Latest PSA - Need Advise

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Kark60
Regular Member


Date Joined Jun 2008
Total Posts : 91
   Posted 4/16/2010 10:31 PM (GMT -6)   
Just got the results from my latest PSA... after having a .01 in July 08 following my surgery in May 08, and then a long string of 0.0 at three month intervals, I learned this afternoon my latest score was .1. When I spoke with the uro's nurse, she told me the PSA scores still looked "very good" and that nothing more needed to be done unless the score reached .2. She said I could wait for my next "regular" PSA in July 2010, or "for my own piece of mind," could get re-tested in six weeks. She also said these scores tend to "jump around sometimes."

I thought .1 was detectable and thought this score was bad news. Given my profile (4+3, EPE, pre-surgery PSA 13.7) I can't say a recurrence would be a big surprise.

Any advise about the likelihood of this being a recurrence? How likely is this a fluke reading? How long should I wait for the next PSA? Any thoughts are appreciated.
Husband and father of two (current ages 6 and 8). Age 47 when diagnosed (currently 49).
Pre-surgery PSA: 13.7 Pre-surgery Gleason: 4+3=7
CT Scan, Bone Scan, PET Scan: Clear
Laproscopic Surgery on May 28, 2008, at Barnes Hospital in St. Louis.
Right nerve bundle spared; left bundle removed.
POST-SURGERY PATH REPORT: Gleason: 4+3=7;10% of prostate with all quadrants involved; extraprostatic extension at left base and apex; extensive perineurual invasion present. Bladder neck, lymphvasular space, seminal vesicles, 17 examined lymph nodes, and all surgical margins FREE of tumor. T3a.
Four-week post-surgical PSA = 0.1; Seven-week post-surgical PSA = .01;October 2008 PSA = 0.0; January 2009 PSA = 0.0; April 2009 PSA = 0.0; July 2009 PSA = 0.0; October 2009 PSA = 0.0; January 2010 PSA= 0.0; Next PSA scheduled for April 2010.


Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 669
   Posted 4/17/2010 12:51 AM (GMT -6)   
When I reached .1 (both times), my doc immediately had me come back in for a re-take. Maybe some docs aren't as concerned about a 0.1 as others, but if it were me, I'd take the offer to be rechecked as early as possible to see if it was a fluke or not. Some define recurrence as 2 consecutive 0.1 readings, others as 2 consecutive 0.2 readings. My doc is in the former. We are watching very closely now. I have had 2 consecutive readings with no change - 0.17. I am encouraged that there is no velocity at the moment, but I am under no pretenses - I have had a recurrence.
I hope your reading is a fluke.
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
Mar 1, PSA 0.17


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 4/17/2010 4:52 AM (GMT -6)   
Did you see the actual result or was she reading it out to you. I would be checking with her that she was reading the result correctly. You would not be the first to have .01 called .1. For this reason it is always advisable to get and keep a copy of the test result. Here's to you having the same result as before and her saying "Oops, I misread that one"
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: http://www.yananow.net/Mentors/BillM2.htm
Never underestimate old people ............ you don't get to be old by being stupid.


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 4/17/2010 6:09 AM (GMT -6)   
I would definetly retest in a month or so. If PSA keeps going up - act, no reason to wait until 0.2. However, focus on a good news:
- this could be a fluke
- it has been two years after surgery, if this indeed is a recurrence, it is very likely a
local one
- you have another "cure" card left
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 4/17/2010 6:54 AM (GMT -6)   
Kark,

I would retest. Also looking at your past scores there were some that appeared to be ultra sensitive (0.01) then others that just reported as 0.0. Could they have changed the tests they were asking for and in reality your score was something like 0.06-0.09 and they just rounded it up to 0.1.

These are questions I would definitely ask in addition to seeking a re-test. The answers sure could take a load of worry off your mind.

Good Luck and let us know what happens,

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/17/2010 9:06 AM (GMT -6)   
Unless that .1 is the result of rounding up as Sonny suggested above, and a closer look at the test should show that, I would definitely be retested sooner, not later. My dr. and then later my rad. oncologisit, both agreed, that once you cross the .1 line for sure, keep testing close, and when I had 3 readings that were above .1 and rising each time, recurrance was declared. Both my uro and rad oncol agreed too, that there was no point waiting for it to get to .2 or any other higher number, and it was time to start planning a salvage treatment.

Just my take.

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, 4/8 .04
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, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/17/2010 11:23 AM (GMT -6)   
I agree with all of the above, get retest. As you can see from my signiture, my Dr had both of my last wo PSA's re-tested. Also, you should consider asking to have the lab send you a copy of their report. I get mine mailed to my home. I usually have the results before I hear from my Dr.
Dx with PC Dec 2008 at 56, PSA 3.4, Biopsy: T1c, Geason 7 (3+4)

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31


Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 4/17/2010 2:15 PM (GMT -6)   
Well....ditto.
I would get re-tested at 6 weeks.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 and thereafter <0.1
http://pcabefore50.blogspot.com


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 4/17/2010 2:34 PM (GMT -6)   
I would also ask for an ultrsensitive test. In my opinion, and in my own situation, I have demanded ultrasensitive. In fact, I got retested in 2 days after I got the result and saw it was not ultrasensitive. I personally have it drawn at a hospital, and then go to medical records in 2 days and get a copy.

Your PSA may come back at .09 ort .08, but at least you can see the change. that first .09 can be a litlle deceving I think.

The nomograms will give you a favorable cure rate with SRT based on a 2 year time frame. In fact, they want to know when it reaches .2 for their calcs, which may be a while for you.

Good luck on your journey.
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
1 year psa (364 days) .01


hangin-in
Regular Member


Date Joined Sep 2008
Total Posts : 78
   Posted 4/17/2010 10:15 PM (GMT -6)   
After a string of .01 I had my results also come back at .1. I got very concerned until I found out that they did not do the ultra-sensitive test. My suggestion is to make sure that the .1 was from the ultrasensitive test.
Good luck to you.

Rising PSA 12/06=1.6 12/07=2.1 5/08=2.6
Biopsy 6/4/08 12 core 4 Positive 15%,15%,8%,3%
Diagnose @ Age 51 Gleason 3+3=6
Bone & Cat Scans Normal
Lapro Surgery 8/18/08 at Memorial Sloan Kettering
Pathology report stage T2c organ confined with positive apical margin Gleason 3+3 = 6 (with tertiary grade 4)
Catheter removed 8/26 - reinserted 8/29 - removed 9/2
No continence or potency problems from the get-go.
First post op PSA 10/2/08  < 0.05
2nd  post op PSA 12/30/08 < 0.05
3rd  post op PSA 3/30/09 < 0.01
4th  post op PSA 6/25/09  0.01
PSA 9/25/09 0.01
PSA 12/28/09 0.01


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 4/19/2010 5:05 PM (GMT -6)   
Sounds like good advise has been given hear. I do think that you are still doing great however do take precaution and get retested soon. Let us know how it goes.

peace to you
dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 4/20/2010 9:02 AM (GMT -6)   

Is it true that both Johns Hopkins and Mayo recommend use of standard psa test rather than the ultrasensitive psa test for post-prostatectomy monitoring of psa levels?   I have heard that but don't know for sure whether it is true (or only in certain cases?)   I read so much about ultrasensitive results (and the anxiety they cause), but these two institutions are not fully of dumb people, so it would be interesting to know their thinking.

 

 


Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.6
 


Kark60
Regular Member


Date Joined Jun 2008
Total Posts : 91
   Posted 4/20/2010 4:57 PM (GMT -6)   
My surgeon also recommended the standard test for this very reason. He said anything below .1 is not significant and easily can be altered by proteins that are "cousins" of PSA. Thus, the ultrasensitive is not necessary or particularly helpful below the .1 level.
Husband and father of two (current ages 6 and 8). Age 47 when diagnosed (currently 49).
Pre-surgery PSA: 13.7 Pre-surgery Gleason: 4+3=7
CT Scan, Bone Scan, PET Scan: Clear
Laproscopic Surgery on May 28, 2008, at Barnes Hospital in St. Louis.
Right nerve bundle spared; left bundle removed.
POST-SURGERY PATH REPORT: Gleason: 4+3=7;10% of prostate with all quadrants involved; extraprostatic extension at left base and apex; extensive perineurual invasion present. Bladder neck, lymphvasular space, seminal vesicles, 17 examined lymph nodes, and all surgical margins FREE of tumor. T3a.
Four-week post-surgical PSA = 0.1; Seven-week post-surgical PSA = .01;October 2008 PSA = 0.0; January 2009 PSA = 0.0; April 2009 PSA = 0.0; July 2009 PSA = 0.0; October 2009 PSA = 0.0; January 2010 PSA= 0.0; Next PSA scheduled for April 2010.

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