What should be normal psa 6 weeks out?

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Runer
New Member


Date Joined Feb 2010
Total Posts : 19
   Posted 3/16/2010 2:31 PM (GMT -6)   
My first psa after surgery, 6 weeks ago came back at 0.1.  The nurse called me with the results and said that was normal but I am waiting to speak with the doctor.  Shouldn't it be less than that?
7/09---routine physical, 4.4 psa
11/5/09---diag: 1 out of 12 cores positive 3+3 Gleason
1/26/10 robotic prostatectomy. 3+3 Gleason, Clear margins
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/16/2010 2:36 PM (GMT -6)   
There is no normal post surgery, it can vary from zero to something else. Many surgeons, including my own, do not like to do a first post surgery PSA until you are fully 3 months out, avoids a lot of mis-reads, and settling down after surgery.

Hopefully at your next test, it will be <.10 and you will be in the zero club

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, 3/6 Cath #13 out - 4 days


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 3/16/2010 2:39 PM (GMT -6)   
Some doctors don't use the ultrasensitive PSA, so it may actually be .05, or something like that. I personally make sure I get the ultrsensitive test.
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


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 3/16/2010 2:39 PM (GMT -6)   
It should be less than 0.1 but...

Medical staff are remarkably casual about PSA numbers -- it may actually be <0.1, but the nurse has just quoted you the "0.1" part. Or it might actually be 0.01 and she forgot a zero.

If she said it was normal, take that as a good sign, and you have nothing to worry about.
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.


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 3/16/2010 2:53 PM (GMT -6)   
Runer, my husband's first post op PSA was also 0.1...he hit zero about a few weeks later. You'll do fine.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs 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!


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 3/16/2010 5:00 PM (GMT -6)   

Sephie:

 

I think I might have asked this elsewhere, but don't remember seeing a response. I noticed that your husband's PSA crept up and then thank goodness went down. We don't see that pattern too often.

Was there anything specific he did? Just curious.

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 was about 75 (way above the 35 threshold). That led to:

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.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 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. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent!

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in late May.


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 3/17/2010 4:43 AM (GMT -6)   
Mel, John did nothing to bring his PSA down...except pray alot (LOL). When the uro called to tell us that his PSA was back to 0.0, I was literally speechless (may have been only the second time in my life that my mouth was working but nothing was coming out!). Anyway, I remember saying to the doctor "that's practically unheard of." His response: "not really...I've seen it happen before." Apparently with nerve sparing surgery, there's a chance that benign prostate tissue was left behind which can cause low levels of PSA that dies on its own over time. Guess that's what happened with my husband - at least that's what I hope happened.

Should know his PSA by this Thursday so I'll keep ya'll posted.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs 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!


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 3/17/2010 7:34 AM (GMT -6)   
As folks have said, there is no exact "normal" just six weeks out.

As I recall my doctor's range of what she would look for at six weeks, you're doing fine!

Barry
Surgery: Da Vinci; July 31, 2007; 54 on surgery day;
Pathology: PSA: 4.3; Gleason: 3+3=6; T2a; Confined to Prostate;
Post RP PSAs: 09/07 <0.04; 12/07 <0.04; 03/08 <0.04;
06/08 <0.04; 12/08 <0.04; 06/09 =0.06; 09/09 <0.04;
Latest PSA 12/09 =0.05


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/17/2010 8:23 AM (GMT -6)   

Runer,

There is a "science" behind the level of PSA decline after surgery...I'll explain how it works, but to answer your question there is no specific "normal psa 6 weeks out."  It depends primarily on one's PSA prior to surgery...the starting point.  Once the primary source of new PSA is removed (the prostate and seminal vesicles), then the PSA already in one's bloodstream diminshes over time.

Studies have been performed which show a distribution of how fast PSA diminishes, but in most men the "half-life" of PSA in one's blood after RP is 2-3 days.  So, if one's "starting point" at the time of surgery is 5 ng/mL (close to yours), and if one assumes a 3-day half-life, and if one assumes no additional source of PSA added into the bloodstream, then the PSA level would reduce like this:

5.0 ng/mL at time of surgery

2.5 ng/mL 3 days later

1.25 ng/mL 3 days later, 6 days after surgery

0.625 ng/mL 3 days later, 9 days after surgery

0.3125 ng/mL 3 days later, 12 days after surgery

0.15 ng/mL 3 days later, 15 days after surgery

0.08 ng/mL 3 days later, 18 days after surgery

0.04 ng/mL 3 days later, 21 days after surgery

etc., etc.

 

This is the "science" behind why surgeons prescribe the first PSA typically 6-8 weeks after surgery (some very conservative doctors want to wait longer...the longest I've heard of is 3 months).  There would be some statistical "outliers" to the 2-3 day typical half-life which would result in a longer time to diminish.

Of course, this half-life decline described above assumes no PSA is being added back into the bloodstream.  There are, however, secondary (minor) sources of PSA, however, which prevent any living, breathing man from every achieving "zero" PSA...the phrase "zero club" is a misnomer which sometimes causes undue worry in men when they hear that their PSA is something other than "zero."  Prostate cancer produces PSA.  But a common source of PSA after RP surgery is the neurovascular bundles which may have been safely left behind during surgery; they do produce a low level of PSA, and the amount produced varies from man-to-man.

Good luck with your doctor follow-up visit...

Post Edited (Casey59) : 3/17/2010 8:31:41 AM (GMT-6)


skeener
Regular Member


Date Joined Dec 2009
Total Posts : 214
   Posted 3/17/2010 4:00 PM (GMT -6)   

Casey:

Thanks.  Excellent answer.  I am always learning.

Skeener


Age:  63 
Biopsy: May 09 showed 2 of 12 cores positive for prostate cancer -- 1 at 5% and 1 at 25%.  Cancer indicated as non aggressive.  Gleason Score: 3+3.
RRP on Oct 23/09 in London, Ontario.  Excellent surgeon. 
7 Weeks Post Op -  The fears I had about bad things about the operation and recovery did not materialise except of course ED!!.  Otherwise, everything went very smoothly.  Incontinence not a problem.  Wear a pad when out just in case. Pain was never a problem.
Pathology:  Unremarkable 
First followup PSA and Visit: Feb 11/10 - 0.0.
 
Next PSA May
Next doctor's visit in 6 months      


deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 246
   Posted 3/17/2010 5:40 PM (GMT -6)   
HI ya'll i had one 3 month period where my psa only went up 1 numeber it puzzled the doc and me, they wanted to know what i did different but i could't tell them because i didn't know ,it was life as normal
DEERHUNTER
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see!!!!!!


TaurusBull
Regular Member


Date Joined Jan 2010
Total Posts : 91
   Posted 3/17/2010 7:11 PM (GMT -6)   
Echoing some of the posts in this thread, just thought I'd mention that my urologist believes that benign prostatic tissue can indeed produce enough PSA to become detectable in blood tests. In fact, in the book entitled "Dr. Peter Scardino's Prostate Book", which I'm certain many here have read, it states on pg. 393: "If a rising PSA comes from remaining bits of benign tissue, the PSA usually rises slowly and peaks at a low level, about 1. How soon the elevation occurs depends on how much prostate tissue is left in place and the sensitivity of the PSA assay".
Dx: in 6/2005 at age 49
PSA tests 3/2005: 3.8 ng/ml, 4/2005: 4.1 ng/ml, Stage: T1c
TRUS biopsy: 2 out of 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 7/23/2009: 0.1, 10/16/2009: 0.2, retested 10/23/2009: 0.1, 1/22/2010: 0.2.
Switched to more sensitive test on 2/5/2010: 0.14 ng/ml.


Runer
New Member


Date Joined Feb 2010
Total Posts : 19
   Posted 3/17/2010 8:04 PM (GMT -6)   
Thank you all for your answers. It turns out PIANO's comments above were right.  The doctor called me back and told me the reading was <0.1. The nurse neglected to read that little sign which made all the difference in the world so I am officially in the "0" club. Thanks again.

8/09---routine physical, 4.4 psa
11/5/09---diag: 1 out of 12 cores positive 3+3 Gleason
1/26/10 robotic prostatectomy. 3+3 Gleason, Clear margins
 3/9/10---psa 0.1


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 3/17/2010 8:22 PM (GMT -6)   

That's much better news

 

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 was about 75 (way above the 35 threshold). That led to:

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.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 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. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent!

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in late May.


skeener
Regular Member


Date Joined Dec 2009
Total Posts : 214
   Posted 3/17/2010 9:40 PM (GMT -6)   
Runer
 
It took a while to make it official but we are so happy to have you in the Zero Club.
 
Isn't it a great feeling to reach this milestone!!
 
Skeener 
Age:  63 
Biopsy: May 09 showed 2 of 12 cores positive for prostate cancer -- 1 at 5% and 1 at 25%.  Cancer indicated as non aggressive.  Gleason Score: 3+3.
RRP on Oct 23/09 in London, Ontario.  Excellent surgeon. 
7 Weeks Post Op -  The fears I had about bad things about the operation and recovery did not materialise except of course ED!!.  Otherwise, everything went very smoothly.  Incontinence not a problem.  Wear a pad when out just in case. Pain was never a problem.
Pathology:  Unremarkable 
First followup PSA and Visit: Feb 11/10 - 0.0.
 
Next PSA May
Next doctor's visit in 6 months      


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 3/18/2010 12:39 AM (GMT -6)   
Hi Runer,

Congrats on being in the zero club. May it ever be so!

Barry
Surgery: Da Vinci; July 31, 2007; 54 on surgery day;
Pathology: PSA: 4.3; Gleason: 3+3=6; T2a; Confined to Prostate;
Post RP PSAs: 09/07 <0.04; 12/07 <0.04; 03/08 <0.04;
06/08 <0.04; 12/08 <0.04; 06/09 =0.06; 09/09 <0.04;
Latest PSA 12/09 =0.05


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 3/18/2010 4:22 AM (GMT -6)   
Runer.
I am a firm believer in getting higher resolution PSA readings post RRP.
There are two boxes that can be checked relating to PSA on the blood test request form. (Actually there are more but I will ignore those for now.)
The boxes are":
"Screening" - Usually has resolution of, and reports to one decimal place e.g. 10.5, 2.3 , 0.2 0.1, etc.
"Diagnostic" - Usually has a resolution of, and reports to 2 or 3 decimal places. e.g. 0.05, 0.15, 0.01.

Several of us compared pricing for these two test and found no significant difference between them. Call around and ask the labs in your area if they have the capability. Then talk with your Uro the next time and ask for the higher resolution. That digit is important in many cases.
Consider someone who gets checked quarterly and had been receiving the following results: 0.1 , 0.1, 0.1, 0.1
Now look at with the extra digit: 0.05, 0.08, 0.11, 0.14 There is a big difference between those two.
Ask for written results and keep your own file. In this journey you are your own best advocate.
Jeff
Married 34 years, 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 next See Uro 1/22/10 Trimix #1. Try 0.08- 25%, 0.12-25%, 2/26/10 try 0.16 First Success! 90%.
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.)
12/11 5 months: Still 3 pads per day. 400-450ml/day
2/26/10 7 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.


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/18/2010 5:07 AM (GMT -6)   
Jeff (Worried Guy),

I'm going to respectfully disagree with you about the Ultra Sensitive PSA test being a good idea for Runer.

For reference, please go to this link, and read the yellow box at the bottom titled "The Downside of Ultra Sensitive PSA Test": http://www.phoenix5.org/Basics/psaPostSurgery.html

The advice I give is individualized. I'm not a believer in 'one size fits all.'  In your case, with 7/12 samples and EPE, I think the Ultra Sensitive test is the right choice.

Runer didn't post his pathology details, but with 1/12 samples and 3+3, he is already in a very low likelihood of anything showing up, and so this article (the link I provided) is specifically applicable to him.

The Ultra Sensitive PSA test is a good tool, but it is not appropriate/needed for everyone because it has downside as well as upside which is more or less for each individual case.

best wishes...

Post Edited (Casey59) : 3/18/2010 7:39:57 AM (GMT-6)


Worried Guy
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Date Joined Jul 2009
Total Posts : 3732
   Posted 3/18/2010 9:36 AM (GMT -6)   
Hi Casey59,
"I'm going to respectfully disagree with you about the Ultra Sensitive PSA test being a good idea for Runer"
That is the beauty of this site. People respectfully disagree. I sure like talking to you.

From the article you quoted above. Chan:
''You cannot reliably detect such a small amount as 0.01,'' he explains. ''From day to day, the results could vary -- it could be 0.03, or maybe even 0.05'' -- and these ''analytical'' variations may not mean a thing. ''It's important that we don't assume anything or take action on a very low level of PSA. In routine practice, because of these analytical variations from day to day, if it's less than 0. 1, we assume it's the same as nondetectable, or zero.''

I understand that there can be variation. In his example he says a 0.01 can be a 0.03 or even a 0.05. That is OK in my book. As long as you understand the capability, you should not get excited by small variations. The issue I have with the single digit test is that your real PSA can keep climbing without anyone noticing for at lest a year or more. Consider quarterly test with results below: 0.03, 0.05, 0.08, 0.10, 0.12, 0.16 . When would the "single digit" show something? 1 year? two years? The results would be 0.1 for all of them , maybe the 0.16 would show up as 0.2 but that test would most likely be repeated. If it came back as 0.1 the process would be delayed another 3 months.
I figure information is always a good thing. We just have to use it wisely.

Jeff

By the way, some guys here even get 3 digit results. Now that might be too much. But I'd take it if offered for the same price.

Post Edited (Worried Guy) : 3/18/2010 9:41:55 AM (GMT-6)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/18/2010 10:05 AM (GMT -6)   
Fair enough. I understand the thought of "more digits" of information. I'm an engineer (despite David's suggestion that I might be an attorney or secretely working for ACS...but that's another discussion), and so I have an appreciation for meaningful data. I also understand the naturally occurring PSA variability (as described in the article), as well as the variability induced by the measurement system (gauge R&R). And, I understand the notion of unnecessary "PSA Anxiety" as described in the article.

So, perhaps we can simple agree to disagree. My personal advice on selecting standard or ultrasensitive PSA test post-prostatectomy is personalized to ones individual case characteristics. In a case like Runer with post-RP pathology of 3+3 and clear margins (I didn't previously notice that he had posted those results in his signature), my feel is that the expected and naturally occuring variation which is detectible on the ultrasensitive PSA test which can cause PSA anxiety—and PSA anxiety is a real thing; it is all over many threads on this web site—is unnecessary/unwarranted. It would be extremely rare for Runer to have a BCR, biochemical reoccurence; so rare that he doesn't need to worry himself about it watching 2nd decimal place digits jump up and down.

Back to you for a last word, then we move on. :-)

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 3/18/2010 11:02 AM (GMT -6)   

Casey:

 

The ultrasensitive test can get very dicey and cause a lot of worry, especially with the emphaisis on PSA doubling times. For my pathology, I would rather do the 2-decimal place test. My doctors indicated they will want to watch it closely and jump quickly if need be. But even with that, these doctors do NOT favor the ultrasensitive test.

But consider my good first reading of .01. Next one could be .02. OMG, IT DOUBLED ALREADY! tHAT sounds scary. But, then again, it's ONLY .02. That's a good number. So, is it good or bad? I guess the PSA after that will show us, but say that is .03. Half full or half empty??

 

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 was about 75 (way above the 35 threshold). That led to:

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.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 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. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent!

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in late May.


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 3/18/2010 11:05 AM (GMT -6)   
Casey
No last word needed.
I still love you. :-)

Jeff (Also an engineer.)
Married 34 years, 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 next See Uro 1/22/10 Trimix #1. Try 0.08- 25%, 0.12-25%, 2/26/10 try 0.16 First Success! 90%.
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.)
12/11 5 months: Still 3 pads per day. 400-450ml/day
2/26/10 7 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.


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 3/18/2010 11:17 AM (GMT -6)   
Being a mathematician, I've noticed quite a few mathamatical types posting here, and I'll even include the financial/accountant types!
 
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 was about 75 (way above the 35 threshold). That led to:

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.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 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. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent!

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in late May.


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/18/2010 12:15 PM (GMT -6)   
compiler said...

But consider my good first reading of .01. Next one could be .02. OMG, IT DOUBLED ALREADY! tHAT sounds scary. But, then again, it's ONLY .02. That's a good number. So, is it good or bad? I guess the PSA after that will show us, but say that is .03. Half full or half empty??


Talk about your case of "PSA Anxiety"!!  shocked

Consider this.  The AUA defines biochemical recurrence as an initial PSA value 0.2 ng/mL followed by a subsequent confirmatory PSA value 0.2 ng/mL.

Reference:  http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/psa09.pdf

 

------------------------

Jeff, I couldn't find a "heart" icon for you...so a smile, wink and grin will have to do... smilewinkgrin

 

. 


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 3/18/2010 2:25 PM (GMT -6)   

Casey:

 

But they also talk about doubling times. Anyway, my POINT is that the ultrasensitive versions CAN cause anxiety. I still would rather have more information than less.

 

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 was about 75 (way above the 35 threshold). That led to:

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.  (Second opinion from Jon Epstein at Hopkins confirmed these results)

 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. Suddenly got MUCH better on 3/10/10, almost overnight. Still some urgency but no pads about 90% of the time.  As of 3/12/10--completely continent!

First post-op PSA on 3/10/10--DRUM ROLL: 0.01 Next PSA in late May.

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