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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 3/2/2010 11:26 AM (GMT -6)   

5 weeks post-op. I was going to do my first PSA today. But you may recall I haven't been feeling well. I blamed some discomfort on manual manipulation yesterday. But:

Since Sunday, not feeling well:

Bladder discomfort/burning while filling up, relieved by urination.

Feels irritated.

Feeling slightly ill with sporadic queasiness/loss of energy.

No fever.

Incontinence was improving and now its worsened.

Went to Dr. today

Urine test revealed red cells and some white cells. COULD be a bladder infection.

He will be culturing the urine. He put me on cipro until the culture comes back in 2-3 days. If nothing is found, we may drop the cipro.

I was going to do my first post-op PSA today, but doctor is unsure if I should.

Should I wait? I have a call in to Ford and I'll be relaying the above information and see what they say. I do not need an artificially high PSA as my first data point! But without a prostate, it might not matter.

 

Mel


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities.

Next Event: First post-op PSA on 3/2/10


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 3/2/2010 11:29 AM (GMT -6)   
Let's hope you just have a very mild problem, easily corrected by a couple antibiotics. Can't say I've ever read of any answer to testing psa during and infection.
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
32 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 3/2/2010 11:50 AM (GMT -6)   
My feeling is if you want consistent, comparable PSA results you should be as consistent as possible.

I do know that I had to wait a week after I finished the Cipro when the Doc was trying to rule out prostatitis. I have no data on the effect of Cipro on PSA reading.

Why not wait until this mess is finished? That way you can rule out a variable when you are comparing your 6 week and your 3 month results.
Jeff

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4089
   Posted 3/2/2010 12:33 PM (GMT -6)   
Mel: Will not hurt to wait just a bit to make sure all the ducks are in line.

The Cajun Jeff
AGE:58, 57dx. PSA 5.4
Biopsy: 9/08 Gleason 3+4=7
open RP: 10?08 Nerve sparing. Path Report : GS 3+3=6 Stg pt2c margins clear
Cath for 10 day. Dry day after removal of Cath
PSA @ 3 months <0.1
6 months <0.1
9 months <0.1
12 months <0.1
16 months <0.1

ED Started VED at 3 months, pills followed VCL none did much, tried MUSE at 9 months (YUCK) Hated it. 15 months out injections Caveject (succecc)


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 3/2/2010 12:45 PM (GMT -6)   

Not feeling well and totally bummed out about all of this.

I'm flat out depressed.

Still awaiting call from Ford to see what they say.

Mel

 


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities.

Next Event: First post-op PSA on 3/2/10


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/2/2010 12:46 PM (GMT -6)   

Hi Mel, sorry to hear you aren't feeling well.

We've already covered in other threads "the science" behind where PSA comes from, and how it gets dissiminated once the prostate and seminal vesicles are removed (and how long it takes).

With a firm understanding of the science, if you have some personal worry about the confounding interaction of any of your other short-term factors...then wait.  Once you've waited the appropriate duration for dissimination to occur (you have), then there certainly is no magic about having the test on any given day or the other.  Do the blood draw at your convenience. 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/2/2010 1:16 PM (GMT -6)   
Good luck Mel, get ready to write a book on the journey as you are your own witness this is not an easy trip.
Cipro is powerful and should do the trick on infection or such.

Best to you!!
Youth is wasted on the Young-(W.C. Fields)


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 3/2/2010 1:16 PM (GMT -6)   
 
 
Dr. Menon's nurse called me back. Apparently, their doctor's do not think it matters. Once the prostate is out, they seem to think you don't have to worry about that stuff.
 
However, their recommendation on the first PSA is 4-6 weeks after surgery, so if I want to wait, I can. I think it would be prudent to wait a week.  She also said if the culture comes back negative and I am still feeling like this, to call them. If the culture is positive she said to make sure I am on the right drug for this.
 
I'd appreciate any other thoughts/insights you may have.
 
Mel
 
 
 
 
 
 
 

63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities.

Next Event: First post-op PSA on 3/2/10


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 3/2/2010 2:09 PM (GMT -6)   
Only advise I can offer is once you start on the antibotics (regardless of which one) always complete the entire regime even if you start feeling better. Otherwise the infection could come back and then the drug won't be as effective. Of course this is if your culture is positive. Otherwise, follow the doctors advise. In your case, for peace of mind, wait until you feel better before taking your next psa test.

One more thing...make sure that your current illness isn't from psa anxiety. I know you have been overly anxious about the upcoming psa test, and the body can do some really strange things when the anxiety is that high. Try to relax...that may actually be the best medicine right now if your culture comes back clear.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 664
   Posted 3/2/2010 2:13 PM (GMT -6)   
Mel, I think it is prudent to wait. I know it is hard (I'm waiting for the doc to call me with my results now), but it will be worth it if the infection skews the results and causes you unnecessary angst as a result. My doc told me that my PSA test was invalid when I had a bladder infection (I was rejoicing over what I thought was an artificially high PSA). I ended up finding out later that my PSA really was high, but at least pre-prostatectomy, an infection affects the results.
Best Regards, Jeff
Gleason, 3+4; PSA, 7.9
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
pT2c, prostate 60.2g, margins: negative; perineural invasion: present; lymphatic invasion: present; 3 lymph nodes removed, clear; seminal vesicle invasion: absent; Gleason 4 comprises 5-10% of carcinoma
PSA consistently <0.1 since surgery until Oct 09, 0.1; retested Oct 09, <0.1,
Jan 10, 0.2
retest Feb 1 confirmed 0.2
CT scan, bone scan Feb 10 both clear


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 3/2/2010 2:54 PM (GMT -6)   
I'd also wait to do the PSA. You have an infection, and taking drugs as well, who knows what effect that might have on PSA. Would the toxins in your blood or the drugs confuse the sensitive PSA test? I'll bet there has not been much research done on these topics. Even a marginal rise in PSA over what it might otherwise be would cause you concern.

So, I'd wait for full health -- get well soon.
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.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 3/2/2010 3:17 PM (GMT -6)   
Mel,

I think your first post PSA was too soon anyhow, think it makes sense to heal up from your current status until you feel better, then have the pesty PSA test done. My uro/sugrgeon makes a strong case for waiting for 90 out from surgery, though other doctors vary of course.

Hope you feel better, most of what you described is common in some combination with most of us surgery guys, definitely healing and recovery doesnt always work neatly to a schedule, this is one of those good times to listen to your body and let it have its ways.

Hope you are on the mend soon, my friend.

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, no problem post SRT
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7197
   Posted 3/2/2010 4:34 PM (GMT -6)   

LV:

I don't think this illness is from PSA Anxiety, although it's possible

. I definitely have been feeling sick and additionally the urine test today did reveal red cells (blood, probably normal given the surgery) and white cells (small number compared to the red, but probably a low-grade infection).

I have queasiness, nausea, and little energy along with bladder discomfort/burning. Looking at the totality of symptoms/lab results, I have a UTI.

This is lousy timing.

I am just so frustrated with all of this.

I'm hoping the drug kicks in soon. I am supposed to be back at work in a week.

 

Mel

 

 

 


63 years old . PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (Free PSA 24%),  after 45 days on cipro! DREs have always been normal. PCA-3

Biopsy on 11/30/09. 5 out of 12 cores positive. Gleason 4+3. 2 cores were 3+3 (one 5% and the other 30%) on one side. On  other side:2 cores are 4+3 (5%)--1 core 3+4 (30%) no peri-neural invasion. prostate is 45 grams. Stage: T1C.  

Surgery with Dr. Menon at Ford Hospital, 1/26/10. He says all looked good. Spared nerves. Unfortunately: Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland. Lymph Nodes: Clear.  Perineural Invasion: yes. Seminal Vessical Involvement: No.  Extraprostatic Extension: yes.  Positive Margin: Yes-- focal-- 1 spot .5mm. Final Weight is 52.7 gms. 

 Incontinence: joined that club-- definite leaks—1 pad/day. Night is dry, was  using 1 pad at night for security, but pretty much dispensed with that most nights. Update: no pads at night. No pads while at home, but still very uncomfortable. Use 1 pad for out-of-house activities.

Next Event: First post-op PSA on 3/2/10


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 3/2/2010 4:41 PM (GMT -6)   
Mel, your symptons almost duplicated my two fairly recent bouts with catheter related UTI's. Can make you feel miserable and a general feeling of weakness. The cultures are important, as it makes a big difference in the class/type of antibiotic to be on.

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, no problem post SRT
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, Caths #13 & #14 same time


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 3/2/2010 4:43 PM (GMT -6)   
I've got to agree with David. There is no point having a PSA test early after surgery. A decent interval has to pass to allow all residual PSA to be eliminated so a true post surgery result is obtained ......... usually about 8 weeks. Having an early test (with a falling PSA) may deliver a detectable result which could cause unnessarsary worry (and I'm an advocate of ultrasensitive testing). On the infection front as I said before I developed one within days of the catheter being removed ......... caused me quite a bit of grief I'll tell you. But it was easily resolved with a course of antibiotics. My G.P. at the time wasn't at all surprised saying that the bladder and urinary tract was virtually open to the outside world with an ideal path to developing such infections. Wishing you a quick recovery Mel.
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

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