Plan B: received 14 week PSA results today

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An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 12/15/2010 2:45 AM (GMT -6)   
Hello all,
 
We have received Paul's 3 month PSA results see link http://www.healingwell.com/community/default.aspx?f=35&m=1973135 
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.
 
Plan B
- 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.
 
Regards,
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 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)


BuiDoi
Regular Member


Date Joined Aug 2010
Total Posts : 234
   Posted 12/15/2010 4:13 AM (GMT -6)   
An... Whilst I do not need a PLAN-B, I implemented it anyway, in the hope/belief that should there be any remaining CTC's, then I will swat them before they get a start.

A healthier diet is first on the list and regular therapeutic doses of OPC. This stuf is showing up in many claims for it ability to control cancer.. I know more than one cancer sufferer who is reducing their cancer with OPC..
OPC, Resveratrol, Pomegranate -- all same-same-but-different, Mediteranian Diet.. The French Paradox..

Many will call it voodoo and black magic but many more are coming to accept the roll of Anti-Oxidants in self cure processes.

As it CAN'T hurt and I have seen MRI's of the capacity to cure cancer, I plan to take it for a long time to come.
.
.
Nov 2009 = First-PSA 5.3 @ 60yo - Asymptomatic - DRE-Non-Palpable
Jan-'10 = TRUS Bx DX - AC T1c - GS(3+3)=6 , 5 & 45% max., L-MidZone
May-'10 = RRP-Nrv-Spare
Post Op. GS(3+4)=7, 1.1cm3, Pos Margins, EPE (focal) Lateral Left
MI(xtensive) Post, Grade3 x 8mm
+8week PSA<0.01, ED-85%, Incont-30%
+16W PSA<0.01, ED -85%, Cont -5%
+17W First 'DRY' day. ED -90%
+26W ED -60%

Highwayman
Regular Member


Date Joined Sep 2010
Total Posts : 148
   Posted 12/15/2010 10:34 AM (GMT -6)   
An,
I am not a Doctor, nor do I play one on TV. I have best wishes for you and your husband. My best recomendation for a prescription is a glass of red wine for the both of you.
You have researched this and you are on top of it. It is fine to plan. However, please wait for a couple more tests before you worry too much.
Best of luck, and I pray that the nearly zero numbers go lower.
Mike
 
Age 48 w/diagnosed
10/06 PSA 3.0
11/06 PSA FREE %13.2
10/07 PSA 3.4
12/07 Biopsy-neg
1/09 PSA 4.6
6/09 psa 5.8
2/10 psa 8.7
7/10 PSA 10.8
8/2010 3rd biopsy GG 3+3=6, one of eight cores -2%
Lap 10/22/10 Dr. Troxel
Path- Neg Margins, Gleason 6, Nerves spared, 85 gm
Cath out Nov 2, Dec 2nd 2 pads/day

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3738
   Posted 12/15/2010 11:01 AM (GMT -6)   
I agree with Highway....Those ultra-sensitive PSA tests can create ridiculous PSA anxiety levels.. You can't let your PSA level become the focal point of your life..Caught in that trap, you have no life....
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 12/15/2010 11:12 AM (GMT -6)   
An,
I'll try to answere some of your questions:
The psa increase of .o1 is not significant; it could be due to normal daily variations. It is a good idea to have monthly psa tests to see if the increase is serial. This may take 4 or 5 months to get a good indication.
Have the patholigist do a plodiy analysis and also check for varients. If unable to do this in Austrailia I believe it can be sent to Boswitck Labs or John Hopkins in the US. Ask for Dr Bostwick or Dr Epstien to review slides.
If there is not an oncologist in Austrialia you feel comfortable with I believe you can get a phone consult with Dr Scholz in Marina Del Rey Ca 310 827 7707 or Dr Myers in Va 434 964 0212. Both of these doctors are familiar with varients.
You can post you questions on prostatepointers p2p and an oncologist may answer your questions.
You are correct in being concerned about the APEX as this is where the vast majority of positive margins are found there.
Good luck.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 12/15/2010 1:08 PM (GMT -6)   
An,
You and I think so alike it is scary. I do everything possible to be consistent before I have my PSA tests. I have it done at the same time of day, eat the same lab, on an empty stomach. I do not use the VED or have sex at least 72 hours beforehand. My numbers with the new protocol have all been <0.01. I set an internal threshold to start some form of treatment if it hits 0.05. I know some people define a biochemical recurrence as having a PSA above 0.2 twice in a row. Well, sorry, "I" know my results and "I" want to do something well before that. "I" need that for my sanity.
I will watch this thread and hope I never need it.
Good luck to you and Paul.
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 prostatitis. 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 PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04
1/14 6 months - 0.05 (Siemens Centaur)
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)

BuiDoi
Regular Member


Date Joined Aug 2010
Total Posts : 234
   Posted 12/15/2010 1:40 PM (GMT -6)   
I'm with YOU, 'Worried Guy'. There is nothing wrong with having a Plan-B or implementing Preventative-Plans, provided that you can treat the process as you would, with taking daily vitamins, and not a Stress-Creating process..
The Prostate 68:1647^1654 (2008) -- Have a look at this article on PC control..
If you can't find it, email me and I'll send it.

have a read of... http://articles.mercola.com/sites/articles/archive/2002/01/09/grapes-part-one.aspx
just as a side interest and see what is reported by Dr Mercola on some things, that OPC have action on...

Stress Not !
.
.
Nov 2009 = First-PSA 5.3 @ 60yo - Asymptomatic - DRE-Non-Palpable
Jan-'10 = TRUS Bx DX - AC T1c - GS(3+3)=6 , 5 & 45% max., L-MidZone
May-'10 = RRP-Nrv-Spare
Post Op. GS(3+4)=7, 1.1cm3, Pos Margins, EPE (focal) Lateral Left
MI(xtensive) Post, Grade3 x 8mm
+8week PSA<0.01, ED-85%, Incont-30%
+16W PSA<0.01, ED -85%, Cont -5%
+17W First 'DRY' day. ED -90%
+26W ED -60%

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 12/15/2010 2:55 PM (GMT -6)   
John,
Thank you for your post. You certainly have provided some answers that we can think about. We will be doing monthly PSA tests now till we can see what the trend is (up, down, flat). The pliody/varients issue is also something we can address sooner than later. I will hold off talking to oncologists either is Sydney or in the US - at this stage we really do not know if the 0.01 increase is important or not - but it's nice to have some options in the back pocket.
 
Jeff,
Planning reduces stress for me, as it obviously does for you too. Doing simultaneous tests at two different labs is something we have decided on as well and we will in the future do our tests at the same time in the day to remove variation.
 
BuiDoi,
Paul already has a very healthy lifestyle and eats almost no junk food and his diet is mostly fish and vegetables. He also is a fit person. He is taking a small amount of asprin everyday and also vitamins. I think that we are comfortable with the preventative aspect of his lifestyle.
 
Fairwind,
I have read your posts over the last few months and believe that you, like me, believe in the power of information and thought in diffusing fear. In a way that is why we are all here at healing well. There are many here that believe that ultrasensitive tests are useless as they just increase anxiety and ruin living. However they are just another source of information. Knowing my husband's Gleason upgraded Gleason score was not much fun and I couldn't do much with the information, but it added to my understanding of the adversary. Likewise, the ultrasensitive tests will do the same once the trend is established. If we ignored what had happened so far we would not do monthly tests and not have a trend and lose valuable information about what's happening.
 
Mike,
Thanks for the red wine and good wishes. I'm not expecting anyone here to be a doctor. Just to point us in the direction of some doctors we can use if we need to or in the direction of any research they may have read.
 
Anyone with answers to the following:
 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 (Can these be done in Australia?)
 
Regards,
An

Post Edited (An38) : 12/15/2010 2:03:36 PM (GMT-7)


BuiDoi
Regular Member


Date Joined Aug 2010
Total Posts : 234
   Posted 12/15/2010 3:59 PM (GMT -6)   
An
http://www.healingwell.com/community/default.aspx?f=35&m=1976127&g=1976903#m1976903

Have a read and BELIEVE ! Follow this line of thinking further !
Diet and exercise is all great for your health !

I fear that in a few years , a lot here will be saying "I only wish I had looked at this stuff, back then"
 
Email me and I will comment on who I think is the BEST !   nono .
 
PS - Don't forget that MANY men find that their Post-Op-GS is raised..  Mine went from the 6 to 7.
.

Post Edited (BuiDoi) : 12/15/2010 3:06:00 PM (GMT-7)


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 12/15/2010 4:20 PM (GMT -6)   
An,
I don't know what is available locally or even how much testing is actually done on patients tumours internationally, (other than for purely research purposes) but this article contains a whole range of tests for prognostic markers for prostate cancer:

www.prostapath.org/download/prognostic-predictive-markers.pdf

Bill

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 12/15/2010 4:47 PM (GMT -6)   
An,
 
I am duly impressed woth your understanding of the situation.  I am also impressed with your calm, collected approach to problem solving.
 
As a Gleason 9, I had my plan B mapped out before I did plan A.  I have since modified it slightly based on surgery results, and PSA testing to date, but it is still there.
 
I am a little surprised at the PSA ultrasensitive paranoia talk.  To me, it only makes sense to follow slight variations, so that one day in six months we are totally surprised by a .1 or .15 result.  It gives me less paranoia to know what is happening, than to wait for the jack-in-the-box to jump out.
 
There is a lot of talk about testing errors and variations.  I can find no scientific talk on the internet to back it up.  PSA tests are accurate to less than .01.  They continually test the machines with contols to insure that they are accurate.  If we follow practical steps of having them done at the same lab with the same assay, and similar diets, time of day, etc, I believe we can trust the results to very small variances.  Mine has tested within .01 since surgery.
 
I have mentioned before on here that Roche Labs, one of the developers of the elctrochemicalluminesense technique, prints on the lab result page that thyey consider .05 to be the nunmber they consider a base for determing BCR.  Thyat is what I am using for my Plan B trigger.
 
I hear guys on hear say that anything less than .1 is a zero or some use .15, or .2.  After a prostatectomy, we should have <.01.  I understand there may be small amounts of prostate tissue around the nerves, etc., but we still should be very close to .01.
 
I have a radiation guy selected, and once my numbers start to rise above .05, I am going in.  I have opted to not do adjuvant for QoL issues.  I have decided that the radiation SE's are not worth the potential 15 % gain in no BCR.  There are so many conflicting studies on adjuvant vs salvage, that I have decided to wait, and only risk the bladder and rectal damage when my PSA dictates it.
 
Good luck on your journey.  I know of several men on here who have had cinsistent .04 results for years.  We have seen some spike, and then go down.  But I suspect you are very correct woth low timor volume, apex foci, etc., to be ready when the time comes.
 
Goodlife

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 12/16/2010 12:34 AM (GMT -6)   
Thank you goodlife,
 
I shouldn't feel like I have to apologize for taking the ultrasensitive tests seriously but I do feel that way here because as I said in the first post in this thread many people, see the <0.1 as a symbol of hope.
 
If you get concerned about an ultrasensitive result under 0.1 the 10 year old "PSA anxiety" quote gets pulled out. I know I am quite concerned that Paul's numbers are not where I would like them to be but I would rather be upset about reality than sticking my head under a pillow and trying to persuade myself that there is absolutely nothing to worry about and wait till the next six monthly test. Now that would make me feel sick.
 
I too cannot find much evidence to back up what is said here about ultrasensitive PSAs. There are people here whose numbers have stayed at 0.05 or 0.03 since their first post op test but this is most likley because some labs do not report below this number. Everything I have read shows that if your assay goes down to <0.01 your prospects for a cure are bright and if you have a nadir reading of 0.04 or above you are in trouble (89% of people at this level get BCR). With a nadir of 0.02 the scales are finely balanced. I hope Paul is one of the lucky ones. The quickest way to find out whats happening is to take the ultrasensitive tests seriously and track the trend on a monthly basis. Which is what we are doing.
 
See Dr Strum's view on ultrasensitive tests at http://www.prostatepointers.org/p2p/2004/Jan/0017.html
 
Regards,
An

Post Edited (An38) : 12/16/2010 5:12:22 AM (GMT-7)


Worried Guy
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Date Joined Jul 2009
Total Posts : 3732
   Posted 12/16/2010 7:18 AM (GMT -6)   
An, Goodlife, Buidoi
Regarding your mention of PSA on the 0.03 vs. 0.01 Look at my PSAs.
Since April 2010 I have been part of a study evaluating a new piece of equipment with a more selective protocol. My samples are run simultaneously on both machines.
June 2006 protocol vs. April 2010 protocol
The June 2006 test indicates 0.03, 0.04, 0.05. The new, April 2010 test equipment reads <0.01.
The lab will be switching over to the new equipment some time next year.

09/03/2009 6 weeks - 0.05 (Siemens Centaur)
10/13/2009 3 months - 0.04 (Siemens Centaur)
01/14/2010 6 months - 0.05 (Siemens Centaur)
04/14/2010 9 months - 0.04 (Siemens Centaur); <0.01 (Roche ECLIA).
07/12/2010 1 year - 0.03 (Siemens Centaur, direct chemilum); <0.01 (Roche Cobas 601 ECLIA)

Make sure you know which machine and protocol the lab uses.
My personal threshold is 0.10 on a Siemens and 0.05 on the Roche Cobas 601.

Jeff

Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2298
   Posted 12/16/2010 9:59 AM (GMT -6)   
Jeff's differing results with two different instruments illustrate one of the problems with comparing small variations using ultrasensitive PSA testing, for example 0.01 vs. 0.02.    As I wrote in an earlier post, even if you test the same sample on the same instrument, the results may vary slightly.
 
Someone noted that there may be differences resulting from a different lab tech running the assay.  In fact, with ultrasensitive PSA instruments, the technician variability is for all intents and purpose nil, because these are automated instruments that use probes to sample the blood.
 
I have included a link below that is an explanation of the variability inherent in lab tests based on 4 factors: accuracy, precision, sensitivity and specifity.  It may be worth a read.
 

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 12/16/2010 10:31 AM (GMT -6)   
Tim,
 
Do you have any documented source for your comment about same sample, different result ?  And if so, is it tied to a specific assay type, or is it just a general statement ?
 
Certainly no expert if the laboratory, but I am finding it hard to believe that a sample would test differently on the same day on the same machine, or at least not by more than .001 or .002, certainly not .01.
 
I may well be wrong, but after seeing the rigorous procedures a lab follows with known controls that the machine must agree with, I find it hard to believe.  Based on Jeff's result log, it could be that a Siemens technioque is not so exact as a Roche.
 
Goodlife

Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2298
   Posted 12/16/2010 10:56 AM (GMT -6)   
Goodlife,
 
I received a B.S. degree in Medical Technology and worked as a medical lab tech for 30 years. I was also a member of western U.S. regional lab inspection teams for the American Society for Clinical Pathology.  I evaluated new instruments, was involved in QC testing and wrote lab procedural manuals. 
 
My statement was a general statement regarding laboratory testing.  Test variation (within certain limits) happens all the time.  Even when the controls are run, a test-to-test variation is allowable.  For example  the low control for a PSA test  may have a range of 0.01 to 0.03, a mid range control 10.50 to 11.30 and a high range control 98 to 103.   Laboratories also use expensive calibration samples to calibrate their instruments several times a year to a precisely determined value, but that does not mean that control values or patient samples will not have some test-to-test variation.  
 
Tim
 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/16/2010 12:43 PM (GMT -6)   
an,

in defense of your thinking, i will share the following from my own case.
i had a high psa velocity issue prior to surgery, nearly tripled in the year before surgery.

after surgery, my first psa was .05, technically a zero, but my dr was most unhappy with the result and warned me that there was cancer left.

3 months later, it doubled to .10, and then kept going up until BCR was declared, and thus, endedup with SRT less than a year after surgery.

He said, that post surgery, a psa reading of .05 is evidence of PC, not the higher ammouns others use.

Interestingly, the radiation oncologist said the same thing, even though there is no connection between the two doctors or practices.

She said the magic number to see if the radiation failed, was that if it went below, and rose again to .05 or higher, it was probably a failure.
In my case, after dropping to a new low of .04, 3 months later, it climbed to .06 (even m uro believes this to be an early sign of faillure)

I dont know what it is now, as I chose to bypass the next 3 month test that was due in November, as I am still recovering from a major urostomy operation. I will be checked again, my choice, at the end of February.

Also, I believe in consistency in using labs. I have used the same lab since 2002 with the exception of one psa test done by my local hospital, and they screwed it up, lol.

pre-dx, all my tests were x.x, and since, all have been x.xx, which with issues like mine, i feel are mandantory.

hope some of this helps your direction, its not always as simple as saying so and so's psa is under .1.

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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 12/16/2010 3:31 PM (GMT -6)   

Tim,

Thank you for that answer.  I certainly was not questioning your qualifications, which are very impressive.  I just hear a lot of statements on here that are not able to be backed up.

I am amazed that the allowable margin of error could be that great.  There goes my confidence.

Goodlife


TTaylor
Regular Member


Date Joined Nov 2010
Total Posts : 102
   Posted 12/16/2010 5:41 PM (GMT -6)   
An
I just think your husband is fortunate to have such a caring and knowledgeable wife. You are with out a doubt on top of this. I simply can't add to what the other guys have said because they have so much more knowledge and experience in dealing with prostate cancer. I am just beginning my journey having experienced a set back after robotic protatectomy and now back on the catheter. I would recommed "Surviving Prostate Cancer" by Dr Patrick Walsh as an excellent read on the topic of PC. He has been head of prostate surgery at Johns Hopkins Hospital for over 30 years and a pioneer in nerve sparing surgery. Sorry I can't add a lot of information, but I was so impressed with your outline of knowledge and questions I wanted to respond and let you know there are many folks that wish you and your husband the very best in this journey of life.
Stay well and blessed
Tom Taylor
Age 67. Robotic prostatectomy 10/26/2010, due for RT in Janury 0f 2011. Eight of 12 lobes positive. Gleason Score 4+4=8, Margin envolvement was present with adipose tissue invasion and perineural invasion, glandular and stromal hyperplasia present,pT3 pNO and no evidence of metastatic adenocarcinoma.

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 12/16/2010 8:55 PM (GMT -6)   
David, I know this PSA game is not much fun. Thank you for sharing your ultrasensitive PSA story.

Tim, very interesting information on lab procedures, it simply means that good or bad tests have a degree of uncertainity.

Billy, thank you again! You have been the source of so much info, hopefully we will never need the next lot but you never know...

Tom, thank you, I am trying hard to be caring and knowledgeable - it is hard to get the balance right between contingency plans (which focus on the negative) and positiveness and hope we need to keep our lives as normal as we can. It would be easier if this was happening to me instead of the man that I love.

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 main involvement in the fibro-muscular zone.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03
Lab 2: Nov 10 - 0.01

Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 12/17/2010 12:31 PM (GMT -6)   
Another good article, Feb 2009, that reviews clinical testing and analysis worth a read: http://labmed.ascpjournals.org/content/40/2/105.full.pdf+html
 
I suddenly find myself in the same 'cusp' boat, having just gotten back a 0.02 after 2 years of <0.01's.  As others have said, its important to know the LLD (lower limit of detectability) for the specific assay that was run, then also understand that at the bottom of any signal detection the inherent variance and influence of noise is greatest.
 
I have a query off to my MD, and I'm going to choose to not worry about it until I get another test back, but will also be lining up a plan B.
 
Best of luck at not needing it. 
 
 

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 12/21/2010 1:32 AM (GMT -6)   

The second pathologist (Dr Cohen, found through yananow) has come back with some results significantly different from the first pathologist. I don't have his report yet but he was kind enough to phone me with the results and answer some questions.

The main outcomes are:
        1)He is confident that the margins are negative even at the apex and this was something I was quite worried about.
        2) The Gleason number is still 3+4 but instead of 5% of Gleason 4 he believes it is 30% of Gleason 4 (!!!)
        3)The volume of cancer in the original report was 0.2cc. He thinks it is actually 0.5-0.7cc using the volume estimation method that he uses.
        4)He doesn't agree that the main cancer is in the fibromuscular zone - he believes it is in the anterior transitional zone. This was freaking me out a bit as the fibromuscular zone is a really odd place to have cancer but he said it was garden variety cancer.

So how do I feel about this? Happy about the first and last points. Concerned about the 30% of gleason 4. Not so concerned about the upgrade in volume - its still a small cancer. His nanogram shows that with the upgrade of the Gleason 4 cancer %, the risk of biochemical recurrance increases from 2% to 4.3% within 2 years. His advice is to watch and wait. I am happy that we had this done but my happiness in confirming that in his opinion the margins are negative is tempered by the significant increase in the % of Gleason 4.

Regards,
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 main involvement in the fibro-muscular zone.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03
Lab 2: Nov 10 - 0.01

Post Edited (An38) : 12/21/2010 1:28:07 AM (GMT-7)


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 12/21/2010 1:43 AM (GMT -6)   
Hi An,

All in All the second opinion seems to be quite conclusive and certainly well worth doing. Interest as to what nanogram you are using to determine the risk of recurrence percentage of grade 4 cells within the grading. Could you post the link to the nanogram, I haven't seen this one before. Many Tks ............Kev
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 Dr Philip Stricker [Sydney]
Upgrade Gleason Score 7.6 [4+3=7]
Stage T2c Three small foci total volume <10%
Margin status- Focal Involvement
Nil - EPE
ED- okay with Meds.
PSA at 2 yrs, no change remains 0.03
"Everyday in Every-way I Get Better'

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1148
   Posted 12/21/2010 2:30 AM (GMT -6)   
Hi Kev,

This is a nanogram that Dr Cohen uses and he plugged my numbers into it while I was speaking to him. He says that this was a nanogram they use in Western Australia.

Regards,
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 main involvement in the fibro-muscular zone.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03
Lab 2: Nov 10 - 0.01

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 12/21/2010 2:35 AM (GMT -6)   
Tks An - I have not seen that type of nanogram before, if you ever get chance to source it, I would love a copy. :-)
Kev
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