I'm not worried... yet

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Im_Patient
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Date Joined Aug 2009
Total Posts : 665
   Posted 2/1/2010 2:22 PM (GMT -6)   
Nearly 2 years out from Da Vinci Prostatectomy, negative margins. PSA consistently <0.1, until last October. Doc called me in immediately for a retake, and that turned out to be undetectable.
Now, my January blood test turned up PSA of 0.2. Just went in to the doctor's office to retake, will know next week what the results are. Doc said not to be concerned, even if it turns out that I am at a steady 0.1-0.2, I could just have a high baseline.

Looking for others that have been in the same boat - are there some of you out there that have had consistent detectable PSA without it rising? Just curious... I know I can't do anything about it, so it will be what it will be.
Thanks
Gleason, 3+4; PSA, 7
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
cancer contained, no penetration, lymph nodes clear
PSA consistently <0.1 since surgery


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 2/1/2010 3:27 PM (GMT -6)   
I'm not sure how someone can have a high baseline after RRP, unless some benign tissue is left behind. I would think PSA in the detectable range after RRP deserves close attention and scrutiny....But maybe I'm missing something.

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 2/1/2010 3:49 PM (GMT -6)   
I'm confused...your PSA after surgery was undetectable since March 2008 that was your nadir or baseline reading. In your case, anything higher than undetectable needs to be explored further. It seems to be going up and down which might mean that benign tissue was left behind - it happens more often than we know. However, you and your doctor need to keep a careful eye on your PSA over the next couple of months - when is your next blood test?
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!


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 2/1/2010 3:49 PM (GMT -6)   
I know there are a lot of discussions about what is a zero, and how ultrasensitive PSA test can be alarming, but this is why I prefer the ultrasensitive.

You can have a PSA for .01 to .09, and still be less that .1. If your initial PSA was a <.01, then a .1 is a jump. But if your baseline was .09, then a .1 is just .01 higher.

It's just my way of thinking and wanting to know. If a .1 to a .2 is of concern, then I think a <.01 to a .1 is equally concerning, but catching it earlier is better.

Good luck my friend. Sounds like you and the doc is right on topo of it.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01


Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 665
   Posted 2/1/2010 5:15 PM (GMT -6)   
To my knowledge, the PSA testing that the lab is doing is the less sensitive sort, and all of my readings, except for 2, have been "<0.1", or "undetectable". One reading so far has been "at 0.1", last October. I was immediately re-tested and was found to be "<0.1", or again "undetectable". My most recent reading, in early January, was "0.2". I was just retested, won't get the results until next week.

If my doctor has access to greater resolution in the testing, she is not sharing it with me. I recall her saying that she does not like to use (or at least respond to) the more sensitive testing, just because of the anxiety it causes everyone. I'm an engineer, so of course I would like more data than less. I think I'll ask her if she has had access to greater resolution than she has been sharing. However, since the granularity of the testing is this coarse, I don't know if we have a trend yet.

What I am convinced of is that my doctor is on top of this, since both times it has not been "undetectable", she has had me in for her own office to perform the test (rather than the lab they normally use).

I do recall her saying, right after surgery, that she was more aggressive removing tissue on the side where the biopsies came back positive, and less so on the other side, to hopefully be less risky with the nerve bundle. I suppose that would imply that there would be more tissue left on one side than on the other. I would also figure that whenever both nerves are spared, there must be some prostate tissue left behind? Otherwise what would the nerves be running against? Perhaps just my ignorance of anatomy. I would imagine, unless the nerves are not spared, there would always be some likelihood of remaining tissue and therefore possibility for some non-zero PSA?
Gleason, 3+4; PSA, 7
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
cancer contained, no penetration, lymph nodes clear
PSA consistently <0.1 since surgery


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 2/1/2010 5:23 PM (GMT -6)   
I recently had my PSA tested at a local hospital. I then can go to the records department and get a copy. When I got it, it said <.1. I immediately called my URO and had them send another script stating "ultrsensitive", which is good to .01.

Just in case my doctor is too busy to notice, I am watching it also !
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 2/1/2010 5:38 PM (GMT -6)   
The jump from <.1 to .2 is alarming. I'm sure your doctor is on top of the situation. Hopefully it is a lab error.
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
11.5 months test 1/21/10 result 0.004


MaxBuck
Regular Member


Date Joined Jan 2010
Total Posts : 75
   Posted 2/1/2010 8:02 PM (GMT -6)   
I've said this same thing elsewhere, but don't conclude that 0.1 to 0.2 is necessarily an increase in actual PSA. Lab accuracy and precision can produce irregular baseline. Re-testing is a good idea, but don't get too anxious about this.
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


Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 665
   Posted 2/8/2010 1:38 PM (GMT -6)   
Well... doctor's independent test results confirm a PSA of 0.2. I see her in a week to discuss the subject. I'm hoping this is not a new chapter of this story I'd rather not be reading. Guess when I quit procrastinating I should update my signature.

My sense is that if I stay at 0.2, no further treatment will be needed, but if it starts rising further, we'll need to do something. Has anyone on this forum gotten word that a low but detectable PSA can just be the presence of remaining but healthy prostate tissue?
Gleason, 3+4; PSA, 7
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
cancer contained, no penetration, lymph nodes clear
PSA consistently <0.1 since surgery


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 2/8/2010 1:57 PM (GMT -6)   
Im, read my signature to see how PSA can go up then go back down to undetectable. Hope you have the same result as my husband.

Take care.
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!


Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 665
   Posted 2/8/2010 2:00 PM (GMT -6)   
Sephie, was there any treatment, or did the PSA just drop by itself?
Thanks
Gleason, 3+4; PSA, 7
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
cancer contained, no penetration, lymph nodes clear
PSA consistently <0.1 since surgery


Jakester
Regular Member


Date Joined Aug 2009
Total Posts : 285
   Posted 2/8/2010 2:42 PM (GMT -6)   
IM,

My urologist stated that he would only send me to see the radiation oncologist if my psa rose above .2 ng/ml which it did after about 3 months to .3 and confirmed again at .3 about two months later. I'm sure I could have insisted on seeing the rad guy sooner but the uro said no radiation would be considered until it was over the .2 threshold (at least in that practice although it seems to vary with others). The uro held hope that the residual psa was due to left-over benign tissue and he had seen this in other patients. May not have been true in my case and I was getting too close to the .5 effectiveness border to chance the delay in starting radiation.

Take care,
Jake
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09
broke ankle bones 6/09
9/21/09 Bone scan clear, psa still .2
11/12/09 chest xray was clear, psa however up to .3,
01/05/10 psa still .3, radiation setup done with tats, 01/19/10 started 39 sessions 70.2gy


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 2/8/2010 5:35 PM (GMT -6)   
IM, nope, no treatment though we were really close to pushing the button with SRT. John (my husband) has his next PSA in mid March (2 years after surgery) and we are continuously praying that it stays at zero.

When we met with the radiation oncologist (a lovely, kind woman), she was surprised that we were thinking about radiation with a PSA of 0.3...in her words "that's still awfully low" even after surgery.
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!


Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 665
   Posted 2/8/2010 7:42 PM (GMT -6)   
Sephie, it looks like there have been many parallels between your husband's journey and mine. Same month surgery, same Gleason score, same negative margin result, some amount of increase in PSA -- I'll be interested to hear how he does, for both our sakes.
Thanks.

Thanks also Jake for your experience.

Jeff
Gleason, 3+4; PSA, 7
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
cancer contained, no penetration, lymph nodes clear
PSA consistently <0.1 since surgery until Oct 09, 0.1; retested Oct 09, <0.1, Jan 10, 0.2; retest confirmed 0.2


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 2/9/2010 6:22 AM (GMT -6)   
Im, yes there are quite a few similarities between your situation and my husband's. I was totally speechless when the uro/surgeon called to tell us that his PSA was back down to undetectable...I think that was only the second time in my life that my mouth was open but nothing was coming out! When I commented to the doctor that this was "practically unheard of" he responded with "not really...I've seen it happen many times before." So, whether it was an anomaly in the PSA test or a natural dying off of PSA in the bloodstream generated by benign prostate tissue, I consider this a miracle and am grateful for it.

Keep us posted, and stay well.
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!

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