TaurusBull-first time poster- concerns about possible reoccurance. Was No Subject

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TaurusBull
Regular Member


Date Joined Jan 2010
Total Posts : 91
   Posted 1/31/2010 7:33 PM (GMT -6)   
Hello to all,

This is a very helpful forum and I thank you for sharing your experiences about PCa.

My situation is fairly self explanatory from my signature. I had a da Vinci robotic prostatectomy on Aug 2, 2005. I was enjoying undetectable PSA readings (<0.1) until July 2009. My last undetectable PSA reading was taken in July 2008. My uro put me on a yearly monitoring schedule due to the 3 years of post-op undetectable PSA readings. From my research, I know that I have one good prognostic factor going for me in that the PSA became detectable more than 2 years out from surgery. However, my PSADT is 6 months which, as you know, is not a favorable prognostic factor. Needless to say I'm mortified, because I had negative margins, which leads me to believe that this does not seem indicative of local recurrence but instead, looking more like distant metastases.

Supposed to see my uro Wed. (2/3).


Added Subject for searching and archiving

Post Edited By Moderator (James C.) : 2/1/2010 8:34:35 AM (GMT-7)


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 1/31/2010 7:40 PM (GMT -6)   
There is no way to say that your situation is fun but at least cool it for three days until you see your uro -- perhaps your self diagnosis is too pessimistic. In any case, then you will have a better idea of what you are up against and what your options are.
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 1/31/2010 7:43 PM (GMT -6)   
Welcome to HW. It appears that you may have recurance after all this time. Beside the meeting with your uro, have you made arrangements to meet with a good radiation oncologist? The next logical step, if needed, would be to consider salvage radation treatments. I have just completed them, and there are several of our regular men undergoing them as I write.

Please keep us posted of your situation and let us know what the dr. tells you or suggests next.

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


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 1/31/2010 8:25 PM (GMT -6)   
Hi Taurus, Welcome to Healing Well.

I noticed your PSA numbers are only to one digit after the decimal - the same resolution as the typical PSA "screening" test. A "diagnostic" PSA will give you two digits after the decimal point -some labs can even do three digits.
Hypothetically, you could have had a PSA of 0.14 that was rounded to 0.1, followed by a 0.16 that was rounded to 0.2. You cannot tell because the resolution was not there.
Please check to see if the lab you are using has the capability. A phone call to the lab should answer that question. Be persistent. Look at the lab work order sheet you have been getting and see which box is checked: Screen or Diagnostic. The difference is significant. Discuss this with your Uro.
(If your Uro says the extra resolution only results in PSA anxiety, ask what box he would check if he wanted results for himself.)
Good luck,
Jeff
DX Age 56. First routine PSA test on April 8th: 17.8. Start 2 weeks of Cipro to rule out protatitis.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, 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.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next? See Uro 1/22/10 Trimix unsuccessful.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
11/14 4 months: Still 3 pads per day. 420ml/day, 91 um leak.
12/11 5 months: Still 3 pads per day. 400-450ml/day
1/11/10 6 months: Still 3 pads but leak is now 320 ml (5 day avg.)
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04, 1/14 6 months - 0.05.


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2222
   Posted 1/31/2010 8:26 PM (GMT -6)   
Taurus,
It would seem that you have some good numbers on your side if you use the Partin table. But your Dr. will help you with that process. I know that has to bother you to have a reoccurence after all of this time, but I hope that yours will have a positive outcome.
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


TaurusBull
Regular Member


Date Joined Jan 2010
Total Posts : 91
   Posted 1/31/2010 8:53 PM (GMT -6)   
Thanks for all your comments and insight people - they are deeply appreciated. I'll let you know what the uro suggests after my Wed. appointment. Jeff, I hear you loud and clear on the PSA decimal. I use Quest Labs and they have always reported to one decimal place. However, one of the items I was intending on bringing up to the doc is that perhaps it's time to move on to the ultra-sensitive assay.

Best,

Fred

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/31/2010 9:30 PM (GMT -6)   
Fred, prior to surgery, you want the one decimal place testing, after surgery or radiation, you want the two decimal place, its the only way you are going to be able to really track an upward movement, i.e. recurrance, with any sense of accuracy.

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


MaxBuck
Regular Member


Date Joined Jan 2010
Total Posts : 75
   Posted 2/1/2010 7:18 AM (GMT -6)   
I understand the desire for two decimal places, but so close to the detection limit, I'd question whether the second digit is very meaningful.

Taurus, your PSA results look pretty consistent to me. Four test results, all between 0.1 and 0.2. I'm not arguing there's no cause for concern, but I don't think there's yet cause for alarm. Your urologist will likely have more useful information for you.
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, no 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


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 2/1/2010 7:29 AM (GMT -6)   
Taurus, sorry you are facing this...especially four years after surgery. Before pushing the panic button, please read my husband's story in my signature. He too experienced a detectable PSA except his was about 17 months after surgery. Two consecutive PSA tests this year had us ready to begin radiation treatment until the third PSA came back as undetectable. A follow-up PSA test 2 months later also came back undetectable. While it doesn't happen often, it does happen. It is possible for benign prostate tissue to still exist and generate low levels of PSA which die off naturally. However, your doctor will definitely be able to guide you as to your next step, if one is needed. Please come back and let us all know how you fared this week.

As to ultrasensitive PSA vs. "regular," the jury appears to be out on whether or not the ultrasensitive has any diagnositic value. I know others disagree but our urologist, the radiation oncologist we interviewed, and John's regular MD do not subscribe to the ultrasensitive PSA test. This is a decision that needs to be made with your doctor - if you feel more comfortable with the ultrasensitive test, then definitely push for it.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


TaurusBull
Regular Member


Date Joined Jan 2010
Total Posts : 91
   Posted 2/5/2010 5:26 PM (GMT -6)   
So, I went to my urologist appointment on Wed (2/3). He wasn't too alarmed about the 0.2 ng/ml result. I did ask him about greater sensitivity PSA tests. He said in theory they make sense, but many labs struggle with being able to accurately test to a greater than one-place decimal sensitivity. However, he did order the more sensitive test; one to take now, and then another in 3 months. I stopped at the lab today, so I'll know the result next week. The next thing I asked for was my post-surgical path report - see signature for details. I never cared too much about it when I was in the zero club, but now I have a copy of it in my hands. As for the next step, we will collect a few more PSA data points. I was probably a bit hasty in calculating my PSADT and then freaking out about it based on only four readings taken over six months at barely the detection limit. As my surgical margins were negative, he doesn't believe SRT would do much good now. I tend to agree. If the margins were positive, I'd feel a bit differently about SRT. Most important thing now is absolute PSA and PSADT.

Sephie, I see your husband's story in your signature. That is truly amazing and uplifting - may it continue forever!
Age at dx 49, 6/2005
PSA tests 3/05: 3.8 ng/ml, 4/05: 4.1 ng/ml, Stage: T1c
TRUS biopsy: 2/10 cores positive, Gleason 6 (3+3), bone scan: neg.
daVinci Robotic Prostatectomy 8/2/2005
Post-surgical Path report: upgraded to Gleason 7 (3+4), pT2c, NX, MX.
neg. surgical margins, neg. seminal vesicles, neg. vasa deferentia
Perineural invasion: present
prostate capsule: tumor focally invaded into, but not beyond prostatic capsule.
Post-surgery PSA tests, all <0.1 ng/ml for about 4 yrs.
Then on 7/23/09: 0.1, 10/16/09: 0.2, retested 10/23/09: 0.1, latest test on 1/22/10: 0.2.


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 2/5/2010 6:37 PM (GMT -6)   
Hey Taurus
When I have the test done I try to be as consistent as possible. I go to the same lab, I have nothing to eat after midnight and I have the blood drawn around 8:30 AM. I try to eliminate any other variables. I also tell the tech that this is a diagnostic PSA and the second decimal makes a difference. I know it is not their job but I do it anyway. (And it makes sure they yse the correct collection tube.)
GoodLuck,
Jeff
DX Age 56. First routine PSA test on April 8, 09: 17.8. Start 2 weeks of Cipro to rule out protatitis. May '09 PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, Gleason 6=3+3. Bone and C/T scans neg.
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.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots, See Uro 1/22/10 Trimix unsuccessful.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
11/14 4 months: Still 3 pads per day. 420ml/day, 91 um leak.
12/11 5 months: Still 3 pads per day. 400-450ml/day
1/11/10 6 months: Still 3 pads but leak is now 320 ml (5 day avg.)
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04, 1/14 6 months - 0.05.

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