Low level PSA after surgery

Thanks to everyone who posts here. I have been "lurking" here for the last year and a half. I've learned so much from all of you who are so willing to share.
Background: Husband diagnosed at 48. Radical prostatectomy in July 2005 at Mayo Clinic. Gleason 7. 5% left and 40% right involved. Negative surgical margins, lymph nodes and vesicles. 16 weeks of Casodex due to close proximity to urethra. DNA anaploid(sp.)Fully continent and just minor issues with e.d. Husband is in great shape, exercises, eats well, does have daily headaches, high stress job but a great support system if I do say so myself!
3 months PSA:<.01
6months :<.04
9months: <.04
15 months :.06 (new software)
18 months: .07
21 months:.07


We were advised that the low level PSA could be due to :
1. PSA is naturally occurring in the body
2.Could be from benign prostate cells left behind
3. Prostate cells beyond the surgical margins.

Are there any other explanations for the low level PSA? Any ideas on the probabilities of the above three scenarios?

Thanks so much for your help.

Hi ~ Opie,   Our welcome letter will follow but I wanted this posting to be under eglman's...     Quote from Opie’s posting above: 3 months PSA:<.01 6months :<.04 9months: <.04 15 months :.06 (new software) 18 months: .07 21 months:.07 We were advised that the low level PSA could be due to : 1. PSA is naturally occurring in the body 2.Could be from benign prostate cells left behind 3. Prostate cells beyond the surgical margins. Are there any other explanations for the low level PSA? Any ideas on the probabilities of the above three scenarios?   I found the answers for 1,2,3 in the books listed below.   In reference to low level PSA… as long as it’s undetectable… that’s what we are looking for.   The fluctuation stated above in the excerpt gives credence to this scenario.   And that’s the rule we will be following as we move forward in “Our Journey” after RRP.     I had a hard time trying to understand the PSA results when reading some post…   So ~ I had Buddy sit down with me to give me a visual!!!   This is a personal view on the PSA information… The information I provide below is specific to “Our Journey ~ RRP” and our lab.    I hope this helps you to understand a little more about your results.   Our lab uses <0.1 as their scale.   So when we got our 1 st and 2 nd call from the nurse she stated that our PSA was <0.1 undetectable  which ='s a Woo~Hoo!! Many labs classify anything   <0.1 (10 pennies) as undetectable   Here’s a question that we would get answered by inquiring of the lab or your urologist. What results do I have to be within to still be in the “undetectable” range with your testing procedure? Based on the lab results I’ve received (2 different programs used) are they classified as being undetectable?   Here’s a scale that helped me to understand our scale with having Retropubic Radical Prostatectomy: ( green is in the undetectable range for our lab) <0.01 (no pennies) 0.01 =      1 penny 0.06 =      6 pennies 0.07 =      7 pennies 0.09 =      9 pennies 0.1   =    10 pennies At this point we would start monitoring. 0.11 =    11 pennies 0.12 =    12 pennies 0.20 =   20 pennies 0.50 =   50 pennies 1.6       =   160 pennies 2.0      =   200 pennies 2.5    =   250 pennies   * Excerpt: PSA Anxiety…   The Downside of Ultra-Sensitive Tests             You’ve had the radical prostatectomy, but deep down, you’re terrified that it didn’t work.   So here you are, a grown man, living in fear of a simple blood test, scared to death that the PSA—an enzyme made only by prostate cells, but all of your prostate cells are supposed to be gone—will come back.   Six months ago, the number was 0.01.   This time, it was 0.02. You have PSA anxiety.   You are not alone This is the bane of the hypersensitive PSA test:   Sometimes, there is such a thing as too much information.   Daniel W. Chan, Ph.D., is professor of pathology, oncology, urology, and radiology, and director of Clinical Chemistry at Johns Hopkins.   He is also an internationally recognized authority on biochemical tumor markers such as PSA, and on immunoassay tests such as the PSA test.   This is some of what he has to say on the subject of PSA anxiety:   The only thing that really matters, he says, is, “At what PSA levels does the concentration indicate that the patient has had a recurrence of cancer?”   For Chan, and the scientists and physicians at Hopkins, the number to take seriously is 0.2 nanogram/milliliter.   ( 20 pennies my italics )    “That’s something we call biochemical recurrence.   But even this doesn’t mean that a man has symptoms yet.   People need to understand that it might take months or even years before there is any clinical, physical evidence.”               On a technical level, in the laboratory, Chan trusts the sensitivity of assays down to 0.1, or slightly less that that.   “You cannot reliably detect such a small amount as 0.01,” he explains.   “From day to day, the results could vary—it could be 0.03, or maybe even 0.05”—and these “analytical” variations may not mean a thing.   “It’s important that we don’t assume anything or take action on a very low level of PSA.   In routine practice, because of these analytical variations from day to day, if it’s less than 0.1, we assume it’s the same as nondetectable, or zero.”     * Dr. Walsh’s Guide to Surviving Prostate Cancer (2001) Chapter 10 How Successful is Treatment? Within this chapter there are many questions answered. What Should I Do if My PSA Comes Back after Surgery? Cancer Control after Radiation Therapy What Happens if PSA Comes Back Again, or If I have Distant Metastases?     Dr. Peter Scardino’s Prostate Book (2006) Chapter 20   Rising PSA after Surgery or Radiation Therapy Read this chapter to learn: Why do some prostate cancers recur? Does a rising PSA always mean cancer? What can be done about a rising PSA after surgery or radiation?   Our thoughts are with you both…as you continue to move forward in your journey.   It sounds like you’ve got a great support group!!   Thanks for allowing us to walk with you. In Friendship ~ Lee & Buddy

Thanks so much to those of you who posted replies. Kitt, eglman, and mama bluebird, I appreciate your help in answering my questions regarding a low level. but rising PSA following surgery. Your explanations made a lot of sense and brought us some peace of mind. My husband likes to know "why" and your posts made a lot of sense. Thank you. Bluebird, thank you for your analogies and I am waiting for a hug! Sorry it took me so long to reply. We've got graduations, a 15 year old with a torn ACL scheduled for surgery next week(8 months after her 18 year old brother had his ACL surgery)and just everyday "stuff".

On another topic, I came across the Ted Koppel and Discovery Channel program, Living With Cancer the other night. I thought it was a great program and provided me more insight as to how cancer can continue to affect a person even after "successful treatment". It can and does stay with you. In good and in not so good ways.
Thanks again. This is a great site.
Opie



Husband 48 at diagnosis. RRP on July 29, 2005. Gleason 7.
16 weeks of Casodex.
PSA:
3 m. <.01
6m. <.04
9 m. <.04
15 m. <.06
18 m. <.07
21 m. <.07

Hey ~ Opie,   As they say ~ better late than never!!!   I’m even longer than you!!! responding eeekkkk!!! I can just imagine your schedule!!!   I’m just happy our information was helpful to you. Hope things went well with the ACL surgery.    This   “Hugs”   for   you !!!         In Friendship ~ Lee & Buddy   P.S. Hope you continue to stay with us!!!  

Hi Opie,

Well, you're scared. I've been there and probably will be again...it's a completely normal place for you to be right now.

"What number did your doctor say it would have to reach before he would move to the next step in treatment??" (Bluebird's words) If he didn't discuss this with you call him and ask.

When you can look ahead a little bit and check what some of your options are, that may help you. My husband doesn't do that but I have to, you know?

For me, knowing sheds some light and lessens the fear.

I did watch the program you mentioned and agree with you...it was good. As you could see there are other things that factor into a person's outcome. Their outlook on life, faith, people around who love them, good medical care, etc. That says to me it's more than numbers or statistics. I hold onto that and hope you can, too.

Please come here to talk and ask questions (we have a bunch of smarties here) because in doing so you help us also.

All the best to you both,
Susan

Hi Opie,

I just wanted to send you a prayer that your husband should be well and that his psa should drop with the next reading. I feel for what you're going through.
Please keep us posted.

Best of luck to you.

A.