PSA 150 - Are we looking at PC w Mets or is there a chance it’s something else?

Good news to report today...we received an end of day call yesterday that the drain sample came back w normal creatine levels, so its looking like lymphatic drainage is the cause for the elevated amounts of fluid from the drain. So wonderful to hear & very thankful 😅. I removed both tubes yesterday evening. Everything came out fine. Soaked the first few drsgs, but its settled down by this morning. He's already regained some control of his bladder. Up to the bathroom a few times through the night so that's a good sign. The catheter was in for 3wks so it might take a bit more time to find his new normal. Not loving the need for the new underwear, but all things considered he's doing great & happy to be free of those tubes. Several more weeks of recovery, and we'll find out full pathology & 1st post-op PSA results in June to see where things go from here. One step @a time! ~LjK

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Husband's Information:
Jan/19 - PSA150, CT-Clear, Bone Scan-Clear
Feb/19 - 12/14 Biopsies Positive (4x3+3/ 1x3+4/ 2x4+4/ 5x4+5)
Diagnosed: PCa High Risk/High Volume G8&9 Cores 55-80% affected.
Feb 15/19-Started Casodex150mg
MRI-Feb27/19-PCa appeared organ confined
Apr/19-PSA 50 w pre-op Casodex
April18/19-RP-Lymphadenectomy & Nerve Sparing

Yes it is 😄! Looking forward to going for a walk w him & maybe for some ice cream🍿.

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Husband's Information:
Jan/19 - PSA150, CT-Clear, Bone Scan-Clear
Feb/19 - 12/14 Biopsies Positive (4x3+3/ 1x3+4/ 2x4+4/ 5x4+5)
Diagnosed: PCa High Risk/High Volume G8&9 Cores 55-80% affected.
Feb 15/19-Started Casodex150mg
MRI-Feb27/19-PCa appeared organ confined
Apr/19-PSA 50 w pre-op Casodex
April18/19-RP-Lymphadenectomy & Nerve Sparing

Great news Jane, sounds like your back on the “normal recovery” track

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I am not a doctor, just another guy without a prostate
Dx Age 64 Nov 2014, PSA 4.3
BX 3 of 12 cores positive original pathology G6
RALP with Dr Ash Tewari Jan 6, 2015
Post surgical pathology G7 (3+4), - ECE, - Margins, -LN, -SV (+ frozen section apex converted to 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 November .046, March 2018 .060. June 2018 .068, July 2018 - .082, August 2018, .078, August 2018 - .08 Start ADT. Sept 2018 Start SRT
Sept 2018 thru November 2018 – T = 4, PSA = <.05
Decipher test, low risk, .37 score
My story.... tinyurl.com/qgyu3xq

Hello all,

We are still waiting for true spring to show itself around here. There’s actually a possibility of frost tonight!

It’s just over 2wks since pulling my husbands catheter & drain; he’s 51/2wks post RP & 20lbs lighter. His color is coming back; he had low iron & albumin levels so we’ve supplemented to brings those back up. His Bp was low too, so very light headed at times, but it’s coming back up slowly also. He had some lymphedema in his L leg after pulling the drain but that’s resolved now as well. He’s been religiously doing his Kegel’s & getting outside for daily walks through town; mowing the lawn w the tractor & helping where he can w our kitchen updates. The surgeon started him on low dose Viagra to improve blood flow, but he’s been hesitant to start it. Still a bit sore!!

Doing really good in my opinion 😀, however, he is understandably frustrated w his significant stress incontinence that is not resolving anywhere near fast enough for him. He was not liking the feeling of the depends underwear so we added the always pads that turn liquid to gel & that’s working better for him. He can change those out easier. He has some control but not when he can’t concentrate completely or he’s up & moving more. He’s having a hard time reconciling how he will deal w things at work as a welder. Thankfully our family doctor decided going back to work @6wks was too soon, so it’s been bumped tentatively to 10wks. We see the surgeon in 10 days for path results. Praying we get good news.

We know this is a fairly normal part of his recovery but it’s still hard. Any suggestions by those who’ve been where he is (we are) would be appreciated. ~LjK.

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Husband's Information:
Jan/19 - PSA150, CT-Clear, Bone Scan-Clear
Feb/19 - 12/14 Biopsies Positive (4x3+3/ 1x3+4/ 2x4+4/ 5x4+5)
Diagnosed: PCa High Risk/High Volume G8&9 Cores 55-80% affected.
Feb 15/19-Started Casodex150mg
MRI-Feb27/19-PCa appeared organ confined
Apr/19-PSA 50 w pre-op Casodex
April18/19-RP-Lymphadenectomy & Nerve Sparing

When I came to the end of your post LadyJaneK the first word that came to mind was "patience". Then I read down and saw Saipan beat me. My experience was the same. Time is our friend.

Hello All,

My husband is officially 9wks post RP. He's doing well w his recovery but has significant stress incontinence and is finding it very difficult some days getting used to this new normal. There has been improvement, so we remain hopeful. Otherwise he's doing great, enjoying his yard & garage, going for his walks & helping where he can w our home improvements.

We have seen the surgeon & finally had a chance to look at his path results and have an official diagnosis. PCaG9(4+5) pT3bN0 (M0 acc to bone scan).

PCa identified in all lobes high volume (no surprise there!); bilateral bladder neck invasion but surgical margins are negative (they took a generous portion of his urethra acc. to the surgical report), R seminal vesicale +ve & L-ve ( abuts but did not invade), all lobar & prostatic basal margins are -ve, but 1 +ve extraprostatic margin in the R apex & several +ve intraprostatic margins of the L apex. The L nerve bundle was +ve and removed to the level of the sphincter involving fragments of prostatic tissue, 15 lymph nodes removed all -ve. I spoke to the surgeon immediately following surgery & he said they had a difficult time removing the prostate & it tore @the apex under traction & he warned me then, he thought the first PSA would give an apical margin & we would do the PSA again at 12 wks before determining further treatment. He explained @6wks sometimes the body is still getting rid of the cancer cells so its not an accurate picture.

First Post-op PSA 1.04. It's much better than 150 or 185, but we were obviously hoping for a lower number. So now the 12wk PSA will determine adjuvant & salvage strategies if necessary. Hopefully not, but we have always been aware this is a likely possibility.

Taking so much of the urethra explains the stress incontinence, he's completely dry @night & can stop & start the stream which we've been told is a good sign. Bladder retraining was advised & the doctor suggested a clamp, so the bladder has a chance to fill up & the muscle doesn't weaken. We ordered the Pacey Cuff, hopefully it's not too uncomfortable & works for him (dealing w pads @work all day will not be fun). The other clamps I looked at reminded me of something you use to close a chip bag! He can drink a lot which I've mentioned before, so backing off a bit is helping especially in the evening. They've taken him off work till mid July now to concentrate on bladder retraining & he'll go back on a GRTW (gradual return-to-work) schedule. Thankfully he has wonderful insurance, I asked the surgeon for a 6mo Rx for incontinence products & they are covering them.

Has anyone else been told this info on the PSA @6wks, told the prostate tore on the way out & could produce an inaccurate 1st post-op PSA; & has anyone tried this Pacey Cuff? Here’s a link, https://paceycuff.com/

Hope you're enjoying these first days of summer! ~LjK

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Husband's Information:
Jan/19 - PSA150, CT-Clear, Bone Scan-Clear
Feb/19 - 12/14 Biopsies Positive (4x3+3/ 1x3+4/ 2x4+4/ 5x4+5)
Diagnosed: PCa High Risk/High Volume G8&9 Cores 55-80% affected.
Feb 15/19-Started Casodex150mg
MRI-Feb27/19-PCa appeared organ confined
Apr/19-PSA 50 w pre-op Casodex
April18/19-RP-Lymphadenectomy & Nerve Sparing
June/19- post RP Dx PCa G9(4+5) pT3bN0M0

Hi Mumbo,

Thanks for responding. I was told by the surgeon prior to surgery that one of the undesirable side effects of pre-op Casodex is it can cause the dead cancer cells to become sticky, sometimes making the prostate more difficult to remove. Obviously it was working on my husbands cancer cells! As soon as I heard it tore, as much as I tried not to, I envisioned cancerous tissue being left behind. The possibility of bone mets is still in the back of my mind too. All we have is a bone scan w multiple hot spots which appear to be osteoarthritis. For now though we put it aside, live our life and remain positive; we’ll know soon enough.

Thanks for letting me know your experience w the clamp & incontinence. We’ll have to watch out for getting used to it. I guess he shouldn’t wear it any more than necessary i.e. only at work or special functions. I swear he’s going to bed earlier just to get a break from the incontinence, which I totally understand. I can see how difficult dealing w it is on him. I’m sure it will get better, but right now it’s testing his patience.

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Husband's Information: 56yrs
Jan/19 - PSA150, CT-Clear, Bone Scan-Clear
Feb/19 - 12/14 Biopsies Positive (4x3+3/ 1x3+4/ 2x4+4/ 5x4+5)
Diagnosed: PCa High Risk/High Volume G8&9 Cores 55-80% affected.
Feb 15/19-Started Casodex150mg
MRI-Feb27/19-PCa appeared organ confined
Apr/19-PSA 50 w pre-op Casodex
April18/19-RP-Lymphadenectomy & Nerve Sparing
June/19- post RP Dx PCa G9(4+5) pT3bN0M0

LJK, It looks, actually, as if things are going as well as can be expected at this point. It's very encouraging that he's dry at night. The stress incontinence is a challenge, and it will get better in time. It can take a long time (months, not weeks) to stabilize.

Most docs do a 6 weeks PSA to ascertain direction, but not as a final thing. And, with the G9, it would be unusual for him to be 'once and done' at this point. That's the reality. To help you think it through, the term 'half-life' is used sometimes. PSA has a half-life of about 5 days, so if his pre-surgery PSA was 180, then in 6 weeks (40 days) he would have had up to 8 halvings: 180-90-45-22-11-6-3-1.5 (which is about where he was!). To get to non-detect, he'd have to have some more: 1.5-.75-.325-.16-.08-.04-.02 etc.

So, for now, cautious optimism is the way to be!

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Age at Diagnosis: 56
RALP on 2/17/15, BJC St. Louis, Dr. Figenshau
58.5g, G3+4, 20%, 4 quadrants involved
PSA Non-Detect since April, 2015
My Story: www.healingwell.com/community/default.aspx?f=35&m=3300024

Halbert,

You're sorta right but mostly wrong but you're wrong about the wrong thing so you're sorta right.

You're right that serum PSA has a half-life but your 5 days figure is off by a factor of two. The usual figure quoted is "two to three days" but the values I've seen tend to cluster around 2.5. ( For instance, see table 2 here: Clearance rates of total prostate specific antigen (PSA) after radical prostatectomy in African-Americans and Caucasians ) If we use a 2.5 day half-life then after six weeks we'd expect something like a 2^-16 reduction giving an expected PSA of 0.00274.

Another reason that surgeons like to wait a bit before checking PSA values after surgery is that it is not uncommon for small amounts of prostate tissue to be left behind after surgery but detached from its blood supply. Those little bits of tissue usually die but they can linger long enough to wreak havoc with PSA half-life analyses. So you're right that six weeks is early-ish but you are wrong about why.

Thing is, with Gleason 9 disease you generally don't want to spend a lot of time sitting around hoping it will go away.

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65 Slow PSA rise 2007-2012: 1.4=>8
4 bxs 2010-2012: 1&2 neg, 3 pos 1/14 6(3+3) 3-4% (2^nd opn. 7(3+4)), 4 neg
DaVinci 6/14/12. "some" nerve sparing on left
Path: pT3a pN0 R1 GS9(4+5) Pos margins on rt
24 mo ADT3 7/12 - 7/14
Adj IMRT 66.6 Gy 10/17/12-12/13/12
8/2012-3/2015: Incont., Trimix, VED, PSA<0.015.
AUS & IPP installed 3/5/2015
Forum Moderator - Not a medical professional

PDA - I took a quick look at that small study and the one person with EPE and G9 was at a 3.95 day half life. Starting PSA’s were considerably lower also than 50 that was much higher before Casodex so I am not sure that anyone knows how to predict PSA in this specific situation. halbert’s math could be as close as anyone’s guess so a 3 mos PSA will solve that problem pretty soon.

LJ - Sounds like you may be following my schedule at 5 mos post-op. I was feeling pretty good at that point and was long past the days after catheter removal. Never had a continence problem through treatment although the bladder did remind me that something was going on down there after a few weeks with some odd feelings and a little urgency once in a while. As I stated in my thread, I am pretty impressed so far with the Varian Trilogy and similar machines that do IMRT/IGRT which means there is a daily scan of the situation and adjustment before each IMRT treatment. Seems to do a good job of avoiding the bladder and rectum areas with direct radiation which helps minimize side effects. The techs will recycle you if the bladder and rectum are not to their liking in the scans which happened a few times over 37 treatments. None of this means anything to the next person in line but thought I would share since I fared ok through the couple months of treatment but not all do if you read through my thread on Adjuvant RT Experiences.

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7/2018-66yo, PSA 4.1->5.1
8/2018-MRI, PI-RADS 5
8/2018-MRI Biopsy, 4+3
9/2018-CT/Bone clear
11/6/18-RALP @ St. Johns
11/2018-Post-Op Path G7 (4+3) 5% Tert Gr 5, pT3a pN0 Grade 3
Pos. Marg (SM+), EPE, <3mm, L=0.1mm?
11/2018-Decipher 0.47, Ave. Risk
1/2019-Epstein-G9(4+5) Gr5
“Difficult to distinguish EPE vs intraprostatic incision, 3mm” Extent:pT2x
2/2019-PSA<0.10
4/2019-6/2019 ART
5/2019-PSA<0.10

Post Edited (Mumbo) : 6/24/2019 8:28:14 PM (GMT-6)

LJK - Good to hear your husband is improving and the clamp is helping. I had my 6 mos PSA during ART and it was still <0.10. another month or so until the next test.

I don’t see how follow up radiation could not be in his near future, with Lupron I would think. Hopefully he doesn’t have systemic mets, but that was a high initial PSA.

Good luck!

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Part I
2015 (Age 54) PSA: 20.8
Bx: All cores G7 (4+3)
RALP & Adjuvant RT
Pathology: G8 (4+4)+5
PSA nadir: 0.1, steady increase until 2019: 64

Part II
2019, March: Lupron/Xtandi, PSA: 0.036

LadyJaneK, I would think as soon as your husband feels he has incontinence control and the urologist believes he is healed up enough from the surgery then the RO will want to start radiation. I'm kinda surprised that they want to wait for 6 wks for another psa test I would think they would have you on a ADT plan already but maybe that's what they are doing with the casodex? Maybe one of the new scans if available to verify no mets as then there would be no reason to have SRT Wishing you the best in whatever treatment you guys choose! 👍 JMHO

Larry

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Male 63 DX @ 60
Dad had PC
2002. Psa. .08
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo,Mn
Gleason 9, pt3bno, SVI, EPE, 45 grams 35 LN CLEAR,
4- 17 Hernia surgery
6- 17 psa 0.13
7- 17 psa 0.12 3TMRI coil - clear
8- 17 shoulder replaced
10- 17 psa 0.16
10-12-17 Lupron
12- 17 psa <0.10
12-18-17 SRT
2-7-18 SRT done 72gy
4-18 psa <0.10
10-18 psa <0.10
3-19-19 Laminectomy Surgery
5-8-19 psa <0.10

Post Edited (Skypilot56) : 7/23/2019 6:03:53 AM (GMT-6)