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ftpolkmp
New Member


Date Joined Jul 2010
Total Posts : 8
   Posted 7/16/2010 7:46 PM (GMT -6)   

I had a Prostatectomy in May 09. My initial PSA after surgery (4 months and 6 months) were .4 and .5. When my Urologist told me that if it did not go down he would send me to a radiation oncologist I was curious and asked him if sex or my E.D. exercises would cause the PSA to go up. He stated that because my Prostate had been removed this would not be the case. I also asked my General Practitioner the same question and she also stated that it would not. I was able to convince her to test it and we found that by having sex within a few days of the test (never tested how many) My PSA would rise as high as .5. After going without sex the PSA would go back down to undetectable. I then got a referral from my insurance to go to John Hopkins where I explained it to my Dr in radiation Oncology. He was doubtful, especially after the first test was undetectable. My second test I made sure to have sex before the test and it was .5, my third test I stopped having any sex for 30 days and it went back to undetectable. I have done this with 2 doctors in 2 different labs about 7 different occasions. I have become very frustrated because I can not find a doctor who is even remotely interested in what is happening. My Radiation Oncolgist wants to do the test 2 more times with me living my life normally and see if the PSA goes above .5. If it doesn't he wants to make that my number to consider radiation. Another John Hopkins docotr in Urology who I emailed said I should start radiation immediately. Neither of these options are acceptable to me because the accepted level is .2 and if mine can be made to increase with sex then that is not normal (according to all my doctors and the ones I've contacted). It has become very frustrating finding a doctor who is interested in finding the cause for the PSA changes. It has me wondering if this is happening to others and they do not notice that it changes with sex so their doctor's start them on radiation that may not be necessary.

 

Biopsy gleason score 3+3=6

<5% PC on the right and left ApexCancer contained to the Prostate

with no cancer in the vessels or nodes.


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3747
   Posted 7/16/2010 7:56 PM (GMT -6)   
Go to Johns-Hopkins search window and type this in "ANXA3" . It's a new prostate cancer marker that can be tested for in urine and blood. It can be used to verify whether the PSA reading is from cancer or not..But it's not 100% reliable..
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. A "top" radiation oncologist here in Denver, equipped with the latest IMRT/IGRT/RapidArc machine says he can do better by me..


ftpolkmp
New Member


Date Joined Jul 2010
Total Posts : 8
   Posted 7/16/2010 8:39 PM (GMT -6)   
Fairwind,
 
Thanks for that information, I'll ask my Oncooligist at Hopkins at my next appointment. I hope that this may be sometype of better test then the PSA. I have a lot of doubts about the PSA test now.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 7/16/2010 8:59 PM (GMT -6)   
Not to be rude, but if the post surgery tests are acurate at .4 and .5, I think you playing some kind of denial thing about recurrance. Without a prostate, you having or not having sex isn't going to be a factor, not like before surgery when you still had an active prostate. I can understand why the doctors aren't cooperating with your line of thinking. You need to have another ultrasensative test done at the same lab, and if it is still registering that high post surgery, then definitely time to be talking to the radiation folks. Just my opinion.

David in sC

P.S. Welcome to HW
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 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 still in place


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3747
   Posted 7/16/2010 9:37 PM (GMT -6)   
Purg is right..If you can conjure up a .5 reading after a RP, SOMETHING is going on. Sometimes some prostate tissue gets left behind and sometimes some cancer gets left behind..

It would seem the sex thing is unique to you...
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. A "top" radiation oncologist here in Denver, equipped with the latest IMRT/IGRT/RapidArc machine says he can do better by me..


ftpolkmp
New Member


Date Joined Jul 2010
Total Posts : 8
   Posted 7/16/2010 9:54 PM (GMT -6)   
Purgatory,
 
I am in noway in denial. I have been doing all the right things and am seeing a Radational Oncologist at John Hopkins. Even he now believes me that sex makes a difference after 3 test at their lab in which my first test afte not having sex was undetectable. A second test 30 days later after doing the ED exercises and sex the PSA test was back to .5 and then another 30 days without to drop it back to undetectable. I have done this 5 other times with my doctor at Dover AFB in which sex and ED exercise are the only difference. I have an 8 month record of my PSA going up and down. My Radation Oncologist wants me to  live a regular life for 2 months and get tested again. If it is again .5 then he is going to set that as my number before starting any Radation treatment. All of this is very disconcerting because I have it documented many times and no one seems to believe it until I do it for their lab. It is also troubling to me that my docotr accepts the issue and is satisifed with changing the national standard of .2 to start radation. Because I had such a low level of cancer, (at the time of diagnoses) 46 yrs old, PSA of 2.65, <5% Cancer on the gland and a gleason of 3+3 for 6. He does not believe I have cancer but there maybe tissue that was not removed. I would like to find a doctor who has some idea of what is going on or who does research on issues where tissue may have been left behind. I do not accept the watch and wait just as I did not accept it when I decided to have my Prostate removed even though I had such a small amount of Cancer when it was first detected.

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 7/17/2010 5:33 AM (GMT -6)   
OK...lets follow the trail here. You have sex and your PSA is around .5; no sex and you have undetectable PSA. If PSA can only be generated by prostate tissue, then you have some somewhere. Sex stimulates the prostate gland producing PSA. The fact that you have a PSA reading - regardless of whether or not you officially have a prostate - makes me very nervous. Either your surgeon left behind a good chunk of prostate tissue (this usually happens when the external nerve bundles are spared) or you still have cancer.

I also noticed that your doctor seems to be using the standard PSA assay...while I'm not a huge fan of the ultrasensitive PSA test, your case seems to scream for the more sensitive test. Since your surgical stats are so favorable, I'm wondering if you didn't have one of those rare types of lesser known PCa - did your surgical path report state anything about this? Sounds like you're currently working with Hopkins but that the surgery was done elsewhere...did you have someone at Hopkins read the surgical path slides? If so, did they agree with the original diagnosis?

From the reading I did when we thought my husband was heading for SRT, it seems that any PSA generated by benign tissue dies a natural death and pretty quickly (which is what happened with John). John's PSA was undetectable for 17 months, then he jumped to 0.1 (one month later) and 0.3 (a month after that). One month after that last test, his PSA went down to undetectable and has stayed there. This is a classic case of benign prostate tissue left behind. Cancerous prostate tissue, however, generates PSA at a much faster rate and continues to do so (e.g., PSA continues to rise). Your case is curious since you seem to have a little of both.

I noticed from your signature that the cancer, while very small in volume, was found in the apex which I think is close to the bladder (someone please correct me if I'm wrong). Your signature doesn't state anything about the bladder neck being free of tumor or the seminal vesicles for that matter. These results should be stated in your surgical pathology report - hopefully you have a copy of that.

I'm sorry about all the questions but I'm simply trying to understand your situation as something is not right here. My gut is telling me that a key piece of information is missing here.
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!


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 7/17/2010 8:08 AM (GMT -6)   
Ftpolkmp,

I believe you, but I'm not the people you need to convince. If those were my PSA numbers I'd be on the phone with every lab in the state looking for one that would give me a "Diagnostic" PSA to at least 2 digits, instead of a one digit "Screening" PSA. If that lab cannot do it, look for another. Before you leave the doc's office make sure the Diagnostic box is checked on the lab order - not the screening and make sure your name is in the "cc Results to" box.
A PSA test costs $85. If your insurance won't pay, pay for it yourself.
Back in the stone age a PSA of <1.0 was called undetectable. I just checked the calendar - it says 2010. Time to move on and find a lab with this decade's capability and puts out data you can trust. (Look at my signature to get the names of current equipment. Find out what your current lab is using. If they don't know that should set off alarms in your head.)
I like your experiment of sex vs no sex. I have been consistent with my testing. No sex within 72 hours. (Easy for me to do.)

Keep a diary and make sure you record sexual activity in it. Keep it with your PSA results. You might have the beginnings of a research paper.

Umm... Sephie... Did you and John, ummm have any, you know, amorous activity before his September PSA? Just askin'

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."
5/22/10 10 months: 2 pads per day, 190 ml/day Scope on June 15 "Short sphincter"
7/15/2010 one year: 2 pads per day. 140 ml/day, dry in bed.
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 (Siemens Centaur) and <0.01 (Roche ECLIA).
7/12 1 year - 0.03 (Siemens Centaur, direct chemilum); <0.01 (Roche Cobas 601 ECLIA)


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5828
   Posted 7/17/2010 10:27 AM (GMT -6)   
Why not stop the experiments, stop the sex before psa tests period, and then, the tests will always be undetectable. If they are not then you will know. Don't try to prove a point. If you didn,t have sex before, the issue would not be coming up , unless there is a recuurence. In any case, start from now. No sex, rising psa equals......,, its always your call
age 67 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of Washington Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci, extensive PNI, That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 7/17/2010 5:08 PM (GMT -6)   
Jeff, no we didn't. Even if we did, though, I really can't imagine that it would have affected the PSA results. John's regular MD, during the annual physical, snuck in a PSA test from a different lab in May this year and the result still came back <0.1 (which made me very, very happy). Next PSA is in September.

Logoslidat has a point...

A PSA of .5 no matter the reason is cause for concern. Should you need to push the button with SRT, you wouldn't want your PSA to creep up any higher.
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!


Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 7/17/2010 5:58 PM (GMT -6)   
I've had my PSA measured several times post op, and it's always <0.03 regardless of what I've done.  Well, the explanation for your situation should come from your doctors, but you can ask them if this way of thinking about it makes sense:
 
There are 3 sources of PSA: 1. prostatic tissue, 2. prostate cancer, 3. the periurethral glands.  The amount of PSA coming from the periurethral glands is tiny (see first abstract below). So your PSA has to come from 1 or 2.  Ejaculation makes PSA go up in men with a prostate, presumably because the prostate gets squeezed when fluid is ejected out of it (see second abstract below).  It's a mechanical effect. If there is elevated PSA due to recurrent cancer spread outside the prostate (like extraprostatic extension through the capsule of the prostate, or bone mets) it shouldn't be affected by ejaculation; also it should get higher over time.
 
So this mysterious increase in PSA has to be due to PSA generating cells that are still within the urinary system.  If it always goes back to near zero when you don't have sex, and always goes up to the same number when you do, it seems likely that there's a piece of benign prostate tissue that still there.  If these numbers start going up, well, then it's probably recurrent prostate cancer.  But that's what we are all nervously watching for, an increase in our PSA.  If your baseline (without sex) PSA is very low, and stays very low, that seems like it should be reassuring.
 
 
 
 
 

J Urol. 1996 May;155(5):1658-60.

The periurethral glands do not significantly influence the serum prostate specific antigen concentration.

Oesterling JE, Tekchandani AH, Martin SK, Bergstralh EJ, Reichstein E, Diamandis EP, Yemoto C, Stamey TA.

Michigan Prostate Institute and University of Michigan, Ann Arbor, USA.

Abstract

PURPOSE: The periurethral glands are known to produce prostate specific antigen (PSA). With ultra-sensitive assays now routinely available, it is necessary to determine if the periurethral glands significantly influence serum PSA concentration after radical prostatectomy. MATERIALS AND METHODS: Serum PSA levels of 46 men, 51 to 89 years old (median age 67) who underwent radical cystoprostatectomy and total urethrectomy, were compared with those of 92 men 46 to 91 years old (median age 67) who underwent radical cystoprostatectomy only. All men had transitional cell carcinoma of the bladder without gross or microscopic evidence of prostate cancer and all underwent ileal conduit diversion. Serum was obtained at least 1 year postoperatively. Each specimen was analyzed using the Tosoh, Immulite, and Yu and Diamandis ultra-sensitive PSA assays with analytical detection limits of 0.02 ng./ml., 0.004 ng./ ml. and 0.002 ng./ml., respectively. RESULTS: Median PSA for the radical cystoprostatectomy with urethrectomy group was 0.00 ng./ml. (range 0.00 to 0.14) for each of the 3 assays. For the radical cystoprostatectomy only group the median Tosoh and Immulite PSA assay levels were 0.01 ng./ml. (range 0.00 to 0.22), and median Yu and Diamandis PSA assay level was 0.00 ng./ml. (range 0.00 to 0.31). CONCLUSIONS: The greatest difference in median PSA levels that could be found between men with and without periurethral glands when using 3 different ultra-sensitive assays was 0.01 ng./ml., indicating that the periurethral glands do not have a clinically significant effect on serum PSA concentration after radical prostatectomy. Thus, a serum PSA level above the residual cancer detection limit following radical prostatectomy, even if obtained with a ultra-sensitive assay, reflects either malignant or benign residual prostatic tissue, rather than the presence of periurethral glands.

 Effect of ejaculation on serum total and free prostate

 specific antigen concentrations

Jonathan D. Herschman, Deborah S. Smith and William J. Catalona

From the Division of Urologic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missou

Abstract

Objectives

Measurement of total serum prostate-specific antigen (PSA) is widely used as an aid to early detection of prostate cancer. Measurement of the ratio of free to total PSA may increase the specificity of PSA testing. To improve specificity further, other factors that may cause transient increases in PSA, such as ejaculation, have been identified. We prospectively studied the effect of ejaculation on total and free PSA levels and examined whether changes induced by ejaculation would affect recommendations for performing prostatic biopsy.

Methods

We measured the baseline total and free serum PSA levels and obtained measurements 1, 6, and 24 hours after ejaculation in 20 volunteers (mean age 59 years). All men had baseline PSA levels less than 4.0 ng/mL We used repeated-measures analysis of variance to test for changes in total, free, and percent free PSA after ejaculation. We also calculated the proportion of men with PSA levels greater than the expected biologic variability at each timepoint.

Results

The mean total, free, and percent free serum PSA increased 1 hour after ejaculation. Mean total PSA levels remained significantly increased 6 and 24 hours after ejaculation. Mean free PSA decreased to baseline levels by 6 hours after ejaculation, and percent free PSA returned to baseline by 6 hours after ejaculation and then decreased below baseline by 24 hours. When normal biologic variation was accounted for, 40% of men, at 24 hours after ejaculation, had total PSA levels above the baseline level. Similarly, 24 hours after ejaculation, the percent free PSA remained above baseline level in 10% and below baseline level in 35% of the men.

Conclusions

Both total and free PSA increase immediately after ejaculation, with differing rates of return to baseline levels. PSA testing within 24 hours after ejaculation may lead to an erroneous interpretation of the results of both total and percent free PSA measurements in a small proportion of men.


ftpolkmp
New Member


Date Joined Jul 2010
Total Posts : 8
   Posted 7/17/2010 7:09 PM (GMT -6)   
Thank you alll for the data. I have a very good family practioner who is interested in what is happening so I'm sure she will help me in anyway I need and the information you all have is a little more then what I knew before coming here. My main concern is that none of the Urologists or my Radiation Oncologist seem particularly interested in what is happening. For me I am concerned that (at least in my case) the process is flawed and no one seems to have seen it before so which number should I trust and is there an increase chance of cancer reoccurance in the future. I appreciate those of you who understand why I am concerned and do not want to just "accept" that everything is ok and, becuase it goes back to undetectable, I should let it be. If I had not found out "on my own" that by stopping my E.D. exercises and the sex (something my Urologist wanted me to do almost on a daily basis) then I would have been having radiation as we speak. That in itself would not have been as discouraging as the fact that no one could really tell me if it was necessary.

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5828
   Posted 7/19/2010 11:44 AM (GMT -6)   
So plz tell us, " the end of the story ", when you can ! Is this a BCR or not!
age 67 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of Washington Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci, extensive PNI, That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/19/2010 12:52 PM (GMT -6)   
ftpolkmp- I found this very interesting and have not heard it before that I can remember (but hey I did ADT3 drugs for awhile too, LOL). We had one guy on this forum whos prostate was not totally removed via his DaVinci method (probably inexperienced new guy doc), he found out later and proved it. Maybe that is a possibility. The other is adrenal glands can mfg. testostorone, so by sex maybe the adrenal glands are working harder, and maybe some residual PCa cells are reacting to this 'T' like a flare idea? I am only throwing ideas up, don't claim to know anything on this phenomena. Also I did not stay at Holiday Inn Express either.

Maybe someone has a good guess at this without having enough medical parameters and knowledge to know for sure. Interested in knowing anything new or different on PCa.
Youth is wasted on the Young-(W.C. Fields)


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 7/19/2010 2:48 PM (GMT -6)   
I thought that biochemical recurrance was defined by three consective rises in psa or any consecutive rise above 0.2 if the initial psa reading after surgery didn't not fall below 0.1. In this case his psa is not rising except after sex.

My guess....he has some benign tissue left behind and not cancer. Probably the reason for the varied opinions from his doctors.

If I were in your shoes...I would wait until there has been a solid consective rise in the psa.


You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009     .06
                   6 month Apr 2009     .06
                   9 month Jul  2009     .08
                 12 month Oct 2009     .09 
                 18 month April 2010   .19


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5828
   Posted 7/19/2010 8:05 PM (GMT -6)   
I'll rest my case on this one.
age 67 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of Washington Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci, extensive PNI, That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


ftpolkmp
New Member


Date Joined Jul 2010
Total Posts : 8
   Posted 7/19/2010 10:33 PM (GMT -6)   
 suspect that it is due to left over cells of Prostate but do not know. I have no idea what BCR is, Please explain. My PSA for the first 3 test were not below .4. It wasn't until the 3rd one that I had asked my Family Practioner to test if sex made the difference At the time my Urologist had written a perscription for a pump and Levitra and i was using the pump daily and the Levitra weekly (Doctor wanted every 3 days but those things are pretty expensive). I immediately stopped that and sex for the next test and it was my first undetectable. I'm fairly certain that eventually I will have to start radiation. When I decided on my Devinci at 46 yrs old the decision was fairly easy, get the cancer out. The decision for radiation has become much more difficult because now i am not convinced of the processes accuracy. I wish there were some kind of studies on this because I find it hard to believe that I am the first to ever have this happen. When I did the Devinci I did extensive research about the procedure, the side effects, and the issues I may run into. I was very well prepared and accepted the fact that I may have incontinence and ED issues. It was worth it to me to get the cancer out. Now there is nothing and I can't even find a doctor interested in the situation. The not knowing and doubt about what PSA means has made me really doubt the system. I am going to try the Walter Reed medical Center next and see if someone has some answers or will be willing to work with me. I refuse to accept that I should just use .5 as the high for my PSA when the norm is .2 and they were all talking about radiation as my next step.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/20/2010 5:48 AM (GMT -6)   
BCR- means bio-chemical re-occurrance   (reoccurring or returning of PCa- i.e. failure to cure and that those synonomous things).  Three letters nobody wishes to hear ever.
 
DaVinci    (to be totally correct, but everyone understood anyway..just trying to help you correct spelling going forward when talking about it)   (not the English teacher-police) :-0
 
I leave SRT discussion to others herein whom may have done alot of research into it and might have some links and abstracts that you should read up on prior to getting it done.
 
Hope you find decent docs that will be working totally with your wishes and concerns.
 
You don't want to hear my speech on doubting the system, I have been thinking that from  2002 when diagnosed and have yet to be convinced otherwise, but always willing to listen up.

ftpolkmp
New Member


Date Joined Jul 2010
Total Posts : 8
   Posted 7/20/2010 3:20 PM (GMT -6)   
Don't mind spelling police as long as it comes with some suggestions. Spelling police just to corrct spelling I can do without. ILike you I have really come to doubt the system. It just doesn't make sense to me that 3 doctors tell me something and when it is shown to be wrong they adjust the settings or keep the course. I'm amazed that no one is even the least bit curious about something that they say shouldn't occur. I'm also pretty sure I can't be the oly one. I have begun to wonder how many people have been told by their doctor to try to get their sexual life back and like me have thier numbers go up. The how many of those eventually get radiation.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 7/20/2010 3:39 PM (GMT -6)   
I agree, spelling police not important here, least of our troubles. It would bother me deeply if my stats were your post op stats, and my doctors weren't deeply concerned and interested. Again, at the radiation clinic where I went for SRT, they don't like to see recurrance numbers over .2, let alone .5, if it can be helped. My highest recurrance number was .16, which doesn't sound much, but it was considering what extreme PSA velocity I underwent prior to my primary treatment. I discussed the notion of beneign prostate tissue being left with my doctors, and they said it was quite rare, but possible, and there was any, it would produce minute PSA, but that it would top out and not really change. The person Zufus refered to was right here from SC also, and his surgeon in a very backwoods part of this state bungled a robotic op, and left quite a bit of his prostate behind, and then covered it up with a blotched radiation job. The guy didn't stay with us very long, I spoke a few times by phone with him, and he was in the early stages of litigation last I ever heard. He was left in a terrible situation. For you, why not pick the lab you trust the most, then do 3 PSA readings a month apart, with no sex at least 3 days before hand, and see if you can get a better reading, and of course, use an ultrasensative test, because in your case, you need .xx at the end of that number to see if there is any true upward direction.
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: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 7/21/2010 5:12 AM (GMT -6)   
Here is another study showing the effects of ejaculation on PSA at 1, 6, 24 and 48 hours. Note the key word here is "ejaculation".

By the way, this is the first time I have seen real numbers mentioned instead of the fuzzy "it has a significant effect" .


Urology. 1996 Apr;47(4):511-6.
Ejaculation increases the serum prostate-specific antigen concentration.

Tchetgen MB, Song JT, Strawderman M, Jacobsen SJ, Oesterling JE.

Michigan Prostate Institute, University of Michigan, Ann Arbor 48109, USA.
Abstract

OBJECTIVES: To determine the effect of ejaculation on the serum prostate-specific antigen (PSA) concentration in men at risk for developing prostate cancer. METHODS: A prospective, community-based study was conducted in which 64 men, aged 49 to 79 years, underwent a serum PSA determination immediately before ejaculation (baseline) and at 1 hour, 6 hours, and 24 hours following ejaculation. The serum PSA also was measured 48 hours and 1 week after ejaculation if the concentration had not returned to the baseline value by the previous time interval. All subjects abstained from ejaculation for a minimum of 7 days prior to the study and until the PSA concentration returned to the baseline level. Absolute and relative change in serum PSA concentration, as well as the time to return to baseline PSA concentration following ejaculation, were assessed. RESULTS: The serum PSA concentration increased following ejaculation in 87% of the subjects. The mean baseline PSA was 1.8 ng/mL (median, 0.7 ng/mL). The mean absolute PSA change +/- standard deviation 1 hour, 6 hours, 24 hours, and 48 hours after ejaculation was 0.8 +/- 1.32 ng/mL, 0.3 +/- 0.66 ng/mL, 0.2 +/- 0.33 ng/mL, and 0.4 +/- 0.40 ng/mL, respectively. The mean relative PSA change +/- standard error 1 hour, 6 hours, 24 hours, and 48 hours after ejaculation was 41 +/- 4%, 9 +/- 1.5%, 8 +/- 1.3%, and 10 +/- 2.3%, respectively. The absolute and relative changes in PSA concentration noted 1 hour, 6 hours, and 24 hours after ejaculation were statistically significant (P = 0.0001). A strong correlation was observed between absolute change in PSA and baseline serum PSA, at each time interval (1 hour: r = 0.68, 6 hours: r = 0.77, 24 hours: r = 0.70; P < 0.0001) after ejaculation. Similarly, a significant correlation was noted between absolute change in PSA and patient age at each time interval (1 hour: r = 0.37, 6 hours: r = 0.38; P = 0.002, 24 hours: r = 0.55; P < 0.0001). Ninety-two percent of subjects returned to baseline by 24 hours (95% confidence interval (Cl) = 83% to 97%), whereas 97% of subjects returned to baseline by 48 hours (95% Cl = 89% to 99%). CONCLUSIONS: Ejaculation causes a significant increase in the serum PSA concentration in men between 49 and 79 years of age that may persist for up to 48 hours. This change appears to correlate with age and baseline PSA. It is recommended that men abstain from ejaculation for 48 hours prior to having a serum PSA determination.

I follow that rule even though I have nothing to ejaculate. Why screw around with such an important test.
Jeff

ftpolkmp
New Member


Date Joined Jul 2010
Total Posts : 8
   Posted 7/21/2010 8:42 PM (GMT -6)   
Purge,
 
That was the reason i asked my doctor to go to John Hopkins. I thought that if any place might be interested in what I found, it would be them. I thought I would get someone who would, maybe, have a way to scan to see if anything was left behind or have seen it before and have already done some form of treatment for such a case. After having the Head of Urology, who I sent an email to, tell me that I should start radiation, I was really disappointed. Mainly because I told him that he could look at my records already there at Hopkins. If he had done that then he would have seen my radiation oncologist had told me to wait 3 more months and take it again to see where the PSA was then again after another 3 months (total 6 months) to see if .5 is my norm. Then maybe he and my oncologist would have gotten together and I would have gotten a call saying, hey have the radiation or we discussed it and no you shouldn't. It's like being at a T intersection with 3 one way street signs all pointing to the middle of the intersection. Obviously can't go back and not sure of going to the radiation or the watch and wait. I think I'm going to try this next
 
 
but I think I'm going to wait a few weeks. I've been messing with this for over a year and need to step away and take a break. At least coming here others have helped me to not feel like I'm nuts to think someone should be interested in what is happening with my PSA. It takes a toll trying to convince highly educated doctors that this is not a normal situation, at least in my mind anyway.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 7/21/2010 8:58 PM (GMT -6)   
i hear you, even great doctors sometimes don't listen closely to their patients. I am thankful I have doctors that spend unlimited amt of time with me when needed and never hurry me. and you have learned first hand, that you have to be your own advocate for yourself. i feel that is critically important in our travels. i have others that help me, of course, but i feel its my responsibility to comunicate often and fully with my medical team, only i know how i am really feeling. my uro/surgeon really likes the typed letters that i hand it at the start of each visit, saves him a lot of time catching up to my situation, and stops me from having a memory laspse at the wrong time. leaves him more time to discuss issues i have on my mind. works for me well that way.

you are definitely not nuts, trust me. you have some strange twists in your own path unique to you, and thats just how it is. if you are as stubborn as i am, you wont give up until you get a proper answer. taking a break from it is a good thing to do too, you are right on target there.
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: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19


ftpolkmp
New Member


Date Joined Jul 2010
Total Posts : 8
   Posted 7/21/2010 8:59 PM (GMT -6)   
Sorry there is a part of my story that I though I had put in which is important to my feelings about my condition.
 
The reason my family practioner wanted me to have my biopsy, which found my PC, was because my PSA levels had gone up slightly over 3+ years. My numbers were:
 
Dec 05      2.14
Jul 06        2.48
Feb 08      2.52
Feb 09      3.14
 
So unlike most, my PSA was not even that high to begin with. This at 5 months short of 47 years old

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 7/21/2010 9:05 PM (GMT -6)   
Not high numbers in and by themselves, but age factored a bit up. If you study the signatures here at HW, amazing how serious some PC cases there are with PSA numbers even below the magic 4.0 threshold. And how many of us never had a positive DRE either. Its a fun cancer, not really.
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: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19

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