Paul's PSA has not not come back <0.01 and has gone from 0.02 to 0.03 in 7 weeks. Although there is a good chance that the numbers will stay low for our sanity we need a plan B. I hope you can collectively help me with that.
I understand that there are many who see the <0.1 as a symbol of sorts and this post may offend some of those people who see our results as very positive especially given negative margins, no perinural invasion or SVI.
The reason we need the plan B is:
1) That the post surgery pathology is rare. It is rare to have the primary tumour in the fibromuscular zone, a place with no glands and no capsule. The tumour is 1mm from the edge. Given there is no capsule is the margin really negative? It is also rare to have a very small volume of cancer (0.2cc) with Gleason 4 in it.
2) There is the possibility that we have merely gone from 0.024 to 0.026. The flip side of this is that we may have gone from 0.016 to 0.034
3) I am suspicious of the cancer around the bottom of the apex, there seems to be a lots of small foci and given that the urologist was not expecting to see cancer there, there is a chance that he sacrificed cure for continence when rebuilding the connection to the bladder
4) Paul's uncle died of PCa at 60. His Grandpa died of it at 72. Paul may have a virulent strain of cancer.
- We need a retest monthly to keep track of the PSA (4 monthly check next week)
- We need a second reading of the post-op pathology results (I have been in contact today with Dr Cohen another Australian specialist pathologist obtained from the yananow website and he is going to review the prostate)
In case the next PSA tests do go up:
- We need to find the best prostate oncologist/s in Sydney (any idea's??)
- We need to find the best radiation doctor in Sydney (any ideas??)
- We need to work out which strain of cancer Paul has (any ideas on which tests? Can these be done in Australia?)
- We need someone who understands the rare aspects of our pathology report and can comment on these. (any thoughts?)
- The "Primer on Prostate cancer" wants us to understand the biology of the tumour and we don't. I know that there is an online chat room where people can have access to the specialist oncologists (any idea where to find this??)
We are happy that the results are <0.1. We are not so happy that the result is not <0.01 and is going up. There are many ways of dealing with uncertainity, some people celebrate the positive, for some people, like us, part of our coping process is planning. We would be grateful if you could help us.
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 main involvement in the fibro-muscular zone. T2C.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03|Dec10 – 0.03
Lab 2: Nov 10 - 0.01|Dec10 – 0.01
Post Edited (An38) : 1/6/2011 12:13:04 AM (GMT-7)