Shocked at Post Op Pathology Report

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AZ Guy
Regular Member


Date Joined Feb 2017
Total Posts : 38
   Posted 11/6/2017 3:49 PM (GMT -7)   
So I did confirm with the Uro office that the PSA is .40 (nine weeks out). I'm trying to get an appoint with the surgeon sooner than the currently scheduled appoint for the end of this month. I did have Positive Margins and the surgeon said my prostate was hard to get to. I had already scheduled an appoint with the RO at Mayo Clinic for this week to discuss my case. I feel like I need to get started with radiation and possibly joint ADT as soon as possible with a Persistent PSA score that high.

My Best Doctors case report post-op told me to watch closely for rising PSA given my adverse pathology but I'm sure they'd be surprised my first PSA was .40. I had completely stopped finasteride use after the surgery. Finasteride (Propecia for hair loss) suppresses the PSA but I don't believe that should factor in given I shouldn't have any PSA.

gary was it recommended to you to keep watching for a rising number?
Age 49
DX 2/17: G6 2/12 cores <5% in each; one lobe
PSA 6.6 (doubling actual 3.3 due to Finasteride use)
RALP 8/17
pT2c R1
Gleason 7 (4+3) (Revised to 3+4 by Mass General)
Margin Positive
-ECE; -SVI; +PI
Tumor <10% of gland
PSA .4 10/17

garyi
Regular Member


Date Joined Jun 2017
Total Posts : 238
   Posted 11/6/2017 4:36 PM (GMT -7)   
<<<gary was it recommended to you to keep watching for a rising number>>>

Yes, Two RO's, an MO and my surgeon all advised having monthly PSA's, from the same lab of course, and watching for a trend. I'm getting a Decipher test and a CT/PET scan to better determine what's cooking.

Like me, your pre-surgery PSA wasn't over 10 and your pathology isn't high risk. From all I've researched, I am not jumping on the A/SRT bandwagon just yet. I need added data to make that decision.

I'll be at the National Cancer Institute in Bethesda this week for a clinical trial PET scan, another MRI, and a meeting with their radiologist staff. I'll post what I find out.

What we have is a lot different than the BCR many have experienced, and others are concerned about. Keep the faith.
70 years old @ Dx, LUTS for 7 years
PSA's never over 3.0
Ulcerative Colitis since 1973
TURP 2/16, G3+4 discovered,
3T MRI fusion guided biopsy 6/16
14 cores; G 3+3, one G3+4, Grade T1b
Second 3T MRI 1/17
RALP 7/17 Dr. Gonzaglo The Univ of Miami
G3+4 Organ confined
pT2c pNO pMn/a
Mostly Dry
10 week PSA .32
12 week PSA .40
14 week PSA .42
It's called Persistent PSA
Decipher & DCFPyL PET Scan

garyi
Regular Member


Date Joined Jun 2017
Total Posts : 238
   Posted 11/10/2017 4:59 PM (GMT -7)   
AZ Guy....if you tell me what you learned at the Mayo Clinic, I'll share with you what I learned at the National Cancer Institute. smilewinkgrin
70 years old @ Dx, LUTS for 7 years
PSA's never over 3.0
Ulcerative Colitis since 1973
TURP 2/16, G3+4 discovered,
3T MRI fusion guided biopsy 6/16
14 cores; G 3+3, one G3+4, Grade T1b
Second 3T MRI 1/17
RALP 7/17 Dr. Gonzaglo The Univ of Miami
G3+4 Organ confined
pT2c pNO pMn/a
Mostly Dry
10 week PSA .32
12 week PSA .40
14 week PSA .42
It's called Persistent PSA
Decipher & DCFPyL PET Scan

scar1919
New Member


Date Joined Aug 2017
Total Posts : 18
   Posted 11/10/2017 7:54 PM (GMT -7)   
gary, how did you get signed up for your clinical trial at National Cancer Institute?

I would love to hear what you learned!

garyi
Regular Member


Date Joined Jun 2017
Total Posts : 238
   Posted 11/10/2017 11:30 PM (GMT -7)   
I will post a full report tomorrow.
 
scar....if you post your email address in your profile I'll get you more data. Where do you live, what insurance do you have, what specialists are you seeing now, your latest PSA reading, your last Gleason score, your husband did have surgery IIRC...all this data in your signature would assist greatly in sending you more focused information.
 
The best way to get a referral to a clinical trial at the NIH is through your physician.
 
An Endorectal coil 3T mpMRI exam, locally if possible, will help determine if there is a remaining tumor in the prostate cavity. Only four months after surgery and I have such a tumor, it's significant, at 2.6cm.
 
Getting Axumin PET scan is also a good idea. It's an FDA-approved, Medicare-covered CT PET scan that can show early detection of recurrent prostate cancer after surgery or radiation.
 
Hopefully AZ guy will come back and share what MAYO is doing for his persistent PSA.

Post Edited (garyi) : 11/11/2017 1:16:10 AM (GMT-7)


AZ Guy
Regular Member


Date Joined Feb 2017
Total Posts : 38
   Posted 11/11/2017 9:38 AM (GMT -7)   
Dang Gary very sorry to hear about the tumor. sad That seems surprising given your post-op pathalogy with G3+4. Please share more about the results when you can.

Mayo is recommending SRT plus 6-month Lupron shot. They will do a confirmation PSA with their own lab. I am 11 weeks out now. They also want to do a Pelvis MRI. A DRE was negative. Doctor didn't recommend full body bone scan or PET as he was sure nothing would show at this point. Also I found it interesting that Mayo didn't feel a need to have a consult with my surgeon to get further information about the surgery, what he experienced, etc....everything they need is in the post op notes and the pathology.
Age 49
DX 2/17: G6 2/12 cores <5% in each; one lobe
PSA 6.6 (doubling actual 3.3 due to Finasteride use)
RALP 8/17
pT2c R1
Gleason 7 (4+3) (Revised to 3+4 by Mass General)
Margin Positive
-ECE; -SVI; +PI
Tumor <10% of gland
PSA .4 10/17

scar1919
New Member


Date Joined Aug 2017
Total Posts : 18
   Posted 11/11/2017 7:56 PM (GMT -7)   
Gary, I added my email address. Thank you for your help.

Post Edited (scar1919) : 11/11/2017 8:00:02 PM (GMT-7)


scar1919
New Member


Date Joined Aug 2017
Total Posts : 18
   Posted 11/11/2017 7:59 PM (GMT -7)   
gary, sorry to hear about your tumor. It is good to know what you are tackling though.

I added my husbands information in signature.

As of now, just a full body MRI scheduled in a few weeks, but sounds like Axumin or PSMA would give more information??
5/2015 PSA 3.51
10/2016 PSA 6.87
5/2017 PSA 8.44

December 2015 - Biopsy 15 cores with one core showing 1/2 mm Gleason 6 (3 + 3)
June 2017 - Biopsy 15 cores with 9 had more than 1 mm of Gleason 7 (3+ 4)

August 2017 RALP
Good recovery: Urinary Incontinence - improving but leaks when moving around
ED: Good recovery at first, but major issues now.

Pathology Report:
Tumor Grade Gleason 7 (3+4)
Invaded bladder neck
LN, SV and other margins negative

September 2017 - Almost 7 weeks PSA post prostatectomy 0.41
October 2017 - 12 weeks post RALP 0.50

Bone Scan October 2017 - Maybe something on humerus - waiting on bone biopsy

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8791
   Posted 11/11/2017 8:33 PM (GMT -7)   
scar1919-

The purpose of the PET scan is to rule out distant metastases as the cause for the persistent PSA. It also sometimes detects cancer in pelvic LNs. Once you can rule out distant mets, he can go ahead and have salvage radiation with greater confidence that it will be curative. If they see involvement in any of the pelvic LNs, he could have radiation to both the prostate bed and the pelvic LN area. If there are distant mets, radiation will only do harm with no benefit, and it would be better to start ADT immediately.

The humerus would be a very unusual place for a first bone met. i've never heard of a full-body MRI (only a pelvic CT or MRI) being used, except in conjunction with a PET scan. I don't really understand what they hope to learn from that - sounds like a recipe for needless anxiety, imho, not to mention the cost of it and the amount of time in the machine.

He can get the best PSMA PET scan (called DCFPyL) for free from NIH. It's better than Axumin too. I have found that the folks at NIH are happy to talk to patients directly. Just call Contact: Yolanda McKinney, R.N. (301) 443-6913 ymckinney@mail.nih.gov

Here are the trial details:
/clinicaltrials.gov/ct2/show/NCT03181867
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

scar1919
New Member


Date Joined Aug 2017
Total Posts : 18
   Posted 11/11/2017 8:45 PM (GMT -7)   
Allen, yes, I totally agree about the MRI.

I really want him to get the PSMA PET scan from NIH or anywhere for that matter.

My husband has called and left messages for Yolanda McKinney, at (301) 443-691and emailed her at ymckinney@mail.nih.gov but have not received a response to either.

Not sure what to do from here. Any suggestions are welcome.

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8791
   Posted 11/11/2017 9:34 PM (GMT -7)   
Try Peter Choyke - he's the principal investigator for the trial.

pchoyke@nih.gov

301-402-8409
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

garyi
Regular Member


Date Joined Jun 2017
Total Posts : 238
   Posted 11/12/2017 9:43 AM (GMT -7)   
As usual, TA is unbelievably helpful and spot on!

Yolanda will get back to you. Read through the clinical trial criteria carefully. They are strict about it. The National Cancer Center and the people who work there are exceptional. Try hard to get a DCF PET scan.
Do it ASAP, persistent PSA is serious.

I see my local RO and MO on Monday, and I should have more data to report.

Sorry about the late reply. We've been without internet service for three days, with at least two more to go. This coffee shop, with it's $7 drinks is getting costly & old ;-)

More to come....
70 years old @ Dx, LUTS for 7 years
PSA's never over 3.0
Ulcerative Colitis since 1973
TURP 2/16, G3+4 discovered,
3T MRI fusion guided biopsy 6/16
14 cores; G 3+3, one G3+4, Grade T1b
Second 3T MRI 1/17
RALP 7/17 Dr. Gonzaglo The Univ of Miami
G3+4 Organ confined
pT2c pNO pMn/a
Mostly Dry
10 week PSA .32
12 week PSA .40
14 week PSA .42
It's called Persistent PSA
Decipher & DCFPyL PET Scan

Pratoman
Veteran Member


Date Joined Nov 2012
Total Posts : 4896
   Posted 11/12/2017 11:56 AM (GMT -7)   
Gary, so it looks like the criteria to be eligible for the scan is psa >.02, if you don't have high risk pathology?

So that leads to a decision, does one hit it early? Or does one wait for .2 in hopes of avoiding useless SRT should the source of PSA be distant micrnets, thus taking the risk that by the time it does hit .2, it actually has metastasized.

I know that doesn't apply to persistent PSA but to others who have been undetectable, then become low detectable that is unstable.
Dx Age 64 Nov 2014, 4.3
BX 3 of 12 cores positive original pathologyG6, G6, G8 (3+5)
downgraded to 3+3=6 by tDr Epstein, JH
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology – G7 (3+4), ECE, Margivns, LN, SV all negative
PSA @ 6 weeks 2/15, .<02, remained <0.02 until January 2017, .02, repeat Feb 2017, still .02. May 2017-.033, August 2017- .033
Decipher test, low risk, .37 score

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8791
   Posted 11/12/2017 1:58 PM (GMT -7)   
Pratoman said...
So that leads to a decision, does one hit it early? Or does one wait for .2 in hopes of avoiding useless SRT should the source of PSA be distant micrnets, thus taking the risk that by the time it does hit .2, it actually has metastasized.


I assume you meant that there is no real question, and that no sane person would do that. It would be a self-fulfilling prophecy to wait until distant mets are detectable.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Gemlin
Veteran Member


Date Joined Jul 2015
Total Posts : 603
   Posted 11/12/2017 3:12 PM (GMT -7)   
Is this a correct interpretation of the discussion?

1. The criteria to be eligible for this scan is that the PSA greater than or equal to 0.2 ng/mL (after surgery).
2. The metastasis incidence rate is 15% among men treated with SRT at PSA levels of 0.2 to 0.5 ng/mL.

So this scan could identify those 15% and then giving them ADT instead of SRT. You must be very sure that the scan result is correct to say no to SRT. confused

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8791
   Posted 11/12/2017 3:40 PM (GMT -7)   
The cancer detection rate for the Ga-68-PSMA PET/CT for men with PSA 0.2-0.5 after prostatectomy is 27%-58% (depending on the study). The DCFPyL PET/CT is 33% better than that PET overall. It is very specific, so false positives are low. You are right that most cancer detected at these low PSAs will not be from distant metastases, but if distant mets are detected, then one can rule out SRT with good reliability.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Pratoman
Veteran Member


Date Joined Nov 2012
Total Posts : 4896
   Posted 11/12/2017 3:51 PM (GMT -7)   
Tall Allen said...
Pratoman said...
So that leads to a decision, does one hit it early? Or does one wait for .2 in hopes of avoiding useless SRT should the source of PSA be distant micrnets, thus taking the risk that by the time it does hit .2, it actually has metastasized.


I assume you meant that there is no real question, and that no sane person would do that. It would be a self-fulfilling prophecy to wait until distant mets are detectable.


Nobody said i was sane.

But regarding your post, thats my point. Lets say my PSA, currently at .03, rises to 04, then .05, then .06. then .09 Time to hit it, right? I'm pretty sure Zelefsky would say yes, even at .06, based on my meeting with him. But i would hate to go through SRT, only to find out the cancer was elsewhere. At this point, no approved scan is going to detect anything. Maybe this new scan would. (or maybe i'm mistaken). And if it did it would allow me to avoid unnecessary SRT. But as you said, if i waited till .2, it could turn out that it was in the prostate bed, which we'd never know for sure, but now its out and about, its become a self fulfilling prophecy.

So its a quandry. It's something Gary and I have discussed. I really dont want SRT. If PSA continues to rise, and i have a way to know its in the prostate bed , i'm all in. But what a sh!tty thing to have if it wasn't going to do anything anyway except maybe give you strictures and bowel problems.

My point is, other than someone who was never detectable to begin with, why would anyone sign up for that trial if it meant they had to wait until .2

Post Edited (Pratoman) : 11/12/2017 3:55:19 PM (GMT-7)


Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8791
   Posted 11/12/2017 4:41 PM (GMT -7)   
No sane person is going to wait for PSA to rise just so he can be eligible for the trial. The trial is for men who are already at a PSA over 0.2 after prostatectomy. Some have persistent PSA, like Garyi; others just waited too long. Fortunately, we know that distant mets at low PSAs are unusual (as Gemlin pointed out), and the prostate bed is usually a wide enough field for salvage radiation. In my mind, the biggest potential benefit of the PSMA PET is to identify whether the pelvic LNs should be included in the radiation field; but with very low PSAs, the likelihood of finding cancer there is limited.

There really is no quandary if your goal is cure. We know from 3 major RCTs that the wait-and-see attitude is inferior. Can you be 100% certain without an advanced PET scan? - no, and not even with one. If you want to know the odds your recurrent PC is curable with SRT, the best you can do is use a nomogram. Admittedly, the stats in the nomogram won't have much basis of men with your exact specs:

/pcnrv.blogspot.com/2016/08/probability-of-remaining-recurrence.html
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

island time
Veteran Member


Date Joined Dec 2014
Total Posts : 1262
   Posted 11/12/2017 9:09 PM (GMT -7)   
Tall Allen said...
No sane person is going to wait for PSA to rise just so he can be eligible for the trial. The trial is for men who are already at a PSA over 0.2 after prostatectomy. Some have persistent PSA, like Garyi; others just waited too long. Fortunately, we know that distant mets at low PSAs are unusual (as Gemlin pointed out), and the prostate bed is usually a wide enough field for salvage radiation. In my mind, the biggest potential benefit of the PSMA PET is to identify whether the pelvic LNs should be included in the radiation field; but with very low PSAs, the likelihood of finding cancer there is limited.

There really is no quandary if your goal is cure. We know from 3 major RCTs that the wait-and-see attitude is inferior. Can you be 100% certain without an advanced PET scan? - no, and not even with one. If you want to know the odds your recurrent PC is curable with SRT, the best you can do is use a nomogram. Admittedly, the stats in the nomogram won't have much basis of men with your exact specs:

/pcnrv.blogspot.com/2016/08/probability-of-remaining-recurrence.html


according to this nomogram.....G7 PSM+ SV- EPE-

no ADT......delaying radiation for PSA to rise from .05 to .2 results in a negligible difference in cure rates. (even waiting as long as PSA of .5 only results in a single digit percent difference in cure rate)

with ADT....one can with until 1.0 (or even higher) and get the same results.

Am I reading this wrong?
PSA 2010 thru 2014...4.0 +/- .7
Dx 12/14 @ 56 yo...2 cores G6 <5%, 1 core G6 20%, 1 core HGPIN.
RALP 11/25/15...3+4. 3 to 5 mm surgical margin 15% involvement pT2+
2/16-.01...4/16-.00...7/16-.00...10/16-.01...1/17-.01...4/17-.02...7/17-.02
10/17-.02

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8791
   Posted 11/13/2017 1:54 AM (GMT -7)   
IT-

The problem with nomograms is it depends on the number of people with each combination of risk factors. As I wrote there, "It included post-op ultrasensitive PSA test results for some (18 percent) of the patients, but only 18 patients were treated at a PSA≤0.05 ng/ml.", so you can't rely on stats with that small a base. The other small base was for men treated with radiation doses that are widely now considered curative (around 70 Gy). Your unique set of risk factors may have only had one or two men in that nomogram.

This is the problem with trying to make decisions based on outmoded diagnostics and therapeutics -- by the time you accumulate enough data, it's no longer relevant. It also doesn't include such factors as duration of ADT, PSADT, or genomic risk. Their model has a predictive accuracy of about 68 percent for freedom from biochemical failure.

To get a better handle on the effect of one risk factor, like early treatment, you have to look at a database where there is a large sample of men treated at a low uPSA, like this one:

/pcnrv.blogspot.com/2016/09/very-early-salvage-radiation-has-up-to.html

As you can see, if you look at it as a single risk factor, treating at a lower PSA makes an enormous difference.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

garyi
Regular Member


Date Joined Jun 2017
Total Posts : 238
   Posted 11/13/2017 5:36 AM (GMT -7)   
scar....thanks for all the info, there is lots of PET scan data here:

http://downloads.hindawi.com/journals/bmri/2014/827265.pdf

AZ Guy....thanks. From all I've read, MAYO is suggesting the correct treatment for you. No surprise there.

Allen....just thanks, thanks, thanks!

Prato....we're talking persistent PSA. Check your very low PSA again rolleyes wink

Post Edited (garyi) : 11/13/2017 5:39:03 AM (GMT-7)


Gemlin
Veteran Member


Date Joined Jul 2015
Total Posts : 603
   Posted 11/13/2017 7:43 AM (GMT -7)   
This study looks relevant for the discussion in this thread.

It challenge the dogma of using SRT at the very first sign of recurrence in all patients regardless of disease characteristics. Instead, it showed a clear benefit of early SRT only in certain subgroups of men with either BCR or PSA persistence after surgery.

Impact of Early Salvage Radiation Therapy in Patients with Persistently Elevated or Rising Prostate-specific Antigen After Radical Prostatectomy

Five distinct risk groups were identified based on clinical and pathologic characteristics. Early SRT administration was noted to be associated with improved cancer control for low-, intermediate-, and high-risk patients. Conversely, very low-risk (undetectable PSA after RP, Gleason score ≤ 7, and tumour stage ≤ pT3a) and very high-risk patients (PSA persistence after RP, and Gleason score ≥ 8) did not benefit from early salvage treatment.

Pratoman, you (like me) might find this statement reassuring (unfortunately not applicable for az and gari):
Particularly, very low-risk patients (undetectable PSA after RP, Gleason score ≤ 7, and tumour stage ≤ pT3a) had a quite favourable 8-yr metastasis-free survival of 98%, and these patients’ outcomes were not influenced by pre-SRT PSA level.
Age at detection: 60
PSA 4.1 2014-02-25
Biopsy 2014-04-24, 4 of 10 cores positive, G: 3+4,4+3,4+3 EPE,4+3. PNI+
Bone scan negative
DaVinci 2014-08-31, nerve sparing right side
Prostate 35 g, 46x37x38 mm
Tumor dorsal PZ, SV-, 14 LN-, SM-, pT3a, G7 (4+3), EPE+ left side
PSA:
2014-10 <0.05
2015-03 <0.05
2015-09 <0.05
2016-03 <0.05
2016-09 <0.05
2017-09 <0.1

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 8791
   Posted 11/13/2017 1:08 PM (GMT -7)   
This points to a difficulty in using "8-yr metastasis-free survival" as a surrogate endpoint. It's a problem I have with Decipher as well. Because of long lead times in the PSA era, PC is usually treated very early in its progression history. That means an intermediate risk patient, even if left completely untreated, will probably not develop detectable metastases within 10 years of his initial diagnosis.

We saw this in a recent active surveillance analysis of intermediate risk men from Sunnybrook. They observed them for twice as long - 15 years - and found that metastasis-free survival was 84% for those diagnosed with GS 3+4, and only 63% for those diagnosed with GS 4+3. (Even GS 3+3 has been found to progress in half the cases if given long enough.) I would guess that the debulking of the RP slowed detectable progression even further. And in all of these studies, "detectable metastases" means detectable with a bone scan, and not with PET/CT. Bone scans require larger tumors for detectability. The presence of systemic micrometastases, which renders the cancer incurable, undoubtedly begins much earlier.

So, if life expectancy is only 10 years, GS 7's who have a recurrence may not need further treatment, but the average age at RP is about 60. If life expectancy is greater than 10 years, I think there is a lot of risk in delaying SRT, based on what we know now.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Pratoman
Veteran Member


Date Joined Nov 2012
Total Posts : 4896
   Posted 11/13/2017 2:37 PM (GMT -7)   
garyi said...


Prato....we're talking persistent PSA. Check your very low PSA again [img]/community/emoticons/rolleyes.gif[/img] [img]/community/emoticons/wink.gif[/img]


Garyi...i realize that. I think i referred to it in an earlier post.

I checked my low PSA this morning, will probably get results in a few days, will report back. smhair
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