the cuff opinions with my post surgery psa readings.  Friday will mark 9 months to the day since my open surgery.

I will update my signature next.

David in SC, disapointed, but not totally caught by surprise

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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, corrective laser surgery scheduled for 8/18

 

Certainly is getting complicated, David,
But I agree with Galileo, you have time to try to get a handle on the blockage issue first. I believe that it is recurrence as well, as you have had three consecutive increases in PSA, the PSA is above undetectable levels to most Assays, and you had a positive margin. It is very probably that is it local recurrence, but since you are in a wait mode, perhaps asking if better imaging is a good idea. JohnT swears by it, and this could be a good call to see if you can get it done...

Tony

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 Age 47 (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  

My InfoLink page is at Tony's Prostate Cancer InfoLink Page

STAY POSITIVE!

David, Your results closely approximate mine. Except for urinary complications. By the time you PSA reaches 0.2 (a most accepted definition of recurrence) you probably will be at 1 year mark. From what I read, local margin, undetectable post-op PSA and a year+ to recurrence make local recurrence very likely. That means radiation. But the longer you wait, the more chances for it to spread beyond prostate bed. So, my off the cuff non-medical advice is to slow cancer down with short term HT, especially since there is research that suggest better salvage outcomes. That buys you time to take care of your urinary issues AND improves the probability of positive outcome from salvage. 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

David,

Not trying to put a damper on things...but just because you will get the cath out after your upcoming surgery two weeks later doesn't mean you're healed enough for radiation treatment...at least in my opinion. Ask the oncologist this Friday his take on your particular situation, because it is certainly not a normal one by any means. Geebra made a great suggestion about the HT as a temporary...something like six months maybe to keep the PCa at bay until you are healed enough for that second shot at a cure. I know it isn't any fun (HT), but going into radiation while healing could cause greater issues.

I know you hoped for better PSA reading, but it did move significantly up enough for any doctors protocol as a recurrence.

Best of luck to you in this new unexpected journey

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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

Hi David:

Sorry about the PSA rise...I was hoping for better and I know you were also!  Most suggestions at this point are beyond my area of expertise so I'll just stick with support.  I'll pray for successful treatment of your blockage, a swift recovery from that and that you find the right choices as you move to the next step of this journey.

Best regards,

Tudpock

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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 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

Tudpock's Brachytherapy Journey: https://www.healingwell.com/community/default.aspx?f=35&m=1305643

Hi David, Away from home and office at the moment. Just had a peek here. Sheesh...not what any of us wanted to hear. The other posters are right in saying you have time to get the urinary block under control and heal a bit from that. And I was pulling really hard for you today too!!!

As always, you'll be in my thoughts.

Talk soon.

Mike

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-Hernia, mesh and large scar, surgery early 2006

-Nov/Dec 07, March 08 and Dec 08: Severe perineum pain . Septra/Bactrim for 8 months for diagnosed prostatitis.

-PSA start of 2008: 5.3..... PSA June of 2008: 7.3

-14 DRE all benign or nothing felt

-TRUS Biopsy Nov 08: 5 of 8 cores positive GS 3+3 or 6. 30-65%. Perineural invasion.

-General Health: pretty good, 5' 10", 180 lbs, slim.

-Bone scan Dec 08: Negative

-Barium enema X-ray March 09: Small diverticulosis

-MRI with endorectal coil (April 09 as part of a study)

-3D advanced TRUS (April 09 as part of a study)

-CT (April 09 as part of a study)

-Open RP surgery: May 09 both nerve bundles spared. Bilateral lymph node dissection performed. Discharged 48 hours after surgery.

-Post Surgery Pathology: pT3a N0 MX, extraprostatic extension (EPE), stage III prostate cancer, lymph nodes clear, seminal vesicles clear, Gleason upraded to 3+4 GS 7. EPE within surgical margins. Other than prostate and EPE, all tissue removed negative for cancer involvement.

David,
You may want to talk to your Dr about taking Casodex while you are waiting to heal. It should stop any futher progression and the side affects are pretty mild. Loss of Libido, minor hot flashes, but mine went away after about 2 months. Also ask your Doc to give you Femera with the Casodex to prevent any breast growth. The Libido loss goes away as soon as you stop taking the drug. It should also make the radiation more effective.
with any reoccurrance I would also get an opinion from a good oncologist to see what he might. recommend. With such a low PSA I don't think a scan like an MRIS would see anything, but I could be wrong.
JohnT

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64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT

les, you make a good point on the healing part, right now, there's no part of me thinking about HT, but reality may have to change my mind, i will bring the rad. oncl. dr. up to speed and see what he thinks about that

squirm, never thought of the proton thing in my case, will put that in my brain file

thanks bro tud, mike, and david/cpa - i can feel the concern

magaboo, you care and concern is good enough for me, thanks

johnt - good suggestion, but this may sound superficial on my part, i am one of the few surgery pc guys that had zero ed after surgery, and thats with only one nerve bundle, i would hate to do anything to end the little bit of sex life i have left. who knows, after radiation, i may never peform on my own again.

Thank you too, bro. jeff for your kindness.

Got lots of things to think about, but hey, another blinding bladder spasm is tearing into me even as I type. Life gets gooder and gooder.

Sure glad to know you are all out there.

David in SC

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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, 8/9 .16

Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18,

meeting with Rad. Oncl on 8/14 about lastest PSA

 

thanks dale,

the one thing i have learned strongly in the past year of my life, is that PC doesn't play fair, and it really is an evil class of cancer, not to say that any cancer is good. but with many cancers, once its gone, its gone, and that s all there is to it. The other thing, is the infinite amount of variables when dealing wiht PC, what is normal? Is there anything normal or consistent about it? I think I met those as retorical only.

i feel like my stats are forcing me into action i really dont want to take. when it came to the dx and the primary treatment of surgery, i was enough of a number's person to think that really had a shot of knocking the PC out of the ball park on the first pass. my life has adjusted to the side effects, and that is now my new normal and reality. i sense that if i am pushed into the salvage radiation route, then the playing field is going to change once more, and then, of course, what if that doesn't work either? yes, i know i am getting ahead of the game here a bit. but being a former chess pro, i am use to thinking about things many moves ahead of where i am at, but with PC, that is grounds to drive one insane with worry, fretting, and endless what ifs.

right now, this stupid catheter hurts like the hades, i am sick of it, it annoys me endlessly. i have to make it to next week, and then really really trust my dr/surgeon with his laser skills . weird to think that after i am knocked out, they will scope me again, dialate me once again to make room, have video capabiltiy, and still have room to move in the laser surgical equip, all in a tube that fits inside my urethra which isnt large in diameter to start with. i am hoping and praying that it doesnt make me start at square one on the incontinence trail, since i have been 100% dry for some months, or worse, leave me that way. and i hope that my future pee flow will at least somewhat resemble what i had before all of this.

sorry for the rambling, but lot going on in my head right now, its surprising that i am not a drinking man or a user of illegal drugs, i deal with all this unpleasanty being completely straight. perhaps i am the fool for that standard.

but i will keep up the good fight, as long as i have the ability and mindset to do so, which i am hoping will be many more years.

david in sc, deep in thought tonight

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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, 8/9 .16

Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18,

meeting with Rad. Oncl on 8/14 about lastest PSA

 

David; you are in my prayers.

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Open retropubic prostatectomy 12-15-2008

Catheter removed 2 weeks later, no leakage problems

Margins clear, nodes clean

Return to work 6 weeks post-op

Resumed regular workout routine 8 weeks post-op

Taking Cialis daily

Age  55

pre-surgery PSA 9.04

3 month post-op PSA 0.07

thanks bob and down not out, every kind word helps

david in sc

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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, 8/9 .16

Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18,

meeting with Rad. Oncl on 8/14 about lastest PSA

 

David,

Nothing to say that hasn't already been said. Just know that I like everyone else is pulling for you. Just reading through this forum can give us hope seeing guys who have been beating this monster back for years. Your gun is not out of bullets yet.

With my Gleason 9 I am watching your progress closely, because I fully expect to see a very similar path. I see BARR posting PSA rises after 12 years, so with my G9, I will not be surprised.

In spite of your modesty, your sincerity, and transperency really does help us all. Like all of us, there are times I am sure you just want to be alone and cry, but you continually tell us what you are feeling and thinking. Thank you !

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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)

Hello David,

I really do not have any advice to offer. Just wanted to say that I have been following your posts here. I sincerely hope that things turn around for you and soon. Keep your spirits up.

Don

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Diagnosed 04/10/08 Age 58 at the time

Gleason 4 + 3

DRE palpable tumor on left side

100% of 12 cores positive for PCa range 35% to 85%

Bone scan clear and chest x ray clear

CT scan shows potential lymph node involvement in pelvic region

Started Casodex on May 2 and stopped on June 1, 2008

Lupron injection on May 15 and every four months for next two years

Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled

First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.

Last 20 to prostate only. Total dose to prostate 81 Gray.

Completed IMRT/IGRT 09/11/08.

PSA 02/08 21.5 at diagnosis

PSA 07/08 .82 after 8 wks of hormones

PSA 10/08 .642 one month after completion of IMRT, 6 months hormone

PSA 03/09 .38 six months post radiation and nine months into hormones 

PSA 06/09 .36 or .30 depending on who did the test