Post op PSA results in!

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DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 3/16/2011 5:21 PM (GMT -6)   
Well....I just got the call from the Uro nurse with my 1st post-op PSA results: 0.26....POOH! mad
I have my Uro visit next Weds. the 23rd, I'm sure we'll talk about what's next. Gonna be a B*#CH trying to sleep tonight. Kinda bummed sad
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/16/2011 5:32 PM (GMT -6)   
Ouch is right ,feel for you. With your T3 situation and 40% involvement, sounds like you will needing the Radiation route, unless you feel a re-test is in order. Plus you had such high pre-surgery PSA. Please keep us posted, and we will hope for the best for you. Good luck.

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 2/11 1.24
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 9/10,

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 3/16/2011 7:15 PM (GMT -6)   
daslink -
- sorry about the bad numbers -
- the RT guys I have met through my work have done well with it all - one even used the phrase "piece of cake - go for it"...
-it may seem very dark right now - but it will lighten up by the time you talk to your URO ( was he also your surgeon?) - keep looking and researching - vent when you need to vent ... bring notes and questions to the meeting ... take no prisoners... do what is best for you.

hugs,
BRONSON
Age: 55 - gay with spouse of 14 years, Steve
location: Peterborough, Ontario, Canada
PSA: 10/06/09 - 3.86
Biopsy: 10/16/09- 6 of 12 cancerous samples, Gleason 7 (4+3)
Radical Prostatectomy: 11/18/09
Pathology: pT3a -Gleason 7 -extraprostatic extension -perineural invasion -prostate weight -34.1 gm
PSA: 04/08/10 -0.05 -Zero Club
PSA: 09/23/10 -0.05 -Zero Club
PSA: 03/24/11 - TBA

profman
Regular Member


Date Joined Jan 2010
Total Posts : 55
   Posted 3/16/2011 8:49 PM (GMT -6)   
So sorry to hear that, and I wish you the best of luck. I am in your neck of the woods, had my surgery at University Hospital in Cincinnati - if radiation is in your future there are excellent facilities in the city. Please keep us posted.
Diagnosed 9/4/09, age 59
PSA 3.5, up from 1.8 year before
Two biopsies showed 8/20 positive cores, Gleason 3+3, up to 40% involvement, T2a
RRP on 12/15/09, home 12/16
Biopsy - Gleason 6, margins clear all around, no EPE, no perineural invasion, no SV involvement
Catheter out on 12/29/10
Continent in six weeks, ED still present
PSAs nondetectable (six weeks, six months, 12 months)

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 3/16/2011 8:52 PM (GMT -6)   
Darn I hate hearing news like this but hang in there. Let us know what the Uro think and keep us posted.

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
2 year PSA <0.1
Only issue at this time is ED but getting better

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 3/16/2011 9:11 PM (GMT -6)   
Sorry about your post surgery PSA. none of us likes to see that. It looks like radiation is in your future. You can still beat this thing, stay positve.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18, 21 months) undetectable
Latest PSA test (2 years) <.008 ?

MikeS24
Regular Member


Date Joined Oct 2010
Total Posts : 131
   Posted 3/17/2011 9:15 AM (GMT -6)   
DaSlink: Don't get discouraged. I know I sound like a broken record but read the section in Walsh's book on Surviving Prostate Cancer that has the heading, what to do if your PSA goes up after surgery. It has a lot of good advice and most of all it provides hope. Don't give up you have lots options, ammunition and time on your side.

Keeping you in my thoughts and prayers.

Mike S.

DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 3/17/2011 9:40 AM (GMT -6)   
I have no plans of giving up! Still a little down but I will be ok. I see where guys have had additional therapy and are doin ok,and I can be that too.
In 09' I survived a stroke that usually 65% of the people who have them never make it to the hospital.I can get passed this! I'm trying not to let it overwhelm me till I talk to the Uro,but it ain't easy! Right now it's a harder pill to swallow than the original DX.
Profman; good to see some one in my area and I'll be in touch I'm sure!
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear

MikeS24
Regular Member


Date Joined Oct 2010
Total Posts : 131
   Posted 3/17/2011 10:48 AM (GMT -6)   
DaSlink: We are routing for you. It is easy to get discouraged. Again, read the book, I think you will get some comfort and encouragement from it.

MikeS.

DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 3/17/2011 11:25 AM (GMT -6)   
Mike I got to get the book.I have a couple but not that one. Today I have been reading peoples signatures, and as I read Fairwinds, it made me feel a but more at ease.
I know in my heart it's not all bad news,so I'll be ok. I don't even have grand kids yet and I'm not gonna miss that!
The other thing that worries me is work. I have been off work for some time and our insurance is through my union.With construction still way down and the possibility if not probability of further treatments can lead to a sticky coverage situation. It is some thing that weighs heavy on my mind.
I tend to worry about things a lot and this is just some thing else to pile on my plate!
Fishing and riding season are almost here and those will help ease my mind!!!!
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear

MikeS24
Regular Member


Date Joined Oct 2010
Total Posts : 131
   Posted 3/17/2011 1:21 PM (GMT -6)   
DaSlink: Yes, getting Walsh's book will really help. It address your issue (PSA not going to zero after first post surgical test) and makes some very concrete and supportive statements about what to consider doing. As you can see in this "game" knowledge is power. Knowledge is also a fear reliever. Walsh says in one section that when the first post PSA test comes back without being zero, Men usually ask Well, how long do I have to live?" With sensitivity to all concerned, Walsh points out that the question is very premature. With several therapeutic lines of defense in your arsenal, most men can expect many, many years of symptom free life. In fact, your issue may be easily treatable with local radiation and you might well be rid of the problem in short order. Get the book, read, and then get your questions lined up and write them down so when you see your doctor you won't forget anything that is critical to ask. While difficult bumps in the road lie ahead, you will get through them.

Insurance is a nasty thing. Explore your options now so that you don't run out of coverage before you need some additional treatment. You may be jumping to conclusions that you won't be back to work soon and be able to carry on with insurance. Don't assume that the next steps in recovery and further treatment will keep you from working.

Peace my friend. Praying from my lips to God's ears.
Mike S.

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3739
   Posted 3/17/2011 2:20 PM (GMT -6)   
Hey Slink,
I just finished pulling your chain in that other thread and was kind of beating around the bush about treatment since your PSA was so high.

I have seen some comments here about the 18 week post surgery window to "git er done". So don't be dilly dallying around now.
I hear you. My PSa was 23, biposy 7/12 Up to 70% Pt3a with the bad alphabet soup: EPE and PNI. I let the window close because I was in such bad shape with other QOL issues. Don't make the same "mistake".

On a lighter note - (only because you and I are the kind of guys that will make light of any bad situation):
This might be a good time for a trip to Japan. Those nuke plants will need pipe fitters and with the strong Yen, the wages will be tremendous. $200-250k /year. Plus as an added bonus, you'll get a free dose of radiation. I can't guarantee it will be in the right spot or be effective but it will be free. I speak Japanese if you need me to send in your resume.


Keep in touch.
Jeff
Age: 58, Mar 35 yrs, 56 dx, PSA: 4/09 17.8 6/09 23.2
Biopsy: 6/09 7 of 12 Pos, 20-70%, Gleason 4+3 Bone, CT Neg
DaVinci RP: 7/09, U of Roch Med Ctr
Path Rpt: Glsn 3+4, pT3aNOMx, 56g, Tumor 2.5x1.8 cm both lobes and apex
EPE present, PNI extensive, Sem Ves, Vas def clear, Lymph 0/13
Incont: 200ml/day ED: Trimix
Post Surg PSA: 10/09 .04, 4/10 .04, 7/10 <0.01, 12/10 <0.01
AdVance Sling 1/10/11 Dry

DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 3/17/2011 9:38 PM (GMT -6)   
Well we already had the book. It was on my wife's side of the bed. She is the reader here. I read the section that Mike S recommended but I'm still a little confused. My gleason was 7, but PSA high. Most of it refers to a gleason 7 and below as low risk and 8 and above as being high risk. So maybe that puts me in the middle.
I do feel better when the book said retest then decide,and that I have some time and this can go bye-bye with treatments.Uro visit should be interesting. The decision will be made quickly.Not gonna waste too much time.
Jeff, I worked years ago in one of the nuke facilities here(Fernald) and look what it got me! They processed uranium there and did what magic they do and turned it into 300lbs ingots to be made into fed rods.
The PSA numbers have me baffled....0.0anythhing is good and 0.2 has concerns. Do the numbers go 0.0 to 0.9 then 1.0 to whatever? Not sure how it works.
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear

DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 3/17/2011 9:49 PM (GMT -6)   
Jeff; which other thread? I'm confused confused of course I'm like that a lot lately!
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 3/17/2011 10:50 PM (GMT -6)   
Slink,

Without a prostate, you should have no PSA, or at least very, very little. .2 is kind of a magic number that anything above that indicates that PC is still active. Don't know if you have seen any of Snuffy Myers videos, but he shares one story of a guy who had an inexperienced doctor and left a large portion of his prostate, which gave him a high PSA. Snuffy would also say retest and watch the doubling time before proceeding to next step.

Shake it off, and get ready to face the next phase of your journey.

Good luck.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 3/17/2011 10:57 PM (GMT -6)   
Hey Slink, my post-op PSA came back 0.9 I asked my surgeon what I had paid him for, since at that moment i was in the hospital fighting a staph infection he had given me...We haven't talked much since..

Chin up! Time for a new deck! Choose a good Radiation Oncologist with good equipment and move on...
Age 68.
PSA age 55: 3.5, DRE normal.
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 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

mgl
Regular Member


Date Joined Feb 2007
Total Posts : 122
   Posted 3/18/2011 6:16 AM (GMT -6)   
My first post op PSA was .28, So I did the next step and had radiation .It sounds scary but for myself is was not bad , just a pain going to the hospital everyday for treatments. I had no pain from the treatments. If that is the route you take I'm sure you'll do just fine .
I hope the best for you

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3739
   Posted 3/18/2011 7:06 AM (GMT -6)   
Hey Slink,
I hope you slept a bit. You have some busy days ahead.
I know you are hoping to be considered low or medium risk. But, sorry pal... You're young, you had a small prostate and your PSA was well above 20 and climbing like the temperature in a Japanese reactor. You're high risk. And now that your PSA came back 0.26 after RP? That nails it.
Gleason 7 can easily be an 8. You had one lab give you an opinion. There are guys here who send their slides out to experts to get 2nd and 3rd opinions. Did you see that last word there? Opinions. 0.26 is fact. Not a pretty fact, but a fact.
Casey sent a link a while back with patient guidelines and recommendations for what to do next.
Go to page 47 It's for guys with PSA above 20 above and work through the flow chart. Next step is most likely Adjuvant Radiation (But I am not a doc.) The time window for best results is fast approaching.

Send me an email - my address is in my profile -if you want to talk. A 5 or 10 minute phone call will clear up some questions for you. Guys helped me this way so I'm just returning the favor. Plus I can have free US calling and hate to waste it.

(Oh, the thread I was talking about was the one where you and I discussed the Nut splitter jeans It was your Pre-psa thread.)

Hey, you see what mgl just posted above? Listen to him.

Jeff
Age: 58, Mar 35 yrs, 56 dx, PSA: 4/09 17.8 6/09 23.2
Biopsy: 6/09 7 of 12 Pos, 20-70%, Gleason 4+3 Bone, CT Neg
DaVinci RP: 7/09, U of Roch Med Ctr
Path Rpt: Glsn 3+4, pT3aNOMx, 56g, Tumor 2.5x1.8 cm both lobes and apex
EPE present, PNI extensive, Sem Ves, Vas def clear, Lymph 0/13
Incont: 200ml/day ED: Trimix
Post Surg PSA: 10/09 .04, 4/10 .04, 7/10 <0.01, 12/10 <0.01
AdVance Sling 1/10/11 Dry

MikeS24
Regular Member


Date Joined Oct 2010
Total Posts : 131
   Posted 3/18/2011 8:00 AM (GMT -6)   
DaSlink: Yes, that section is confusing in Walsh's book but read it over several time because it repeats other scenarios with some small differences. I read it last night again. I was around page 382 to 387 if memory serves me. Walsh should have created a decision tree to make it easier to follow. He just uses narrative instead.

I agree with Worried Guy. Your pre surgical PSA was high and you never reached zero post surgically. Read every instance in the book that talks about what to do if your PSA does not reach zero after surgery. Walsh is cautious but injects some optimism in his remarks. As you know PC is complex and NOW is the time to become well educated in what to do next. Some people agonize over the purchase of a brand of refrigerator or a car and spend weeks researching which is better. Do the same for yourself. Research what is best for you so that you have really good questions for any doctor you visit. If they are good docs they will appreciate a good debate about what to do rather than having them lead you through a decision passively with you just nodding your head.

Also this is a good time to be discriminating about what literature you do read. I would put more faith in the literature from major academic resources rather than the first hits you get in a Google search that say "ignore your PSA and eat this specially treated gravel." In some cases it is hard to separate the whack-jobs from the authoritative material.

I found that the complexity using the Walsh book was in determining if the PSA comes from a prostate bed source or a distant metastasis. Frankly, I think even Walsh says that initially it is uncertain as to where the source of the PSA is hiding. Read this carefully. He seems to create a decision tree kind of model using Gleason and PSA along with time. Check other experts as well. You might reach a consensus among top rated prostate authors as to a path to follow.

Peace,
Mike, S.

duke68
Regular Member


Date Joined Mar 2007
Total Posts : 243
   Posted 3/18/2011 8:02 AM (GMT -6)   
Hi Slink,

It' a slap in the face when the psa is elevated after rrp.
Mine was 0.6. :( With a bad pathology.

My radiation oncologist and medical oncologist said that men with a positive margin and or other ece (extra capsular extension) have a better chance with radiation.

If you had a good pathology there would be usually no reason for the residual psa other than systemic.

After radiation with 6 months adt2 I went for 3 years undetectable.

Best wishes
Gerry
age 68 diag. oct 2006 G8 T2b psa 11.7
4 of 8 cores 20% 30% 60% 100%
rrp dec 2006 G9 4+5 m+ sv+ ece after 6 weeks psa 0.6 second opinion Dana-Farber pT3b 4+4 + T5 = G9
Rt 35 sessions to lymph nodes and prostrate 4-2007
3/2007 cab 6 months lupron + casodex.
psa <0.1 from june 2007 to march 2010
psa 6/10 0.3 9/10 0.6 12/10 2.5 :(

Dana- Farber Phase 2 trial Avastin Lupron and casodex

Viperguy
Regular Member


Date Joined Nov 2010
Total Posts : 259
   Posted 3/18/2011 8:24 AM (GMT -6)   
Sorry for the bad news Slink.  Probably should have it nuked on the advice of doctor.  There is another guy on the forum that spoke of Calypso radiation where they insert makers (lot like the needle biopsy) and then nuke the target area.  He is in the first week or two of therapy and seems to be handling it well.  You're in my prayers, guy.  
2009 PSA 2.2
2010 PSA 3.2
Biopsy 24 cores 3 positive
Gleason 3 plus 3
Robotic Surgery March 3, 2011 @ 6 am
At home recovering
Cath removal scheduled 3/17/11
Pathological report confusing, no seminal invasion Gleason 6 but margins not completely clear.

DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 3/18/2011 9:56 AM (GMT -6)   
I had a great surgeon,and highly recommended with over 1600 davinci surgeries. Some times all this information is over whelming. That stupid stroke I had makes it hard for me to process a lot of information at one time,so I have to spread it out and go over it several times. I can't multi-task worth a darn either-Stupid Stroke!
I write a lot of stuff down but some times it's hard to keep track of where it all goes,not enough side notes I guess.
My wife goes to all the visits because by nature women ask more questions then men, and she has a GOOD memory.
Maybe a little interaction with some grown ups this weekend will help. I haven't seen any friends since the surgery. Also an adult beverage may be in order. That too has been a long time coming!
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3739
   Posted 3/18/2011 11:16 AM (GMT -6)   
Hey Slink buddy,
It's like drinking from a fire hose. So, here, I'll break it down for ya'.

Slink rest this weekend. Drink beer. Make big pee in toilet. Slink Happy.
Slink hug wife and do something fun this weekend.
Monday, Slink's wife call radiation onco doc and make appointment soon.
Slink get nuts nuked.
Slink and wife live long and prosper.

Got it? Good! ;-)
Jeff

DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 3/18/2011 1:25 PM (GMT -6)   
Whew smhair Thanks. I like a guy who speaks registered Appalachian! smilewinkgrin
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear

DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 3/18/2011 1:31 PM (GMT -6)   
Ya know what Jeff? That language may be more from my Cherokee side than the Appalachian side. Both are registered!
Go ahead and nuke the nuts. It's not like I'm using them any way!
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear
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