...On the other, logically if you have no prostate you should have no PSA. Something is there.
Not sure what to think...
I understand your high level of confusion (and naturally, some worry too). You might have seen in other posts at this site about the so-called "zero club", and lots of talk about being at "zero." Naturally, when your PSA result was (as you noted above) not "zero" and you thought it should be reported at "zero"...then this has caused you confusion and anxiety. Very understandable.
Here's what you probably didn't know...technically there is no such thing as a "zero" PSA in a living, breathing man.
The concept of the "zero club" is a misnomer which has been casually adopted at this site, and unfortunately every couple of weeks someone else (like you) gets—lets just use the words you've already used: "confused"—about not being at "zero." Despite the anxiety it causes many newcomers here, the "zero club" for the old-timers has meant a low level, or an undetectible level (below the detection limits of the test), depending on who you might ask at any given time. Sorry for the unnecessary confusion/worry it might have caused you.
You are absolutely correct that there will have been some benign, PSA-producing tissue left behind when your prostate was removed, especially if the surgeon did "nerve sparing" surgery (but even if he didn't). This tissue will produce a low level of PSA which is almost always below the lower detection limit (LDL) of the "standard" PSA test (the one that only goes one decimal place, and so the lowest possible reading is <0.1 ng/mL).
Furthermore, please do understand that there is natural variation in the actual amount of PSA, and also variation in the test results. So, PSA variation of a few hundredths, either up or down, usually means absolutely nothing.
This natural variation in the hundredths place is exactly the reason that some surgeons do NOT prescribe the ultra-sensitive PSA test...because the small variations at those tiny levels don't matter, and (as your doctor has suggested) only when the PSA gets above 0.1 ng/mL is there reason to take note. I suggest reading this short article on "PSA Anxiety", located at the bottom of the page (in the yellow box) at this link: http://www.phoenix5.org/Basics/psaPostSurgery.html
Just for completeness, there could still be some cancerous tissue left behind...I don't want you to think that it's not possible. If you had negative surgical margins (SM) and no extraprostatic extensions (EPE), then this would be very, very unlikely. Many doctors prescribe only the "standard" test for patients with no SMs and no EPE. Ultra-sensitive PSA tests are a good idea for patients with positive surgical margins.
I hope that this clears up your confusion and worry...
added later as edit...
Also, regarding your follow-up question about being "T2c"...this happens to everyone after surgery. The "T1x" staging is done "clinically"; that is, from the "outside." Once they excise your prostate and do a complete pathology, they are no longer guessing from the outside, they know exactly what stage it is, so the "1" becomes a "2." Did I explain that well enough??
Post Edited (Casey59) : 5/24/2010 7:30:23 PM (GMT-6)