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gregory m helman
New Member

Date Joined Oct 2009
Total Posts : 16
   Posted 10/30/2009 7:46 PM (GMT -6)   
hello every one on the board, i am new on the board.
i had perineal prostate surgery, which i could not have it done any other way due to scare tissue and mesh from hernia surgery.
my psa was.95 before i had a biopsy. my family doctor did a exam and found something on my prostrate so he sent me to a uroligist and had a biopsy. the gleason score was 3+4= 7. so i had it psa after six weeks was at 0.55 and month later it was down to 0.39. had it checked 2 days ago it is now 0.44. my surgeon says if does not fall to 0.20 or less , i must have a radiation of the pelvis. now this scares me, would they have to find it first before they start zapping with radiation.i go to see a radiation oncologist monday and have a talk with him. i had my last psa done at my hospital instead the hospital i had surgery at. do you think the 2 hospitals would have 2 different readings?.i will have it checked on monday when i go to see the radiation since i had this surgery they couldn't take the lmph nodes out.they thought it was confined to the prostrate, now they think it might not. the surgeon thinks it might take several more months to see no reading . i am not going to jump to conclusions until i see the radiation oncologist. i think it should have dropped lower or have no reading at all. i guess you can't go by a psa reading like in my case. low reading and then found something on my prostrate. i get a routine physical every year and can thank my family doctor on finding this.

Veteran Member

Date Joined Jul 2009
Total Posts : 1267
   Posted 10/30/2009 8:20 PM (GMT -6)   
Hello Gregory, there are a number of members here who are pretty sharp on PCa and I'm sure will be able to give you some good advice. But, I did want to welcome you and say while I'm sorry you have to be here, I'm glad you found us. I'll be watching this thread to learn more myself.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09  0.02
Oct 1st 09 -- dry at night, during day some stress issues, but better every week. 
Feel free to email me at:    

Regular Member

Date Joined May 2009
Total Posts : 215
   Posted 10/31/2009 7:33 AM (GMT -6)   
Hey Gregory,

Welcome to our group. I am sure that there will be some excellent replies to your post and you will gain some knowledge from the collective experience of the members here. Keep us updated on how things are going and we will be here for you.

Keep well,
Age 64. Diagnosed with Pca January 2009.
PSA 5.6, Gleason 3+3=6, T1c
TRUS biopsies of prostate left adenocarcinoma of prostate involving part of 1/4 biopsy fragments, less than 10% of the surface area involved, CT scan clear.
Treatment choice:
Robotic Assisted Laparoscopic Prostatectomy - September 29/09. 
Pre-op PSA down to 5.28 which I attribute to visualization techniques and a new vegetarian diet.
Robotic Prostatectomy - 09/29/09, back home 10/02/09.
Pathology - 10/14/09  Gleason Score remained at 3+3 = 6 as it was when originally diagnosed. There were no positive margins. Tumors were found in both lobes and involved 3-5% of the prostate. There was no Seminal Vesicle, Perineural, Lymphovascular or Lymph node involvement, and the bladder neck was also cancer free. 
10/16/09 - 3-4 pads a day and working on pelvic floor exercises as prescribed.
10/16/09 - Zip, nada
State of mind:
Excellent - always positive.

Veteran Member

Date Joined Aug 2009
Total Posts : 2448
   Posted 10/31/2009 7:54 AM (GMT -6)   

I would like to add my welcome to you from us here at HW. I am just 6 weeks post surgery myself and beginning to watch the follow up PSA tests to see if further action is required. There are a bunch of knowledgeable folks here who have traveled the same path as you and I am sure they will be along shortly.

In the meantime it will help in the discussions if you can arrange your information and test results the same as we all do here, in our signature lines.

Welcome and bless you and your family,

61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

da Vinci 9/17/09 Dr. Mani Menon Henry Ford Medical Institute

Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
Margins: focally positive right posterior mid level
Perineural Invasion: present
Seminal Invasion: absent
Venous Invasion: absent
Angiolymphatic Invasion: absent
Left Internal iliac lymph node: reveals zero
Right Internal lymph node: reveals zero

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 10/31/2009 7:01 PM (GMT -6)   
Hello there Greg and welcome to the forum.
Ideally following prostatectomy PSA should become undetectable (written as <0.1 Ng/mL or lower). Are you sure on your initial figure as 0.95 seems somewhat low to trigger a biopsy. It always pays to get copies of all reports you are given and maintain your own file. It is amazing how numbers get jumbled with the passage of time when we are faced with so many of them. There are various explanations of why your readings may not have become undetectable from the surgeon leaving behind some benign prostate tissue to the tumour being outside the gland. The PSA levels should indicate what may be going on. If it begins to increase then the rate is an important indicator. Don't get in a knot about the radiation. It is not an uncommon follow up procedure and many members chose it as their initial treatment. Please ask any questions you may have and a great crew will provide answers. Remember, knowledge is power with this disease and the more you have the better you will feel. We all came here anxious and worried and I will guarantee that after a week speaking with others on the same road as yourself you will fell better. You can set up a signature of your journey by going to "control panel" (top left of this page), then to "edit profile" on the page that comes up. Put your journey info in the signature at the bottom of that page and hit "submit". Stay with us, you will find it invaluable over the coming months.
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01

Post Edited (BillyMac) : 11/1/2009 1:59:49 PM (GMT-7)

gregory m helman
New Member

Date Joined Oct 2009
Total Posts : 16
   Posted 11/1/2009 1:53 PM (GMT -6)   
yes my reading of psa before biopsy was family doctor did a rectal exam and said he felt something on he sent me to a urologist and felt something and not sure. so he did a biopsy. .i need to get biopsy report from urologist and give you the summary.
the urologist said my in my best intrest is to have the prostrate removed.he found some cancer when tests results came back.
psa readings before surgery .096.
post psa 6 weeks----- .055
month later -------.039
6 weeks-------.044
will get reports  soon and post

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 11/1/2009 3:57 PM (GMT -6)   
Wish you do well, you mentioned that your doc says "if" psa is too high..then you "must do radiation"....what it this guy the soup ****????? Nobody has to do any protocol and can choose alternatives and choices, even death or whatever. For anybody herein, don't let any one particular doc tell have to do anything (B.S.), get other opinions and choices looked into. He might suggest you do...yada-yada-yada and you can think about such and contemplate what you wish to go through or choose. Only you walk the walk, it is solitare man after the 'works are done'.
You could even choose another doc that does the same proceedure, because that is your right and choice and for whatever reasons you want to put on it, you are hiring someone....they should never dictate anything, of course you could say "Hile" when you walk in the office which is another choice you have, I fired a couple of docs along the way and loved it 100%...they found out about side effects=less money or no cash cow when patient says bye-bye
:-) :-))

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2461
   Posted 11/1/2009 6:22 PM (GMT -6)   
Welcome to the forum. When I had my surgery, my Urologist told me that it takes 8 weeks before your pre-surgery PSA is flushed out. 8 weeks after surgery your PSA should be <.1, anything higher than that is a sign that there is still something left behind. As far as getting radiation, that normally is what is recommended as long as you consult with a prostate oncologist and a radiologist.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1

gregory m helman
New Member

Date Joined Oct 2009
Total Posts : 16
   Posted 11/1/2009 7:22 PM (GMT -6)   
i  will see a radiation oncologist tomorrow and will see what he has to say.
i will a have my psa checked again also . now at 0.44
its been 3 months since surgery. surgery on july 29th.
what is involved when doing spot radiation.they are talking about doing the pelvic area.
don't they have to locate where the cancer is before the start this procedure?.
after the visit , i will get a 2nd opinion, i don't want to jump into anything and don't want to wait to long.

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 11/1/2009 9:33 PM (GMT -6)   

You just raised the most logical question in the jungle of PCa? Where is the PCa so they can zap it, defeat it or such.  This is the real skinny, salvage radiation is a crapshoot at best, they do not know where the cancer is and so you get a generalized pelvic area that is considered safe to radiate and in some cases does the magic the patient is looking for, but in plenty of other cases it does not lead to overall cure. I believe salvage radiation cure rates are less than 50/50, if someone wishes to post a referrence it might be worth looking at, although alot stats are skewed or only measuring 5, 8, 10 yr. periods and other variables.

They cannot detect very small amounts of PCa with current technology. Alot of good hot air spent on ct and bone scans, which is nice to hear you have a clear scan, but it is not a guarantee. They cannot detect micro mets or small clusters of PCa cells that are say 1-billion or less, they don't show up on machines we currently have. This is not what anybody with PCa wants to hear, however it is the truth of the situation and even though many docs will elaborate on how wonderful there machines are at detecting(very costly tests too)....they are not wonderful enough and you don't have to take my word on it. But, do research this area before you decide what course of action you are taking. Not saying don't do or consider such, just analyze is this want you want to persue and know it is not guaranteed at all. There still is hormone therapies, drugs of a variety of types, more than many uro-docs ever mention or even know about (see onco-docs), as further ways to fight this and have some reasonable success at living a longer span.

You are prudent in not rushing into anything, rational judgements are a process and not at a whim. If your psa was to rise seemingly fast you can take drugs like casodex, zoladex, lupron, eligard, flutimide and others that will keep the PCa at bay while you make a decision on a modality.  Don't be shy about challenging your docs statements or getting second opinions, patients are at a huge disadvantage when placed into this arena. 
 (Dx-2002 with literally terminal scenario type stats, total urinary blockage etc., I have managed to do well thus far, fired a few docs along the way thing I ever did)

Post Edited (zufus) : 11/1/2009 7:55:56 PM (GMT-7)

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 11/1/2009 9:53 PM (GMT -6)   
zufas, you are exactly right on this question. It's an educated crap shoot at best. The remaining cancer cells don't glow in the dark, no current means of testing to show location. In my own situation, due to sharp PSA velocity both pre and post surgery, my own radiation oncologist puts the odds of my salvage radiation working in the 30-40% range. I don't like those odds, but willing to gamble and hope for once in the Game of PC that I can be on the "good" side of percentages. If it doesn't work, at least I know I tried. Now what this doctor did do, was to study my pelvic bed from a large number of scans, and studied my surgical notes in great detail, and with the IMRT planning, tried to recreate exactly where my prostate was extracted and based on that, tried to concentrate where the one itsy bitsy tiny positive margin was noted. She showed me on the radiation machine, how it creates a 3-d zap of my non-existing prostate gland. Will it work, jury is out for now. I am only halfway through my treatments, and always dealing with unpleasant side effects.

The point: we need much more advance testing tools. Things that don't even exist currently.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 11/1/2009 10:10 PM (GMT -6)   
(Purg)-Dave I hope it works for you, a man has the right to know all the parameters and what he is facing before making a huge decision. Sure we all take some gambling on what we do to fight this disease or try to cure it. Might as well stack the deck in our favor if at all possible or atleast know the game.

Greg best to you, learn all you can...books, internet etc. Recommend Dr. Strums book-A Primer on Prostate Cancer (has helped me immensely and empowered me more than I can believe)

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 11/2/2009 1:04 PM (GMT -6)   
What was the final pathology staging after surgery? And I am just curious about the size of the prostate removed. The reason for my question, I have heard of cases where the surgeon did not remove all of the prostate tissue during the procedure. It sounds like you had extenuating circumstances as well before he began the procedure from the hernia repair, and I wonder if that resulted in only a partial removal.

Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
Hormone Therapy May '07 to September '09 ~ Currently off.
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (October 7, 2009): <0.1

My journey is at:

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


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