First Post Op result at 6 weeks: 0.02

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An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1147
   Posted 10/7/2010 2:49 AM (GMT -6)   
Hello all,
 
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.
 
An
 
 
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)


tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2840
   Posted 10/7/2010 4:21 AM (GMT -6)   
An -
I am a member of the Zero club - with a PSA of 0.05 which is <0.10.
Paul is a member of the Zero club - with a PSA of 0.02 which is <0.10.
www.smithmeek.com/zeroclub.jpg
Anything less than 0.10 is classified as undetectable.
I have my next PSA in six months - if it stays at 0.05 then I go on a yearly testing routine. I am going to be around for a long time.

It is possible that the PSA will drop further down in the next testing - depending on the half life of the PSA - my first post-op test was at 16 weeks.
I am so sorry that you are scared. Please arrange to talk to the doctor ( even by yourself if you feel more comfortable) and get the answers directly from him/her.

hugs.
BRONSON

Post Edited (tatt2man) : 10/7/2010 6:56:40 AM (GMT-6)


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2211
   Posted 10/7/2010 5:36 AM (GMT -6)   
I'd say Paul's membership of the Zero club is confirmed.

Where even small amounts of PSA comes from is still not completely certain. (It's been reported that even women can produce PSA so I'd say 0.02 is fine.)

Enjoy yourselves. Cheers!

Alf

ejn
Regular Member


Date Joined Jun 2010
Total Posts : 87
   Posted 10/7/2010 5:54 AM (GMT -6)   
An,  I think this is great news.  Absolutley in the zero club.  When my doctors nurse called me just said "undectable" and was good enough for me.  I might get the actual numbers next time I see him in Jan. but I am not going to stress or think about it at all.  Sounds to me like Paul is doing great and you should be celebrating and relax.  All of us Augies are going to be around for a very long time.  Thanks for the update, now go out and have a good time.  You guys deserve it.
 
Ed

rhb47
Regular Member


Date Joined Mar 2010
Total Posts : 208
   Posted 10/7/2010 6:26 AM (GMT -6)   
An,

This is great news and nothing to worry about. As Bronson said, anything below <.1 is undetectable. On page 3 of the forum is an article titled "ultrasensitive psa anxiety". There is a link to an article in the first post-scroll down to the yellow section about ultra-sensitive tests. I think this article will relieve your anxiety as it states the numbers can vary day to day: example .02, .01, .04 .02.
An, I hate that you are worried about something that is very good news. Paul IS going to be around for a very long time and believe me, if Geoff's psa was .02 instead of .01 I would have been just as happy. Please, please stop worrying!

Your friend,

Renee
Husband diagnosed 3/10
Age 56, PSA 4.7, free 7.6%

Biopsy 5 of 10 cores positve-all right side-25% to 57%
Gleason 6
DaVinci surgery with Dr. Vip Patel scheduled 8/9/10

Post Op: Gleason 3+4=7
Negative surgical margins and lymph nodes
No seminal vesicle and angiolymphaic invasion
perineural invasion present
Both nerve bundles spared
No ED or incontinence
6 wk. PSA .01

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 10/7/2010 6:36 AM (GMT -6)   
Oh An...I can read the anxiety in your post and it brings me back to the "bad old days" when we were watching John's PSA rise up last summer, and then fall back down.

Your anxiety about hubby's post op PSA is so common but is magnified by the lower detection levels of the ultrasensitive PSA assay. If your doctor was using the standard test, and your husband's PSA came back at <0.1, you would jump for joy because that means his PSA is undetectable. There is always PSA in the bloodstream...I once read that some women generate PSA as well at an extremely low level. I know you would like to see his PSA below 0.01 but you've got to believe us when we say that a PSA of 0.02 is an outstanding result.

Keep in mind that you are worrying about something that is infinitesimal and likely has no significant meaning. If his PSA were to be tested every day or even every week, you'd see fluctuations at such a low level. I'm not trying to make light of the situation only trying to help you focus on the very good news...your husband is officially in the ZERO club!

Take a deep breath, and relax.

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4088
   Posted 10/7/2010 7:23 AM (GMT -6)   
An, the anxiety is the exact reason that some Uro dont do the untra sensitive test. Take a deep breath he is in the zero club. Set up the bar you guys are buying the beer!.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
Only issue at this time is ED

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2457
   Posted 10/7/2010 7:30 AM (GMT -6)   
An,
A PSA of .02 six weeks after surgery is an excellent result and admits your husband to the zero club. My doctor told me that it takes 8 weeks before the PSA level reaches its nadir. Hopefully the next PSA test will be even lower.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 10/7/2010 7:59 AM (GMT -6)   
an,

a .02 for a first psa is amazingly low. you have nothing to worry about, and everything to be happy about.

remember, there is no such thing as .00.

i might be wrong, but i wouldnt expect it to go lower, and if it did, it would be .01

good time to enjoy your husband

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6894
   Posted 10/7/2010 8:17 AM (GMT -6)   
An,
 
I have probably mentioned this in several threads, but my uro/surgeon did my first PSA at 7 weeks because of holidays. He normally does it at no sooner than 8 weeks, and he warned me that it might not be at the "bottom" yet, just to keep expectations in line.
 
As well, the clinic does only 1 decimal, so the "<0.1" I got at 7 weeks from them is "undetectable".
 
I took that and ran with it as a wonderful Christmas gift.
 
I didn't even know enough about ultra-sensitive to think I should ask for it until I came here (long after my surgery). When I did ask, the Doc said no - it only feeds anxiety. After my radiation, I did arrange to get the 2 decimal test, and got a <0.01. That was a little over 9 months out from surgery.
 
So was my 7 week PSA .01, .05, .09? Can't answer that.
 
I'd say take 0.02 as a good thing.

t-dog
Regular Member


Date Joined Dec 2009
Total Posts : 154
   Posted 10/7/2010 9:24 AM (GMT -6)   
I am 8 months out from surgery, my psa has dropped from .03 initially to .01 and now is .00 so yes it can continue to drop. Good luck

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1147
   Posted 10/7/2010 3:33 PM (GMT -6)   
Thanks guys, its a new day here in Australia and I just read all your posts.

To my August friends, thank you - I am going to try to put my fears aside.
 
Sephie, thank you for understanding the anxiety, it just grips your stomach and twists.

Ed, 142, Bronson, Alf, Jeff, David Paul's in the zero club and for that I am grateful. Thank you for that and reminding me that 0.02 is still very small.

t-dog, it is very good to see that your numbers have dropped so significantly and there is hope yet that the 6 week number may drop even further. Paul hopes to have his next reading in December and I hope and pray that that drops or stays the same.

What really got me really worried yesterday was the path report which had a note that said that a reading of <0.01 one month post RP meant that the operation was curative. I took it to mean that >0.01 meant it was not. Perhaps that was a bit misleading.

An

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 10/7/2010 4:17 PM (GMT -6)   
Hi An,

I also had my surgery done in Sydney, same place as BillyMac, but different surgeon, I had Dr Philip Sticker. I to was disappointed with my after surgery psa of 0.03. I contacted the pathology people up here called QML pathology, to find out that the lowest their machines report to is actually 0.03. So as it turns out I could be 0.01, but I figure as long as it stays at 0.03, who cares !. Anyway congratulations of the Zero Club entry, and as they say the new boy buys the beers...............Cheers Kev [Gold Coast]
Age 52yrs [Gold Coast Qld, Australia]
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
RP 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c Three small foci total volume <10%
Neg Margins and Nodes
Nil - EPE
Dry less than 1 week. ED- okay with Meds.
PSA at 18mths no change remains 0.03
"Everday in Everyway, I get better"
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