How long till PSA Drops following surgery

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lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 6/8/2010 2:52 PM (GMT -6)   
QUestion for the guru's over here.....I have a friend on another forum that had his prostate surgery 5 weeks ago. He just got his first PSA test back at .3 ......He see's his Doc tomorrow.
 
 
 
I told him the test is most likely a little early at 5 weeks and was curious what the guru's think of as to how long the PSA takes to get out of the blood stream.... The only thing is his PSA Was only 2.3 pre surgery but he insisted on biopsy do to family history and they found cancer in 7 of 12 cores.....He is in his early 40's and african american. (Which I know puts him in a higher risk)
 
Thanks for your thoughts,
 
Larry
Age 55 / age at diagnosis 54, PSA 5.1
Robotic surgery 08/12/09 at Vanderbilt, Nashville TN. 
Final Path report:
20% of the prostate Involved
Tumor graded at T2C
Overall Gleason 3+4 (7)
Lymph Glands Clear, Positive Margin Noted in Right Apex
 
First post Surgery PSA - 0
Six month PSA - 0


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4823
   Posted 6/8/2010 2:58 PM (GMT -6)   
There are a few threads on this...As I recall - more then half the guys here waited 3 Months. (to avoid getting a wrong reading to early)
 
Mine was at three months.
Age 55   - 5'11"   215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
05/18/10 - 24 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6892
   Posted 6/8/2010 3:15 PM (GMT -6)   
My doc would not do the PSA until 8 weeks out.

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 814
   Posted 6/8/2010 3:33 PM (GMT -6)   
Johns Hopkins says 3 months.  The african american thing is debatable about higher risk.  Some studies say yes some say no.  Most important is Gleason score and pathology post-op.
 
I have often wonder what filters PSA out of your blood.  Do some people do it faster then others?  I am sure it varies person to person.  Which also makes PSA a more variable measurement.
Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010


profman
Regular Member


Date Joined Jan 2010
Total Posts : 55
   Posted 6/8/2010 4:10 PM (GMT -6)   
My doc had my first PSA test at six weeks after surgery, which was <0.1. The PSA was 3.5 at time of diagnosis.
Diagnosed 9/4/09, age 59
PSA 3.5, up from 1.8 year before
First biopsy showed 3/10 positive cores, Gleason 3+3, less than 10% involvement in all three cores, diagnosed as T2a; prostate size estimated at 32 gram
Thinking of Active Surveillance but
Second biopsy showed 5/10 positive cores, Gleason 3+3, left side (4 postitive cores) had 40% involvement
RRP on 12/15/09, home 12/16
Catheter out on 12/29/09 (failed cystogram earlier)
Path report was all good news, Gleason 3+3, no margin involvement, no perineural involvement, everything clean other than core of prostate, tumor on both sides, but more prevalent on left side, 5% involvement, 42 gram organ
Within two days down to one pad a day, pad free at six weeks
Back to work 1/4/10
First PSA 1/28/10 - nondetectable (<0.1), next scheduled June 2, 2010
ED present, although blood does flow after Viagra. working with pump now - still trying!


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/8/2010 5:19 PM (GMT -6)   

There is a "science" behind the level of PSA decline after surgery...I'll explain how it works.   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, Larry; and about twice your friend's PSA, but you can easily see where his fits in, below), and if one assumes a 3-day (the slower assumption) 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.

 

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

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."  

A common source of PSA being added back into the bloodstream 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.  The PSA produced by the nerve bundles after surgery is not a sign of cancer, but it can be a measureable/detectable amount of PSA in the bloodstream...depending on the lower detection limit of the PSA test which one chooses. 

Prostate cancer also produces PSA, and so IF PC cells were left behind after surgery, they would also produce an amount of PSA proportional to how much PC was left behind.  Obviously, if PC was left behind and the cells start to multiply, this would lead to an increased production of PSA in the blood stream...which is why we continue to have PSA tests after a RP monitoring for increases.  PC cells produce about 20x the rate of PSA as healthy prostate tissue cells. 

best wishes...


 

 

 

.

Post Edited (Casey59) : 6/9/2010 6:09:36 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 6/8/2010 5:26 PM (GMT -6)   
My surgeon felt strongly about waiting a full 90 days after surgery before doing the first post surgical PSA reading, he said that any readings before that can be misleading and cause unneeded stress. I couldn't imagine why any doctor would order one 5 week out of surgery.
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


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3731
   Posted 6/8/2010 7:24 PM (GMT -6)   
My PSA was 23 before surgery.
I had PSA tests at 6 weeks and at 3 months. The results were 0.05 and 0.04 respectively. At 6 months it was 0.05, at 9 months 0.04 and retested on the newer machine (ECLIA) was <0.01.
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 3+4=7, 3+3=6. 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 controlling fluids.
12/11/09 5 months: 3 pads per day, 400-450ml/day
02/26/10 7 months: 3 pads but leak is now 320 ml (5 day avg.)
03/22/10 8 months: 3 pads per day, 280 ml/day (5 day avg.) PT says all muscles are tight and working properly. There must be another issue. Uro mtg 4/23.
5/22/10 10 months: 2 pads per day, 190 ml/day Scope on June 12.
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04, 1/14 6 months - 0.05, 4/14 9 months - 0.04 and <0.01 with ECLIA.


lewvino
Regular Member


Date Joined Jul 2009
Total Posts : 384
   Posted 6/9/2010 6:46 AM (GMT -6)   
Thanks all for your responses. I've never met this gentleman but have talked to him via phone and email. I was also surprised when he told me his doc did the psa test at 5 weeks post surgery. I beleive his post surgery Gleason came out at 7 and he also has a positive margin noted on his pathology result. He is going to call me later today after seeing his doc that did the surgery. He lives up near Virginia Beach area.

Larry
Age 55 / age at diagnosis 54, PSA 5.1
Robotic surgery 08/12/09 at Vanderbilt, Nashville TN. 
Final Path report:
20% of the prostate Involved
Tumor graded at T2C
Overall Gleason 3+4 (7)
Lymph Glands Clear, Positive Margin Noted in Right Apex
 
First post Surgery PSA - 0
Six month PSA - 0


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/9/2010 7:36 AM (GMT -6)   

Glad to help.

Now that you understand the "science" behind it, as long as you are mildly skilled with math you can understand why a man starting with 2.5 ng/mL before surgery will have reached his PSA nadir (low point) within less than 5-weeks (actually, far less)...so this time duration is no problem.

Good luck to your new friend...


 

 

 

 

.

Post Edited (Casey59) : 6/9/2010 7:41:10 AM (GMT-6)


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 6/9/2010 8:26 AM (GMT -6)   
My psa was 6.7 at surgery. I had a regular doctors appt. 8 days later and they tested psa as part of the blood work. In 8 days my psa had dropped to .31. At 6 weeks, it was .04.
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% invloved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 110 gms., margins clear
3 Years: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/9/2010 8:44 AM (GMT -6)   
James C. said...
My psa was 6.7 at surgery. I had a regular doctors appt. 8 days later and they tested psa as part of the blood work. In 8 days my psa had dropped to .31. At 6 weeks, it was .04.

Doing the math in reverse, James, the PSA half-life in your body is a hair under 2-days.  You are in the normal range...!  (At least on this subject!)  smilewinkgrin

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 6/9/2010 11:09 AM (GMT -6)   
Casy59 said:
You are in the normal range...! (At least on this subject!)

Uh, ok?, I think... smilewinkgrin
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% invloved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 110 gms., margins clear
3 Years: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 6/9/2010 1:26 PM (GMT -6)   
James, can we talk about your abnormal subjects instead? Might make a good thread. hee hee
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

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