Second PSA after recent protectectomy

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Regular Member

Date Joined Jan 2010
Total Posts : 28
   Posted 4/13/2010 8:39 AM (GMT -6)   
Been on pins and needles since robotic surgery with respect to post op PSA. Thought I'd see what the knowledgeable folks here might know and advise.
3 mo. PSA <.1 Scale(0.0-4.0)
6 mo. PSA 0.1 same test same lab.
Lab notes say test is Siemens/Bayer method for post prostectomy patients

My GP says this .1 is the lowest detectable. He will be discussing this with my Urol and a Rad onc. in the next few days. My question is how significant a rise is this. Is this already a pattern or is it too short a period of time/ numbers to be reliably indicative of anything. I read on here all the time about rising PSA anxiety. Now I know. The rad onc said even before this 2nd PSA he wanted to do radiation, something I at this point would like to avoid as I continue to heal slowly from my Nov. 09 prost and would like nothing better than to heal and return to some type of normalcy. Will this give him enough ammunition to push his case? My understanding is rad at this point is still an unproven procedure.

Advice and thoughts from this forum have been very helpful to me thus far, and I look forward to your feedback
60 year old, sometimes happy, sometimes grumpy guy
Robotic RP 11/09
Otherwise good health
Gleason 8, T3a
Margins uninvolved
extraprostatic extension present,
Seminal vesticle invasion: absent
PSA 1/25/10 undetectable
Great support, wife, family, employer

Veteran Member

Date Joined May 2009
Total Posts : 2691
   Posted 4/13/2010 9:01 AM (GMT -6)   
It is an ongoing discussion here about the value of extended precision PSA. If your first PSA was .09, then an increase to .1 is a small one, and can be explained by several factors. If your first PSA was a .01 or .02, then a .1 is a significant jump.

My personal advice would be to wait, maybe in 4 weeks have another PSA test and see what it says. Most URO's will want 2 or 3 consecutive increases before they start the next treatment phase.

Best of luck as you watch these numbers. It may just be a bad day at the lab, and will be <.1 the next time.
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

Regular Member

Date Joined Mar 2010
Total Posts : 479
   Posted 4/13/2010 9:50 AM (GMT -6)   
Your psa results are quite good. It reads like your surgeon did the best anyone could. Have a glass or an entire bottle.
The extension is a concern and any G 4 is always a cause for vigilance. I think that yourGP/ surgeon/urologist means that any psa recorded at less than 0.1 is undetectable in the sense that no change of treatment would be considered. If the psa can be detected by some other assay at a lower level, but the changes within this lower range would be ignored for medical purposes, then that is the same as undetectable. Was it 0.093 before (hypothetically)? If so, has this change become relevant? I think this is the issue the doctors are considering.
The wait on radiation is wise. The ability to regain all functions before any radiation will have long term reward. You might consider vitamin D3 supplementation, diet changes and other nutriceuticals for the time being until this is sorted out. It is likely that this anxiety and concern will be a long term issue. Wrap your mid around that first and then you can successfully accept the challenge of the future.
SWOG 8794 was a long term trial for men such as yourself. You can google it and the Journal of AMA is free reading. There has been a more recent update. The results are strongly positive for adjuvant radiation for men such as yourself. This was a top notch, first class trial. Results with more modern radiation by the best radiologists would likely be better than the results from the trial in the 1990's.

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2209
   Posted 4/13/2010 10:44 AM (GMT -6)   
Hi "Happy/Grumpy" guy (I'm one too)

I am just about to start RT because of a raised PSA (0.4) at about 7 months. After a 0.1 to start with I was told that 0.2 would be the level at which they would want to act.

I think that the reason for wanting to act in your case might be the combination of your PSA plus the stage 3 plus the Gleason 8. The attitude seems to be that RT works better the sooner it is used.

Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc.
Nov 17th 2009 PSA = 0.1
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 4/13/2010 7:32 PM (GMT -6)   
Your concerns illustrate why I am a fan of ultrasensitive testing. Your G.P. is not correct in stating that 0.1 is the lowest detectable PSA. Currently the lowest limit of detection is 0.003 but a result at this infitesimal level can be variable, even when done on the same sample. I elected to go with the ultrasensitive testing because of (1) 1st post op pathology said 4+4=8 and a 2nd post op opinion said 3+4=7 and (2) both said an EPE present and a substantial volume of tumour within the gland. My reading led me to believe that ultrasensitive testing can give a much earlier (up to 2 years) indication of any changes that may be happening so far as recurrence is concerned. It also gave me an absolute baseline (nadir) reading to go on. What I mean by this is, a result of <0.1 could mean anything from 0.003 to 0.099. A steady climb from say .008 to .02 to .04 to.07 to me clearly indicates a recurrence is underway and a next step (whether to radiate or not) could be planned somewhat earlier.
So far as your results are concerned there may have been no change at all. The earlier test may well have been 0.099 giving a reported result of <0.1 and now the latest test says 0.1 which is really not a change at all. Somebody may even have left out the < sign on this test.......... it would not be an unusual occurence with PSA reporting. I would go with what the other members have suggested and get another test in a month or so ........ you could even have them order an ultrasensitive result so you have a true baseline to work from.
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:
Never underestimate old people ............ you don't get to be old by being stupid.

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