Persistent PSA

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Fairwind
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Date Joined Jul 2010
Total Posts : 3748
   Posted 4/7/2011 11:27 AM (GMT -6)   
Here is a paragraph cut from a blog posted by "prostate doc"...This is the first time I have heard the term "persistent PSA" used when discussing the results of prostate surgery...Any thoughts on this?

"Defining a PSA recurrence seems pretty obvious at first glance. After all, PSA after prostatectomy should be 0. Any other number is considered a PSA recurrence. In reality, things are not that simple. First, we have to differentiate PSA recurrence from PSA persistence. A first PSA test obtained 1-3 months after prostatectomy should be 0. However, any PSA value other than 0 is not considered a PSA recurrence at this time. The reason for this is that the PSA has not recurred but, rather, has persisted. Although this difference in terminology may seem like nothing more than semantics, it makes a tremendous difference in terms of prognosis and understanding the status of the prostate cancer. Patient who have a persistent PSA after prostatectomy almost always have metastatic disease. While imaging tests like a bone scan or CT scan may be negative, a persistent PSA indicates that some cancer cells are lurking somewhere in the body that are simply too small to identify on imaging tests. These cells are then labeled micrometastatic disease. Unfortunately, patients in this situation can no longer be considered curable. Instead, they often get palliative hormonal therapy which, fortunately, can often keep those few micrometastatic cancer cells from significantly growing for many years. These patients may also qualify for clinical trials."
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

Newporter
Regular Member


Date Joined Sep 2010
Total Posts : 225
   Posted 4/7/2011 12:01 PM (GMT -6)   
A very dear friend was diagnosed 9 yrs ago and had surgery. Unfortunately he had BCR within a year and underwent salvage radiation. PSA after salvage never went back down but grew to about 1 within a year. However, surprisingly it has been at 1 for the past 7 yrs. His doctor was puzzled but told him to enjoy his good fortune. So, this is probably considered persistent PSA. No one knows how long things will stay that way but I assume his doctor will watch things carefully.

tigre
Regular Member


Date Joined Sep 2010
Total Posts : 69
   Posted 4/7/2011 1:04 PM (GMT -6)   
i'm a little confused about reading that someone's psa that does not reach zero after rp is almost always micromets. my psa at first test after rp was 0.02. i did have a positive margin. completed radiation about 10 months ago and have had three consecutive <0.1 results. docs seem to agree that in my case there is a good chance the cancer left was in the bed area that got zapped and the hope is that psa would come down and stay down with no additional treatment. is the positive margin the same as micromets or are you referring to something else?

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 4/7/2011 1:30 PM (GMT -6)   
I would seem to fit into this definition to a T. My first PSA after surgery was .4 and then the rest is history. Upon completing RT, just 3 months after surgery, my PSA was 1.0 and it has been steadily going up since. My most recent PSA, March 2011 was 4.2.

I had MET radiation 10 months following surgery.

This is the answer my doc has been giving me each time we meet. I just seem to have enough cancer cells running around in my body to generate the PSA, but I am not feeling any effects from it at this point. We are doing another Bone Scan/Survey in May to see if there are any changes since my last one May 2010. This is when we found the MET.

Thanks for posting this. Gives my doc a little more credence with me.

Sonny
60 years old - PSA 11/07 3.0 PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5% positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy
2/23/10 Post IMRT PSA 1.0
3/22/10 PSA 1.5
4/19/10 PSA 1.2
5/22/10 PSA 1.3
8/9/10 Radiation for MET
9/7/10 PSA 2.2
1/5/11 PSA 3.9
3/7/11 PSA 4.2

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/7/2011 2:46 PM (GMT -6)   
Sonny,

It scares me how much our paths are becoming similar, my latest jump from 1.24 to 3.81 in just 7 weeks, made quantam leaps in a very rapid order. This latest jump didn't really startle me as much as the previous leap from .06 (still under .10) to the 1.24 in just 6 months. It's like the monster is building up steam now and making a run for it.

I hope you keep holding off your own beast, the best you can. I know we share similar views on the subject.

My best to you, brother, and do Lynn.

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,

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/7/2011 4:56 PM (GMT -6)   
I understand that in some cases some benign prostate tissue can be left behind and result in a post surgery PSA reading. This is why docs want to see consecutive increases in PSA before calling it a BCR.
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/7/2011 4:58 PM (GMT -6)   
Also, it seems to me that PCa can still be local and curable.

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/7/2011 8:00 PM (GMT -6)   

I can see how the discussion on this blog can get a little confusing for many men.  The Prostate Doc has attempted to write a brief overview that provides a very basic level of understanding, and he (probably appropriately) avoids too many details which, in reality, makes the simplistic perspective too complex for a short blog intended for a general audience.  I’m not saying that the Prostate Doc doesn’t understand these differences (because of course I think he does understand them), I’m just saying he’s simplified things for the sake of a general audience.

The reality is that there have been many discussions here at HW which have been more in-depth than this high-level blog, and so many readers here will recognize the blog shortcomings.  I think the blog does provide a decent overview for men who know just-a-little about PSA after surgery…which is a lot of guys.  Not everyone wants to get into the hairy details, and not everyone needs to, and the target audience for this blog was not those with considerable patient knowledge of PSA and PSA testing.

 

You’ll notice that the Prostate Doc does make mention of the ultrasensitive PSA test down at the end of his 3re paragraph, “With the advent of ultrasensitive PSA…”, so it is important to realize that everything above there is talking only about the standard PSA test (lower detection limit of 0.1ng/mL). 

The comment made by BB_Fan is exactly correct, that some benign prostate tissue left behind, especially after nerve-sparing surgery, can frequently be detected…with the ultrasensitive test down to a lower detection limit of 0.01ng/mL (typically).  This is the original use of the term "PSA Anxiety" for guys getting the ultrasensitive test and seeing the naturally occuring variation of benign tissue.  The standard test won't pick-up benign traces because it is almost always below the standard test lower detection limit.

If PSA is detected with the standard test after RP, this is a typical indicator of systemic (persistent) prostate cancer.  If there were only local PC left in the prostate bed after surgery (not systemic mets), then the PSA would typically (not always) be initially below the standard test detection limit, but increase over time to become detectable.

Many here have been getting the ultrasensitive PSA test, and it is often prescribed if there are unfavorable pathology outcomes or high clinical risk cases…but these situations are not covered in the Prostate Doc’s blog.

I hope this helps clarify…


Post Edited (Casey59) : 4/7/2011 8:04:28 PM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 4/7/2011 8:04 PM (GMT -6)   
I think that the post by Prostate Doc makes sense, but I would add some futher clarification. By 0 I thinks he means <.1 on the standard psa test and not absolute 0. Also a final pathology with negative margins and a persistant psa would indicate micromets. A persistant psa with a positive margin may be more indicative of a local occurrance.
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.

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/8/2011 8:32 AM (GMT -6)   
Hope 1 said...
I have always understood there is no such thing as zero PSA and any reading under .1
is undetectable.
Hope 1.
 
Hope 1,
 
At a high-level, this is also pretty much what Prostate Doc is telling you.  That's usually enough information for the general population.  If you want to know more, then read on...but if that's enough information for you, then stop here.
 
 
 
 
There are now two types of PSA tests:  the "standard" PSA test, and the newer "ultrasensitive" PSA test.
 
The "standard" test has a lower detection limit of 0.1 ng/mL, so if (as you said) a reading is less than that threshold, it is reported as "undetectable."  There really is no such thing, also as you noted, as zero PSA in a living breathing man even after RP, but the amount of PSA may be so low that it is undetectable in the "standard" test. 
 
The "ultrasensitive" test typically goes down to a lower threshold of 0.01ng/mL (or a little higher, or lower; there are several types of ultrasensitive tests, but this is the most common one).  After RP, there may be trace amounts of benign tissue left behind from the prostate that still gives off trace amounts of PSA which MAY be measurable with the ultrasensitive test.  This is certainly a detectable amount using the ultrasensitive test, but would have probably been undetectable using the standard test.
 
Hope this further explains...if you wanted that additional info.

DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 4/8/2011 10:03 AM (GMT -6)   
I went to the Rad doc for the first time yesterday,meet & greet. We discussed my first post surgery PSA reading of 0.26. I was told that because my PSA was so high at the time of surgery,that my level was to be expected. The 1/2 life of PSA was not really enough time to dissipate at 8 weeks. We are waiting until my next test on May 9th to see if I have any increase,decrease,or leveling off of my PSA level. At that time we will plan the next attack.
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
1st post op PSA-0.26-03/16/11

tigre
Regular Member


Date Joined Sep 2010
Total Posts : 69
   Posted 4/8/2011 5:55 PM (GMT -6)   
casey, thanks for the further explanation.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3748
   Posted 4/9/2011 11:46 PM (GMT -6)   
Why do I have this feeling that "Prostate Doc" and "Casey59" are the same person.....

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/9/2011 11:57 PM (GMT -6)   
hope, your statement is generally accepted the way you stated it there is no such thing as a .0 or a point .00 or even a point .000 reading, depending on the test assay. most consider anything <.1 as been undectable. here on hw, when we refer to the zero club, we don't mean a literal zero reading, its a phrase we use to celebrate someone's reading below that .1 mark. so your thinking is correct.

daslink: good luck on your may psa reading, my next one will be at the end of may

fairwind, let's hope not, as that would be a major forumn rules violation if someone had multiple accounts or identity here on HW
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,
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