PSA drop after PCa diagnosis???

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Philap
New Member


Date Joined Nov 2009
Total Posts : 15
   Posted 2/18/2010 9:27 PM (GMT -6)   
Age 55.

In November I was diagnosed with low grade, low volume PCa. My PSA had jumped from 1 to 3 from March to October of last year.
Biopsy = < 1% of 1 of 12 samples. Gleason 3+3. Second biopsy read confimed it.

Even with such an early diagnosis I plunged into all the research and associated anxiety albeit not in a high risk category, for which I am very grateful. I set a March 8 date for robotic.

With the encouragement from a cousin who is a cancer researcher in CA, I went for a follow-up blood test. Was prepared for a repeat PSA of 3 or more. Result = 1.6!!! I find that totally confounding. My Uro/surgeon dismissed it saying the biopsy trumps PSA. My researcher/relative (who specializes in PCa) research says it proof to not rush to surgery.

Has anyone dealt with such Low Volume/Low Grade? PSA up from 1 to 3, drop to 1.67.

I have no idea what to make of it. Could a double read biopsy be wrong? Can changes in diet an other habits be impacting this??

Thanks. This is a great group.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/18/2010 9:44 PM (GMT -6)   
Dont think the changes in diet/habits is effecting whether you have pc or not. If you are only reporting <1% cancer in one of twelve cores, I think I would slow things down and make sure. If that biopsy is true, you have an extremely low grade low volume case of cancer going on, and you would would be a good candidate for almost any treatment, even AS>

It might be worth being on AS, continue to have the periodic PSA tests, and have another biopsy in a years time. Even though I am a surgery guy (whole different set of numbers than you), not sure I would want to have surgery this soon with such a low reading. But that's just me, I didn't have any other sensible options in my case.

Keep us posted, and good luck with whatever you do in the end.

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, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4271
   Posted 2/18/2010 9:53 PM (GMT -6)   
Dear Philap:
 
I was just thinking what David just said...with your diagnosis, perhaps you should re-consider rushing into any invasive treatment at this time.  At the very least, I would suggest you take the time to talk with a doctor who is experienced in monitoring AS patients...
 
Tudpock
 
 
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 12/09.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/18/2010 10:28 PM (GMT -6)   
Tud, his case reminded me of another fellow we had with an ultra low case, they did surgery on him, he has had all kinds of negative side effects, and his post pathology report came back with no cancer found. I know that is a rare case. But with Philap here, if he really only has one positive core with less than 1% cancer, and assuming that is all there really is, if it were me, would definitely want to re-think my strategy.

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, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 2/18/2010 10:34 PM (GMT -6)   
Less than 1% in one of 12 samples and the uro has you scheduled in 3 weeks. None of us here(and almost all have had some type of treatment) will ever tell anybody what they should do, but I think in your case the general consenus here would be to delay that surgery decision. I would put a lot more time in researching the ins and outs of prostate cancer given those stats and then make your decision based on a sound understanding of the disease. Treatment is life changing so you want to really understand why or why not such treatment is called for.
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
PSA December 09 <0.01

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


Uncle Harley
Regular Member


Date Joined Feb 2009
Total Posts : 85
   Posted 2/19/2010 9:51 AM (GMT -6)   
Hi Philap. I've got to agree with BillyMac. What you about to go thru will be life changing. Your numbers don't warrant an immediate decision to go the surgery route. I'm an AS guy at the moment & have seen my PSA go up & down. My uro said, like yours, that it still doesn't change the biopsy results. Cancer is cancer. Some guys can't live with the fact that it's in their body. Some like me, after spending a lot of time reading & thinking how immediate treatment would change my life, have chosen Active Surveilance. AS is where you continue monitoring your PSA & possibly doing more biopsies. You can chose surgery anytime, you can't undo it though. Have you considered a 2nd opinion? Everyone's condition is unique. There's no one size fits all solution. Family & friends may try to sway your choice of what to do, but until it's their body, their life, they really can't provide a good solution. Ultimately, you'll have that decision to make. Do it with a clear & full understanding of the current treatments & the future impact on your quality of life.


PSA History
3/99 1.2
3/00 1.04
3/01 1.16
7/02 1.24
2/06 1.59
3/07 1.79
3/08 2.54
8/08 2.3
4/09 2.3
7/09 2.6
12/09 2.3
12 needle prostate biopsy Jan 09
Dx of (1) core adenocarcinoma 20%
Negative DRE
All other cores benign
Gleason 3+3 T1C
12 needle prostate biopsy Dec 09
Dx of (2) core adenocarcinoma 10% each
All others benign
Gleason 3+3 T1C on each
Currently in Active Surveillence W/ Dr Approval
Age 61


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 2/19/2010 7:26 PM (GMT -6)   
Gleason 6 and less than 1% is considered clinicaly insignificant. Most men over 50 have this and it never know it. It may some day grow into a tumor or it may never amount to anything. It surely won't hurt you at this stage. The most appropriate action is to watch it, get regular psa tests and another biopsy in a year. Your initial psa and its reduction is an indication that it is not agressive. The good news is that if you ever want to be treated in the future, delayed treatment has the exact same cure rate as immediate treatment.
JohnT

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


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 2/20/2010 4:26 AM (GMT -6)   
Another surgery guy here. With your numbers, I also would choose AS without hesitation.

However, as always it's an individual choice -- while others may be happy to do AS, you may be happier to have it out.
Pre-op:
Age 63 at diagnosis, now 64.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores.
Operation:
Non-nerve sparing RRP on 7 March 2008.
Two nights in hospital; catheter out after 7 days.
Post-op:
Continent; no pads needed from the get-go.
Pathology showed organ confined and negative margins. Gleason downgraded to 4+4=8.
PSAs:
6-week : <0.05
7-month: <0.05
13-month: 0.07 (start of a trend?)
19-month: 0.09 (maybe)
ED:
After a learning curve, Bimix injections (0.2ml) worked well. From 14 months, occasional nocturnal erections. Have "graduated" to just the pump.


Franchot
Regular Member


Date Joined Jun 2009
Total Posts : 131
   Posted 2/20/2010 4:52 AM (GMT -6)   
Definitely seek out more opinions from other doctors before proceeding with the surgery. Your current doctor is not offering you all the options available with such low-grade cancer.

(As many others have stated, AS would be my choice in your case.)
Age: 53 6' 0" Weight: 170 Caucasian

Rising PSA over the last six years (from when I started being tested) from 3.9 to 5.2 to 4.6 to 4.5 to 4.9.

DX with PC in January 2009 after biopsy. Bone scan--negative

Consulted Cedars-Sinai Beverly Hills urologist--recommended surgery
Consulted Cedars-Sinai Beverly Hills radiologist--recommended IMRT
Consulted San Diego Cyber-Blade doctor--recommended treatments
Consulted Long Beach radiologist--recommended IGRT
Consulted Loma Linda radiologist--recommended Hypo-fractionated Proton treatments

Insurance approved any treatment I wanted.

Consulted Marnia del Rey urologist Dr. Scholz.
Dr. Scholz referred me to Dr. Bahn for a Color Doppler test.
Scholz and Bahn recommended Active Surveillance, some diet changes, and steady exercise.

I am currently on Active Surveillance.


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2217
   Posted 2/20/2010 7:29 AM (GMT -6)   
Philap
I'm a surgery guy too, but I think you should ask your doc for more time, and more information.

Ask him for another PSA test. Don't let anyone give you a DRE beforehand and don't have sex beforehand etc to make sure the prostate is nice and calm.

Then in a while definitely another biopsy.

Get your stats run through a nomogram too.

There was some posting recently about how quickly you need to act and I think you fall into the category where you should ask your uro if your stats really do require a rapid decision to go for surgery.

Do you have any family history of PCa? As that is the only sort of thing that might make a uro think it was right to suggest a bit of a faster response.

Alfred

Philap
New Member


Date Joined Nov 2009
Total Posts : 15
   Posted 2/21/2010 1:16 PM (GMT -6)   
I want to thank all who responded. I am always quick to say I am grateful for an early diagnosis - and realize there are many guys out there who would trade places.

Having said that - it doesn't make the decision making part any less impactful. I've heard an entire spectrum of opinions from 'use mushroom supplements' to 'surgery now'.

John T makes a good point re the 'clinical significance' of the diagnosis - indeed many of us are walking around with this and not "crisis".

Having this solid consensus helps. Add to that a PCa researcher at the University of California at SF (who happens to be related) - her first words: "what's the rush"?

Thank you all again.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/21/2010 1:20 PM (GMT -6)   
Lol, we would all agree, I am certain, 100%, that the Mushroom supplements' isn't going to cut it. Now if you want some mushrooms in your salad or sauteed with your steak, that's another matter. Good luck.
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, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 2/22/2010 5:30 PM (GMT -6)   
Phil,

Do you take a any Flax oil supps ? if so read the attached article.

I think I read that ejaculating 2-3 days prior to the PSA test can give an elevated reading

psa-rising.com/foodnews/2007/06/flaxseed-slows-prostate-cancer-more-evidence/
Stats:
Age: 52, PSA (2008)=1.9
Biopsy on 01/09/09, Gleason Score = 3+3
One (1) out of twelve (12) cores was positive, plus external nodule found
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Post Op Path 3+3
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, <0.01 - 3 months post-op
PSA 1/10 undetectable, <0.01 - 9 months post-op
Trimix provides 100% erectile function


Philap
New Member


Date Joined Nov 2009
Total Posts : 15
   Posted 12/19/2010 12:23 PM (GMT -6)   
It's been quite some time since I posted. I was the low grad/volume guy - who in the face of declining PSA canceled surgery (thread above). Biopsy showed <1% of 1 of 12 samples. I am also the guy with low T using minimal dose of Androgel (which scares the crap out of everyone).

Here's the latest:
PSA History: 1.0 (forever), 3.0 Nov. '09, 1.67 (Feb. '10 - canceled surgery), 1.83 (June). Just got back latest (1.27). I have gone totally plant-based diet and guzzle green tea.

I do still use 2.5 g of Andro tho T is very low (210) with it. I have read that low T can cause low PSA reads.
Still, if 1.27 were my PSA a year ago my primary probably would've had me check PSA in 6 months and I would never have gotten into the urologist loop (not that it's not good to know what goes on).

My question is this: is there ANY reason to re biopsy at this point? The urologist/surgeon has pushed it since I canceled surgery. But 1.27?? opinions please.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 12/19/2010 1:13 PM (GMT -6)   
Get a new urologist, one that specializes in AS, as your current doc is not doing you any favors. Read "Invasion of the Prostate Snatchers" for realistic monitoring protocols while on AS. Re diet and AS: The UCSF program on AS has a group of patients on a diet, coupled with excercise and meditation compared to a control group. Thus far no one on the diet has experienced any progression compared to 6 people in the control group that have progressed. This is the closest study we have currently going on the affects of diet on low risk cancer progression. It is doubtful that a repeat biopsy would ever hit a 1% core again. I would get a color doppler before I had another biopsy. Your psa shows no signs of progression and close monitoring should be the preferred treatment at this stage.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 12/19/2010 1:25 PM (GMT -6)   
Philap,
The good news is that this is exactly how indolant PC acts and manifests itself.
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 12/19/2010 1:39 PM (GMT -6)   
Philap,
Very interesting story....please keep us posted.
jnm

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/19/2010 1:46 PM (GMT -6)   
First off forget the panic, John T is very well informed on PCa issues in general and has done plenty of analyzing and his own multiple doctors and opinions journey is of epic life learning lessons on PCa for everyone to take notice of, if you didn't know about all that. It is a revelation into what is an 'expert'-doc on PCa and what maybe isn't, and that you don't find out about such in books.

My brother has similar stats to yours, has done nothing basically for 6 years and no change in psa movement, likely he has no issues and was defined with indolant PCa in the beginning. He is in no hurry to have surgery or whatever.

Go to www.yananow.net/PSA101 or within the website great info.
Terry Herbert did psa tests everyday for 30 days as a testimonal on what happens to psa values....varies like you would not believe. I got mine tested less than two hours apart for fun, and I was post multiple treatments and basically stabilzed psa person...well they were not the same and had some reasonable variation that one could note...luckily it was not significant enough to make me get worried...and it went back down some after the next month or so.

I have one guy I talk to whom had more significant stats than yours, back 1996 he decided he liked being normal and did only ADT3 drugs for 13 months, quit and stayed on Proscar only....has had rebiopsies even within the last year and no PCa was found. Plus he is normal as a man and can still choose any treatment, so is dumb for not rushing into surgery????? His results thus far are note worth at 14 +yrs.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 12/19/2010 2:12 PM (GMT -6)   
Listen to your cousin, he has no vested interest other than your well being, the doctor on the other hand. . . . . . .

I don't trust Dr's that rush to do surgery, even with my initial G-9 my Dr urged me to check out ALL options during the time my prostate was healing from the biopsy, she held a time in the OR just in case I decided to go with surgery, which I did.

I had no choice, some form of treatment had to happen. Even with an outstanding surgical outcome I wish that I was back to "normal" at times. With your stat's I'd have done AS, and I'm not a huge fan of AS in most cases.

It's a scary thing knowing CANCER is inside you but PCa can be a very slow growing cancer and you may have years of normal life before needing a treatment.
Diagnosed 12-09 age 55
07-06 PSA 2.5
01-08 PSA 5.5 (PCP did not tell me of increase or schedule follow-up!!!!)
09-09 PSA 6.5 Sent for consult with Urologist
11-09 Consult, scheduled for biopsy, found out about PSA from '08 (yes I was pissed)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5, ain't much but I'll take it.
01-10 Bone Scan, "appears negative"
03-01-10 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson, no naked eye evidence of spread, Vesicles and lymph nodes taken for microscopic exam.

03-16-10 Removal of cath' and pathology results of samples.
Multifocal carcinoma with areas of Gleason pattern 3, 4 and 5, Overall Gleason grade 4+4 with tertiary 5, Bilateral involving 21% of left lobe, 3% of right lobe, Invasion of left Seminal vesicle, Tumor focally present at left resection margin, 9 lymph nodes removed all negative, Tumor staging pT3b NO MX

04-23-10 PSA <0.04....... 06-07-10 PSA <0.04..... 08-03-10 <0.04
05-03-10 1 week without pads
06-28-10 ;-)

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 12/19/2010 10:23 PM (GMT -6)   
My husband had 1/12 @10% 3+3.
His PSA dropped from 4.1 to 2.7 just after the diagnosis.

He had a RRP and it turned out that he had a anterior predocminant PC which is the case in about 25% of PCa.
This doesn't get very easily picked up with a biopsy as this is the part of the prostate which is further from the rectum.

However, with your very low PSA numbers of 1.27, you may be a very good candidate for AS. There is certainly no need to rush into an option.

Regards,
An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg (margins, seminal vesicles, extraprostatic extension). Multifocal, with main involvement in the fibro-muscular zone.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03
Lab 2: Nov 10 - 0.01
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