test or not to test

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Regular Member

Date Joined Oct 2009
Total Posts : 22
   Posted 11/8/2009 1:01 PM (GMT -6)   
 This was subject was brought up elsewhere, and to keep that thread from getting off track I'm starting a new one. It was asked why my doctor is waiting so long after surgery for my first psa test. This was corrected later, as it is in the 3 month period. Now this would not be any big deal except, I have been wondering myself why I'm not being tested before this time. I know that different case require different approaches to testing. But I also see where the cases are close to the same doctors have varied on testing times. In my case my doctor whats to meet with me and do the first test at his office in January, and because we live quite a distance from there the following tests will be done with my GP. There seems to be alot of guys here that are being tested at 6 weeks, so I'm thinking I want to do this with my GP, as this would establish a base line with his lab. ( and maybe some peace of mind) But if the psa level is still going down the test may not be anygood anyway. Also this would put tests at 6 weeks, 13 weeks, and 18 weeks. I'm thinking this may be over doing it.
Thoughts anybody?
Also thankyou billymac and everbody else here for keeping your eyes open for thing that may seem odd. People helping people to the best of their ability is what makes this place great. 
age 46
diognosed age 45
PSA 3.9
preop and postop gleason score 3+4
daVince robotic surgery at Fremont area medical center, Fremont NE, 9/30/2009
stage T2c
involvement 2%
perineural invasion focal
extraprostatic extension, seminal vesticle, and lymph nodes negative
apex margin negative
peripheral margins positive, left dorsolateral 0.8, and 0.3mm, right dorsolateral 2.0mm

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 11/8/2009 1:28 PM (GMT -6)   
My uro's standard is to do the first post-surgical PSA at 3 months. On the other hand, given your pathology, there is probably no reason not to have your GP do a 6 week test just for peace of mind.

If that comes back low, then I would wait for the three month test -- there is little to be gained by more testing if you start at zero. If the 6 week comes back at an uncomfortable level, then you probably need an appointment with a radiologist who can decide on future testing and action.
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
6 mo. PSA 0.00 -- 1 light pad/day

Veteran Member

Date Joined Aug 2009
Total Posts : 2448
   Posted 11/8/2009 1:30 PM (GMT -6)   

I can only speak from my own experience as a baseline. My surgeon (very respected in the PCa community) was located in Detroit. I live in Orlando. He sent me home with orders for a PSA test at 30 days from surgery and a return to Detroit at 4 months following surgery.

My 30 day test came back a 0.4, and I was a little disappointed. The many knowledgeable and more experienced folks here said that 30 days may give a false reading because of the possibility of PSA still in the blood stream in just 30 days. I called my doc and he kinda said the same thing and we would know more at the 4 month mark.

Personally I could not wait for the 4 month visit, so last week I called my GP and had orders written for the Ultra Sensitive Post Surgery Test to be done. This would be at 7 weeks and 1 day. I should get the results back Tuesday.

This was just for my own piece of mind. It is what it is, but I just want to know.

Anyway, that is my take on handling the time frames and taking personal charge of it for my own piece of mind.

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

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 11/8/2009 1:41 PM (GMT -6)   
My first test was at 6 weeks, then each 3 months for the next year, then 6 months during the second year. Mine has never varied from the standard .04. My GP says we will test each 6 months, the uro suggests yearly. I'll go with the GP and his 6 months until the 5 year mark.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, Bimix .3ml PRN or Trimix .15ml PRN

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 11/8/2009 1:48 PM (GMT -6)   
Go get a psa test anytime you wish from another source even if you have to pay for it.
What value should a patient place on peace of mind? Especially on something this important.
"Just do it"- Nike :-)

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4849
   Posted 11/8/2009 3:00 PM (GMT -6)   
To me ignorance was bliss. No test equals peace of mind scool
I bet if you took a survey - most guys here had their first test at 3 months.
Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 11/8/2009 3:14 PM (GMT -6)   
My uro/surgeon uses the old standard of post surgery psa at 3 months, 6 months, 9 months, and 1 year for the first year, and if one is still a zero at one year ,to move it to six months for the next year, then yearly after that.
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 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place

Regular Member

Date Joined Jul 2006
Total Posts : 202
   Posted 11/8/2009 5:03 PM (GMT -6)   
It depends upon what you need to sleep at night.  Personally, after the surgery I needed a break from the anxiety.  I wasn't anxious for that first PSA test because I didn't want to deal with it. 
It seems like 6 weeks is enough time for PSA to get out of your system, so a 6 week PSA test should give you relevant feedback.  If you want it.
PSA 5/22/06: 5.6
DaVinci surgery: 9/14/06
Gleason: 3+3
Organ confined, clean margins.
Both nerve bundles spared.

Veteran Member

Date Joined Sep 2009
Total Posts : 6090
   Posted 11/8/2009 5:34 PM (GMT -6)   
I think I'll split the difference and go for 9 weeks, but will check with doc, who normally does 6 weeks,than 3mos 1st year, semi till2 annually after , all based on stable lows. I have post op consult Monday , then backhome, in retrospect, it wasn't that bad!, gotta love selective memory!!!, Jack
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
11% of prostate affected. gleason 3+4, I suppose thats a negative

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 11/8/2009 5:44 PM (GMT -6)   
Following my surgery, despite the pathology I received my surgeon made no mention of whether adjuvent therapy was advisable or not. It was not till about 8 or 9 months later, following research, that I understood there was an argument for it being done as an precautionary addition to surgery. There have been quite a few studies that have pointed out the benefits of adjuvent therapy where there were doubts on margins. This is usually carried out at about the 3-4 month mark after you have well and truly healed from surgery. By taking a PSA at about 6-8 weeks you will establish a baseline PSA and then taking a couple of PSAs over the next 3 months may give you an idea of anything going on, allowing early intervention with additional treatment. My only concern when I read your details was that your first PSA was scheduled for what I thought was 4 months post surgery. Should this have a small reading then further PSAs over the following months would be needed to establish what was going on.
To me this is the real benefit of the ultra-sensitive test. But we are all different in how we react.......some don't want to know about testing and others want to know what's going on to the Nth degree.
But having said all that if you look at my case............. looking back, because of my pathology there was a very good case for adjuvent therapy being carried out, but as I have to date been undetectable at the ultra-sensitive level, it would probably be judged now, again with 20/20 hindsight, as being unnecessary. Then again, should I ever relapse, salvage therapy is still available. That's the trouble with this bloody disease.
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

My Journey: www.yananow.net/Mentors/BillM2.htm

Post Edited (BillyMac) : 11/9/2009 2:08:03 PM (GMT-7)

Regular Member

Date Joined Oct 2009
Total Posts : 22
   Posted 11/8/2009 6:49 PM (GMT -6)   
 I guess I'm one of us that has to know everything to the n th degree. Not a very patient patient so to say. But I also believe sometimes things can be over done, and a line needs to be drawn somewhere. Some of this anxiety may be because cancer has not been good to my family. mother with breast cancer,and is not doing very good, father with oral cancer, but is doing good, and a younger brother that died of testicular cancer.
age 46
diognosed age 45
PSA 3.9
preop and postop gleason score 3+4
daVince robotic surgery at Fremont area medical center, Fremont NE, 9/30/2009
stage T2c
involvement 2%
perineural invasion focal
extraprostatic extension, seminal vesticle, and lymph nodes negative
apex margin negative
peripheral margins positive, left dorsolateral 0.8, and 0.3mm, right dorsolateral 2.0mm

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 11/9/2009 9:23 AM (GMT -6)   
Brad...I have mixed feelings about having the 5-6 week test done. In my case it gave an indication that was different than the 3 month mark. I suppose peace of mind is good to have even if only for a short period of time, however there have been others that had a higher reading at 6 weeks than at the 3 month...go figure.

I know it is pretty much standard with positive margins to get tested at the 6 weeks, but I really think it is more for the surgeon than the patient. Even if adjunctive therapy is involved or recommended I think they usually like to have some healing take place from the surgery first...which is still 3 months after surgery.

Whatever you decide I am certain your doctor will go along with.
You are beating back cancer, so hold your head up with dignity
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
                 12 month Oct 2009 .09 

Worried Guy
Veteran Member

Date Joined Jul 2009
Total Posts : 3743
   Posted 11/9/2009 12:43 PM (GMT -6)   
I had a 6 week and a 3 month. The numbers were practically the same. (My presurgery PSA was 23 and I was a pT3a so that might have been the reason for the 6 week. Jeff
DX Age 56. First routine PSA test on April 8th: 17.8.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 10/31 3 months, Still no activity, nada, zip
Incontinence - 8/20 4 full pads per day
. 9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea. I know.)
9/17 2 months: Still 3 pads per day.
10/31 14 weeks: Still 3 pads per day. At this rate I'll be fine in 2012.
Post Surgery PSA - 9/3 6 weeks- 0.05, 10/13 3 months- 0.04 undetectable.

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