90-day PSA Not Good

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SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 1/21/2010 8:06 PM (GMT -6)   
Got my 90 day post surgery PSA today, .15.  The 30-day PSA was .07.  Not a good sign.  My urologist already had me do the initial consult with the radiology oncologist (rad onc) after the first test because I had 2 positive margins.  The rad onc  wanted to see the 90-day and recommended immediate IMRT if it went up.  I see the urologist tomorrow and the rad onc on February 2.  I guess I will join the IMRT club.  I don't see any choice now.  I still have mild incontinence and have not even begun to work on the ED.  I guess the important thing is to kill the cancer.  To make the day even worse, just found out I am going to have a $1600 repair bill for my truck.  Some days are definately worse than others!!!!!  Hopefully things can only get better.
Age 63, PSA July 2009 5.66
Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
MRI and Bone Scan Negative.
Open Surgey  October 22, 2009 (6 hours on table; 2 units blood)
Small part of incision infected (2 staples removed); finally healed at 3 month mark.
Prostate, both nerve bundles, seminal vessels, and two lymph nodes removed during surgery.
Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
Returned to work after 6 weeks.  First week worked only half days because of pain from sitting for long periods.
Still slightly incontinant after 12 weeks - 2 pads per day (light). Dry at night. 1-2 trips to toilet.
ED - Yes (will start Levitra possibly in January)
30 day PSA (ultra-sensitive) .07
90 dat PSA (standard) .15


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4110
   Posted 1/21/2010 8:10 PM (GMT -6)   
SubicSquid, So sorry about the PSA and the Truck. I hope that you RT will go as well as Sonnys. I sincerely hope that tomorrow will be better for you.

Jeff T
Cajun Country
Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.
15 months out injections Caveject (success)


pigeonflyer
Regular Member


Date Joined Nov 2009
Total Posts : 85
   Posted 1/21/2010 8:15 PM (GMT -6)   
hey subicsquid, sorry to here of your psa increase. so its off to radiation. wishing you the best outcome with that. keep us posted. we are in this thing together. neil
50 years
da vinci on 9/28/09
gleeson 3+3
psa before surgery 5.1 oct/09 psa 0.06
cather out on oct 5, back in on oct 5
two more trys for cather out, still in .
cather out nov. 13/09
cystocope nov.13/09 , cather back in , out again on nov 15/o9, was taught to self cath, still pluged with scar tissue but no cather. have to self cath 6 to 8 times a day. scar tissue removed on jan. 11 2010. no cathing and totally dry. 


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2229
   Posted 1/21/2010 8:30 PM (GMT -6)   
SubicSquid,
Sorry to hear that, but you are not alone. My 3 month was great but the 6 month and 6 1/2 month put me in the IMRT club. Your gleason was downgraded to a 7 so that is a positive as are the MRI and bone scan. Hopefully it is localized and the radiation will finish the job. keep us posted and you will see about four of us posting updates who are currently taking IMRT.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margin slightly involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only, now none
 started ED tx 7/17, slow go
Post op dx of neuropathy
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Starting IMRT on 1/18/10
Great family and friends
Michael


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/21/2010 8:57 PM (GMT -6)   
Supra, you seem to be joining whats getting to be a long list of failed surgeries, myself included. Not sure what to make of that info, part of it is we are only seeing a tiny speck of the men that are dx with PC and getting treatments. I would wait till you have the 3rd proven increase before committing to doing the radiation.

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
Post SRT PSA: 1/10 .12
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 1/21/2010 10:31 PM (GMT -6)   
Thanks for the support. I too have been wondering about all the surgeries that end up turning into radiation. I know the surgeons can't be expected to get microscopic cells that are outside the margin such as mine. When I brought up having second thoughts about my surgery after the post-surgery pathology report, my urologist basically said you can't look back and second guess your decision. Almost everyone seems to make the surgery choice right away because they "want that nasty cancer out of the body". This is why I never considered radiation. But after a complicated open surgery and the nasty side effects (incontinece and ED) I have to wonder if radiation might have been a better first choice. Drives me crazy. I guess that is why the doctor says not to look back. Of course, if the cancer had been contained in the prostate and my PSA was now zero, I would be saying "that surgery was sure the best choice". This disease really sucks.
Age 63, PSA July 2009 5.66
Diagnosed July 2009, Biopsy: 2 of 12 cores positive, Gleason 3 + 5 = 8
MRI and Bone Scan Negative.
Open Surgey  October 22, 2009 (6 hours on table; 2 units blood)
Small part of incision infected (2 staples removed); finally healed at 3 month mark.
Prostate, both nerve bundles, seminal vessels, and two lymph nodes removed during surgery.
Post surgery Biopsy, Gleason 4 + 3; 2 positive margins
Returned to work after 6 weeks.  First week worked only half days because of pain from sitting for long periods.
Still slightly incontinant after 12 weeks - 2 pads per day (light). Dry at night. 1-2 trips to toilet.
ED - Yes (will start Levitra possibly in January)
30 day PSA (ultra-sensitive) .07
90 dat PSA (standard) .15


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 1/22/2010 1:26 AM (GMT -6)   
Squid,

I was particularly pained to read of your circumstances in your first posting. Let me simply say I'm sorry for how things have unfolded, but know that follow-radiation is most often very effective in cleaning up the remaining cancer.

I was also struck by the dicotomy of responses, which you loosely alude to in your second posting, which follows the follow-up PSA tests. It's either "Whopee, drinks for everyone!" or "Oh crap". It turns out to be "Oh crap" for, as I understand the statistics, about 30% of surgery patients.

Certainly no fault of yours, but unfortunately you aren't done fighting this b*tch yet. I wish you well.

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 1/22/2010 7:07 AM (GMT -6)   
Squid, not the results you and we were wishing for, but onward you go. Keep up your spirits and we're always here when you need us.
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, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


MaxBuck
Regular Member


Date Joined Jan 2010
Total Posts : 75
   Posted 1/22/2010 8:54 AM (GMT -6)   
Squid, given the inherent baseline instability that labs have close to their detection limit (and for PSA that's typically 0.1, I believe), I'd recommend a re-test before making such an important decision. The 90-day result is only a little above that at 0.15, and I question the accuracy (i.e., could the "true result" actually be between 0.05 and 0.2?).

You really haven't established a "trend" in my opinion because the 30-day test used different analytical methodology. It isn't a huge deal to have a little more blood drawn and analyzed, especially when you consider the side-effects of the radiation. Just another thought.
Dx at age 56: Oct 09; PSA 5.8, followed up by 9.9 two weeks later (reproducibility of test - ?)
Biopsy ind cancer in 8/12 cores: Gleason 8 (4+4)
open radical retropubic prostatectomy Dec 4 09
Post-op pathology: 56 g weight, cancer in 21%, Gleason 7 (4+3, tert 5); margins clear, lymph node involvement 0/9, perineural invasion present, T2c N0Mx (but showed clear from distant metastasis in pre-op bone scan and CT scan)
Continence data: 1 "panty liner"/day, with minor leakage when I get up from long seated position; ED pretty complete: some erection possible but current non-functional

Post Edited (MaxBuck) : 1/22/2010 1:01:06 PM (GMT-7)


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 1/22/2010 11:31 AM (GMT -6)   
Squid,
Sorry about your elevated PSA. I sure hope that your IMRT will go well a kill what ever PC cells are lurking around. Good luck.
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 in circumference.
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
8 months PSA test 10/9/09 result <0.1


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 1/22/2010 5:10 PM (GMT -6)   
 
SubicSquid,
 
Sorry to hear you may be joining the IMRT Club but with two positive margins you have a very good chance your cancer is local and they can get it with radiation.  However, I think I would get another PSA in a month or so since 0.15 is still low, mine was 0.5 before I started treatment.  You are only out 3 months and need time to heal and get the incontinence under control if possible before starting radiation.
 
Jerry1
Age 70
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  4+4 = 8 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
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 
12/28/09 PSA 0.5
Start radiation treatments ib January 18th. 


soulmate 101
Regular Member


Date Joined Jan 2010
Total Posts : 57
   Posted 1/22/2010 7:11 PM (GMT -6)   
Squid, as a newbie here, I'll add my encouragement along with the others. Hope you can try to keep your spirits up. One day at a time. One of my children is a cancer survivor and there were days it was "20 minutes at a time." Some days are like that. Stay in the joy. That is my motto for this year, challenging as it can be.
Husband, age 57, diagnosed in December 09, Gleason 4+3 = 7 stage T2c, laparoscopic nerve sparing Da Vinci robotic radical prostatectomy 1/13/10, clear surgical margins no lymph node or seminal vesicle involvement.
Let the healing begin...

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