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1 week post RALP

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Prostate Cancer
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GuitarHunter
Regular Member
Joined : Jan 2018
Posts : 69
Posted 2/18/2021 7:13 AM (GMT -7)
We spoke about the genomic testing and he suggested we decide at my PSA follow-up. The PSA follow-up is actually going to be on 3/30 or about 8 weeks following surgery. I hope that isn't too soon and possibly cloud the results.

He also put me on 50mg Viagra daily to be taken at bedtime. Nothing yet has happened, but I haven't tried either.
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DjinTonic
Veteran Member
Joined : Dec 2019
Posts : 1245
Posted 2/18/2021 7:34 AM (GMT -7)
8 Weeks is not too soon. The typical range is 6 weeks to 3 months. The main objective of early testing is to make sure the initial PSA is <0.1, in other words, there isn't obvious persistent PSA and that the surgery achieved it's main purpose without significant PSA sources being left behind. I would suggest you request that you ask your doc to be followed with an ultrasensitive PSA test -- preferably Labcorp's 3-decimal test, otherwise Quest's "post-prostatectomy" 2-decimal test. This testing will allow you to track better your absolute numbers as well as any upward trend. (The lower limit of Labcorp's uPSA test is now <0.014; that for Quest is <0.02. Labcorp raised its lower limit, which used to be <0.006. The downside is that with a <0.014 result you can't know whether your nadir is below 0.01.)

Another advantage of uPSA testing for higher-risk men with adverse post-op path is to learn your PSA nadir. This usually occurs within the first few months. Several studies have shown that whether your nadir is above or below a threshold is statistically correlated with your chances of remaining BCR-free. A nadir below 0.03 is good; below 0.01 better. The right-most digit of any test holds uncertainty, so rounding the 3-decimal Labcorp test to 2 decimal places is probably more reliable than a 2-decimal test. Keep in mind that very low PSA levels can fluctuate for both intrinsic reasons (you) and extrinsic ones (sample prep, test reagents, equipment calibration, etc.) -- another reason it's good to round to a 3-decimal result to 2 places -- peace of mind smile

Lastly, some higher-risk men may want to start adjuvant or salvage therapy at a PSA below the "official" BCR definition of PSA 0.2 and rising (perhaps 0.1). A uPSA test gives you more lead time to both monitor your values and trend and set up a plan for any further therapy.

Note that all this fuss over uPSA testing is aimed at men at higher risk. Most G6 (3+3) men are happy to get their periodic <0.1 results using a PSA designed for men with prostates.

Djin
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AZ Guy
Regular Member
Joined : Feb 2017
Posts : 167
Posted 2/18/2021 8:07 AM (GMT -7)
GuitarHunter glad you are recovering well. Thought I'd share my experience. I went into surgery as G6 and did the surgery given my young age (49), decipher results as Intermediate Risk, and the wildcard of having used finasteride for hair loss for 20 years. After the surgery I was disappointed with the post-op pathology. I was upgraded to 4+3=7 with positive margins. The disappointment was compounded when my first PSA came back as .40. That is a very high persistent PSA. When I was diagnosed as G6 and with very low volume of cancer per biopsy, it was hard to get my head around these poor results. I felt discouraged that I waited 8 months from diagnosis in January to surgery in August. Everyone says take your time, it's slow growing...

So I had the six month lupron shot and began salvage radiation in December. The Mayo here in Phoenix was great. When it was over my PSA was undetectable where its been since. Wish you the best!
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Stephen S
Regular Member
Joined : Oct 2019
Posts : 270
Posted 2/18/2021 8:45 AM (GMT -7)

AZ Guy said...
I felt discouraged that I waited 8 months from diagnosis in January to surgery in August.Everyone says take your time, it's slow growing...

Yeah I second this sentiment. From a logical perspective at some point PCa goes from manageable to unmanageable. We do not know when the switch is flipped with any certainty. Our tests are imprecise. Our knowledge is incomplete. Once you decide to deal with it act with all dispatch and extreme prejudice. Push your dr's. Make sure you don't fall through the cracks etc...

Thats why the 8 week test is a good barometer, because if you are not less than 0.1 by then an additional 4 weeks is not going to get you to undetectable with a uPSA test. So between 8 weeks and 12 weeks you can use to start lining up a radiation oncologist, start pushing paperwork, educating yourself about next steps etc...

At the time my PSA at 8 weeks was 0.1. My PSA at 12 weeks was still 0.1. At 13 weeks I had my first lurpon shot, and my radiation was scheduled to start 7 weeks later. Hopefully I will ultimately be victorious but I can say with certainty that I did literally everything I could as fast as I could.
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halbert
Veteran Member
Joined : Dec 2014
Posts : 5111
Posted 2/18/2021 8:49 AM (GMT -7)
GH: 8 weeks will tell much. Hopefully you'll be getting the ultrasensitive test--ask to make sure. Another important bit is to always have your bloodwork done at the same site. Different sites have different equipment, so you can't always compare results from different labs.

At that point, you'll have a good idea of what is to come. Best outcome: you get a "<" in front of your number. Second best, your not undetectable, but below 0.1. If you're detectable, many docs want two readings at least a month apart to verify. After that....we'll see.

Good news on the viagra too. It sometimes helps to try the different ED drugs...some guys get nowhere with viagra, but do well with cialis, and vice versa.
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theswan
Veteran Member
Joined : Nov 2005
Posts : 638
Posted 2/18/2021 11:23 AM (GMT -7)
Cialis work's best for me. I use the smaller dose of 5mg daily for my BPH. That actually has staying power however if I'm feeling randy, I'll double the dose and it does a decent job.
Understand that I have significant ED issues that precedes my Pca
I therefore do not get very erect but close. Viagra did not work as well and gave me headache.

GH thanks for continuing to post as some like I await surgery.
Everybody reacts in different ways so understand I'm not against any particular ED medications

Glen
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Mumbo
Veteran Member
Joined : Nov 2018
Posts : 1167
Posted 2/18/2021 12:08 PM (GMT -7)
GH - While you are waiting, a couple of on-line calculators are linked below that may be helpful to play with. You can vary the input and see the effect on the results.

https://www.mskcc.org/nomograms/prostate/post_op
https://riskcalc.org/prostatecancerpredictingpostradicalprostatectomy/

Should give you something to discuss with the doctor about after your PSA test. Different studies provide different results in the case of the Cleveland Clinic results. The concepts are helpful in that high PSA, high Gleason, EPE, positive margin affect the results adversely and you can see the general relationships.

I hope this is not too much info too soon.....
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GuitarHunter
Regular Member
Joined : Jan 2018
Posts : 69
Posted 2/19/2021 4:30 AM (GMT -7)
I had my surgery at The James Cancer Center at The Ohio State University. My urologist's office is in the building and he does all the blood draws in the office and usually has results in less than an hour. I don't know if it's a Quest Lab or Compunet Lab.
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GuitarHunter
Regular Member
Joined : Jan 2018
Posts : 69
Posted 2/20/2021 2:54 PM (GMT -7)
I'm feeling pretty good at the nearly 3-week point. I have noticed a little soreness around the waistline, nowhere near any of the incision sites. I'm only wearing 2 diapers a day now and they are barely wet when I change them. I'm completely dry overnight and during the day it's just a drop or two when I have leakage. I've been thinking about switching over to pads which I'm guessing are way more comfortable.
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halbert
Veteran Member
Joined : Dec 2014
Posts : 5111
Posted 2/20/2021 3:12 PM (GMT -7)
GH: you're right on track. Yes, pads are way more comfy. Soon, you'll call yourself continent. Here's my current definition:

Before RALP, I dripped a bit..mostly after urination due to incomplete emptying. Now, I drip occasionally, but at more random times. I look at it this way: If I was continent then..I am now. What I have found is that the time lag between "I need to go soon" to "I need to go RIGHT NOW" is a lot shorter than it used to be.
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GuitarHunter
Regular Member
Joined : Jan 2018
Posts : 69
Posted 2/21/2021 11:57 AM (GMT -7)
Today has been more leaking than the last 3 days. I'm not sure what I may be doing differently that might have caused this. Maybe it's one of those 2 steps forward, 1 step back kind of situations.
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Pratoman
Forum Moderator
Joined : Nov 2012
Posts : 8503
Posted 2/21/2021 2:25 PM (GMT -7)
GH most likely thats all it is, 2 steps forward one step back. Could be that you are just tired, or muscles tired from doing kegels. I wouldnt worry about more leaking for a day or two.
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Dave'68
New Member
Joined : Feb 2021
Posts : 6
Posted 2/22/2021 7:08 AM (GMT -7)
GH - just read your thread from back to front...... I agree with everyone's opinion. Walk as much as you can, whether outside or inside on treadmill. I find the exercise to be good but also to clear one's head. At least for me, to be alone in my own thoughts post surgery was a good thing. Lots of changes are happening that more likely than not weren't something you thinking about pre surgery. For the incontinence thing, I never had leakage but if I laughed or sneezed hard that's when I get a few dribbles. I usually stop drinking fluids 1-2 hrs before bed and try to go before I jump into bed. I know my doctor said my experience was not the norm and he marked it up to my age and not having any issues pre surgery. Keep up with the Kegel exercises if you still have some leakage.

Seems like your post op was also a bit of a surprise as mine was. That took some getting my head around that as well. Reading the stories on this site (I've been here for 3 days) has certainly helped. Glad you found it a lot sooner than I did.
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GuitarHunter
Regular Member
Joined : Jan 2018
Posts : 69
Posted 2/23/2021 12:10 PM (GMT -7)
Still seem to be healing well. Had a pretty busy day yesterday and that made me tired so I just had a nap. I only had to get up twice last night for a bathroom trip. Things are getting better.
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