The very good news is that Paul's PSA level is 0.02 so I guess that puts him into the zero club!
Unfortunately I was nearly in tears when I heard the news because I so wanted him to be undetectable on the ultrasensitive (ie <0.01). I have managed to hold it together when against all odds, a PSA of 4.0 with a Free PSA of 31% (that no one wanted to biopsy) turned out to be what seemed to be a tiny cancer 3+3 cancer with a good chance of a 100% cure by surgery. Then I managed to hold it together when this cancer turned out to be 3+4 because is was negative margin and very small (0.2cc) and with the Gleason 4 only 5%. But I was so hanging out for unequivacally good news and the 0.02 after six weeks was way better than 0.1 but I wanted it to be better. I understand that a number <0.01 with a good assay (and he is using the same lab as BillyMac) confers a significantly better prognosis.
The surgeon mentioned in passing that the cancer in the fibromuscular tissue (that's where the Gleason 4 was) in the anterior tends to be quite aggressive because it tends to travel along a zonal plane to the outside. Then he also mentioned the fact that because he was expecting a prostate with a small cancer in it he was very careful in the nerve sparing - presumably this means that there may be some tissue on the posterior part of the prostate supporting these nerves which is not such bad news because there was almost no cancer in the posterior part of the prostate where the nerves are. But he reiterated the margins being negative and suggested that the PSA could still fall further in the next few weeks.
So my questions are:
1. Can it fall in the next few weeks to reach a <0.01 nadir?
2. What does this PSA number of 0.02 mean in terms of how we watch this cancer? Where is this PSA coming from? Other people with nerve sparing ops have <0.01 nadirs, why not Paul?
3. Can people with a PSA level of 0.02 post op go on to live a very long life? (I really need my husband to stick around for a long long long time)
I know I'm sounding quite scared but this is the only place where I can vent and I'd rather not be scared in front of Paul. Hopefully the world will seem a little rosier tomorrow.
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg margins, seminal vesicles, extraprostatic extension. Multifocal, with involvement in the peripheral, apex, fibro-muscular and transitional zones.
Post Edited (An38) : 10/7/2010 2:56:18 AM (GMT-6)