where is my PSA coming from?

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English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 11/30/2009 8:05 AM (GMT -6)   
Another one of those big unknowns:

I've been worrying a bit the last few days/nights about having that nagging 0.1 PSA level at the first test after surgery (rather than "<0.1")
Because, while I don't want to get ahead of things, it may mean that there is still something in me that later on will need radiotherapy. And my surgeon says he will want to start radiotherapy at 0.2 and not wait for it to go any higher.

So, given I had seminal vesicale invasion, I'm thinking where is this little bit of prostate that is still seems to be producing PSA in me and how big is it?

I am assuming that a specific amount of PSA is produced by a specific amount of prostate tissue, so are these tiny amounts of PSA produced by:
A few hundred cells in one small clump of cells left behind where prostate used to be?
A dozen tiny clumps of ten cells each not very far away from where the prostate used to be?
Or a few hundred single cells scattered all over my body?

My thinking being that, if I am going to need radiotherapy then how can anyone tell where these PSA producing cells are and thus aim/focus the rays in the right place(s)?

Alfred

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 11/30/2009 8:47 AM (GMT -6)   
Take a deep breath -- 0.1 isn't what anyone would want, but it is not all that bad considering that this is only one test. First of all, it is still possible that the PSA is coming from isolated cells which are slowly dying. Second, by far the most likely situation is that if some PC got left behind it is local. A radiation treatment plan will consider your pathology report. In general the targets are the prostate bed, the seminal vesicles, and the lymph nodes -- usually all of them to a varying degree. The chances of metastasis, wide dispersal of the cancer, is low considering your pathology. So, live life -- you are gathering knowledge if decisions are needed but do not make this the focus of your existence.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/30/2009 8:56 AM (GMT -6)   
The correct and most honest answer is, that no one including doctors or any tests at this point will be able to determine the exact source or location of the cells that are producing these trace amounts of PSA.

This is what my own doctor's told me when I showed evidence of reoccurance.

Radiation, like I just completed, works on the assumption that it is still local to the prostate bed. If the cells are all contained there, then there's a high likelyhood that the radiation will kill off the remainder. But there are no guarantees. Stray cells can easily exit the prostate bed through blood vessels and nerves, etc.

In my own case, I had one tiny positive margin. My dr. felt that one margin was "good" bad news. She said it made it more likely that the cancer was in the region of the positive margin, so when she designed and mapped the IMRT for me, she based it all around the positive margin.

Did the radiation get mine? Jury is out, way too soon to know. Will have my first post radiation PSA drawn late in December, that will give me a new base to compare to.

I already agree with your doctor. If a second PSA test shows more increase to you, and I hope it doesnt, then you wouldnt want to wait indefinintely to begin some form of radiation. It would be jumping the gun in my opinion if you insisted on it know. My drs want to see 3 numbers in a row rise above .10.

Good luck to you.

David in SC
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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
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


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 11/30/2009 11:18 AM (GMT -6)   
After surgery there is always some prostate tissue left; they can never get 100%. These may contain PC cells or they may not. about 50% of those having a positive psa after surgery never progress; only a rising psa will tell you this.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 11/30/2009 6:24 PM (GMT -6)   
Alf,
There is a table in the link below (table 1) which gives the average amount of PSA produced per CC of tumour ranging from normal cells to Gleason 5 cells. It is interesting that 1 cc of Gleason 5 cells leak 1/2 of Gleason 4 per CC which in turn leaks 1/2 of Gleason 3 per CC. The best answer to your question lies in what happens to the PSA. If it remains static indefinately at 0.1 then the assumption could be that non-malignant prostate cells are still there. If the PSA is static for a couple of years and then begins to increase it tends to be indicative of a local relapse at the site of the prostate. On the other hand a continuous rise post surgery would perhaps indicate that some PCa is still there and increasing. This is the value of doubling time. The faster the growing (more aggressive) the shorter the PSA doubling time. If the PSA is static for a couple of years and then begins to increase it tends to be indicative of a local relapse at the site of the prostate. Then again there could be PCa cells there and they decide not to do anything but sit.

http://www.prostate-cancer.org/education/riskases/Strum_StrategyOfSuccess2.html

Bill


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

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