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Regular Member

Date Joined May 2010
Total Posts : 29
   Posted 5/23/2010 11:58 PM (GMT -6)   
I had LRP on 1/2/08. Gleason 3+4, T2C, negative margins.

All PSA's tests until 8/09 were less than 0.04.
8/09 PSA was 0.06, taken by lab at my family doc.

Surgeon says ignore anything under 0.1.

PSA on 12/09 was less than 0.1 as lab was not reporting less than 0.1.

PSA on 5/10 was 0.05, as lab now reporting to this level.

Question - should I worry about these PSAs of 0.06 and 0.05.
On one hand, if the test is that accurate then my PSA actually went down, which most be a good sign. I have read that benign material left behind or even other organs could produce PSAs at the 0.05 or 0.06. It has also been 28 months since the surgery. So it is just noise.

On the other, logically if you have no prostate you should have no PSA. Something is there.

Not sure what to think. As to what to do, I guess I will have another PSA in 6 months and see.


Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 5/24/2010 2:47 AM (GMT -6)   
You are not doing bad at all. I think more information on your post op pathology will help the group help you. Gleason and percent of involvement will be good info.

I personally don't like ultra-sensitive PSA tests. There is room for error and worry. And no prostate does not mean no PSA on those tests.

Welcome, and if you can share some more about your journey!


Advanced Prostate Cancer at age 44 (I am 47 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog :

Veteran Member

Date Joined Jun 2008
Total Posts : 1804
   Posted 5/24/2010 6:18 AM (GMT -6)   
PVE, in my book, any PSA under 0.1 is a good one after surgery. As Tony said, the downside of the more sensitive PSA tests is the constant minute fluctuation of PSA that naturally occurs and often causes "PSA anxiety". Even without a prostate, other tissue can and does produce PSA albeit at much lower levels than an intact prostate.

If you had nerve-sparing surgery (whether both bundles or only one bundle was saved), there is always a possibility that benign prostate tissue was left behind and will generate very low levels of PSA which die off naturally (hence the fluctuation).

Do not worry about your PSA - you are looking real good and your surgical path report looks good as well.
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, March 2010 0.0. Next PSA in 6 months. Thank you God!

English Alf
Veteran Member

Date Joined Oct 2009
Total Posts : 2218
   Posted 5/24/2010 7:38 AM (GMT -6)   
PVE Welcome to the Forum

I'd say your stats are good. I wish I had them
I think you count as being a member of the zero club.

I think one thing about comparing PSA levels is that it is best if all aspects of the test are as similar as possible. Getting your samples tested by the same lab and the same way will give a much more accurate picture of changes over time than having samples tested at a variety of labs all over the place.

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 of urine
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc. but...
Nov 17th 2009 PSA = 0.1
Can still get erections okay, and almost no leaking of urine, but since December 2009 I don't have orgasms, instead I just have intense pain in place where prostate used to be.
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)

Regular Member

Date Joined May 2010
Total Posts : 29
   Posted 5/24/2010 9:41 AM (GMT -6)   
My PSA was 3 +4. I did not get the percent of involvement but was less than suspected from the biopsy.

I am also confused about the T 2C. I had at least 4 DRE's prior to surgery by my family doc, by a very experienced urologist, by a surgeon with over 500 LRP's under his belt at the time, and by a resident. All told me that they could not detect anything. However I know that the surgeon has me classified as T2C.

Thanks again

Veteran Member

Date Joined Sep 2009
Total Posts : 3172
   Posted 5/24/2010 3:39 PM (GMT -6)   
PVE said...

...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:
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)

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 5/24/2010 3:59 PM (GMT -6)   
You are a solid "zero" in the technical sense, many would love to have your PSA numbers right now. When you get into the ultra sensitive testing, your numbers are well into the range of normal tolerances for test. I think you are doing great.
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, next one:  July
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- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 5/24/2010 9:08 PM (GMT -6)   
According to Dr Strum, serial increases in PSA using the ultra sensitive psa can determine a reoccurrance 2 to three years earlier. So this means that if your psa keeps increasing, even though it is <1 it can indicate a reoccurrance.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


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