PSA rise after RRP

Hello Mugaboo,
While looking at the numbers does show an increase the amount you are looking at (.04ng) is really slight. It could well be just a blip in the testing procedure........same equipment? same assay test? even a different technician running the test can produce a slightly different result. The oncologist consultation is a wise move but I would suspect he would want to monitor the results for a while longer in order to clarify things before deciding if further treatment is warranted. Here's hoping it's just a blip on the radar.
Bill

I hate this disease too! Sorry to hear about the slight rise, but I am with Bill and Tony. Hopefully it is a blip on the radar. My father has done radiation and HT, so we are pretty familiar with the process. Wishing you nothing but the best and undetectable PSA's!

Hi to all my friends,

Thanks for your encouraging comments and postings, but the way the PSA is going, we all know deep down that this is not a good sign. I'll see what the Oncologist has to say, but I'm pretty sure that RT is most likely my next battle ground for this scourge on  mankind.

Thanks again for all your comments, concerns and interest.

All the best to all of you.

 

Magaboo

Pelehatchie,
If it were me I would have radiated right after surgery with Magaboo's numbers. Adjuvant treatment is better than salvage treatment in the long run. But it is a difficult decision for anyone to radiate before biochemical relapse. Watchful waiting is a normal part of treatment course for those who decide to not to have RT adjuvantly. Keep in mind anything below 0.1 is considered undetectable.  But you can see what I did. I fired all of the torpedoes immediately after surgery, save Taxotere. Which I wonder if I should have bit the bullet there, too. It's good to see you are back to undetectable numbers. I am certain Magaboo can get there if he starts now, or at 0.4. And waiting will reveal a doubling rate, which might indicate he also needs HT. Better to know what that rate is now.

All my best to both of you,

Tony

Mugaboo, my husband's pathology report staged him at T3a with negative surgical margins, seminal vesicles, etc.  I believe the T3a designation means that the cancer was no longer "organ confined" or localized.  My husband's pathology report stated that a very small extension into the prostate capsule but not through it (whew) with clean surgical margins.

Hope all goes well for you.

Interesting discussion. My cancer had spread into carcinoma of the muscle tissue all the way to the pelvic bone. 4 positive margins, bilateral SVI, and the doctor was sure that he did not get it all near the rectum. I am pT3b on the pathology report. Go figure. The full TNM is in my signature. But we acheived undetectable! Amen. This much I know. I have plenty of livin' to do. So I don't worry about this stuff. I'm headed back into the mountains this week ~ to ride along the wild horses...(Pics at my website!)

Magaboo, keep on keepin' on, brother!

Tony

Hi Sephie,

I do have the pathology report and it contains, among other things, 2 items which I don't fully understand, but resulted (I believe) in the T3a rating:

1. Capsular proliferation identified.

2. Malignancy continuous with distal right and left resection margins.

 

I'm not to sure how to intrepid these 2 items in plain English. Perhaps some more knowledgeable person could help?

The rest of the report is quite clear and leaves no room for guesswork.

I thoroughly enjoyed LV-TX's analogy regarding the difference between T3a and T4 . --- Well done!

Best of health to all of you.

 

Magaboo

To Magaboo, sorry I missed the part in your original email about having the path report.

Lets focus on the positive things in your path report: seminal vesicles and lymph nodes are clean (excellent).

As to the "capsular proliferation", you first need to understand the anatomy of the prostate. There's the gland itself, which is surrounded by a thin membrane called the capsule. When PC is found only in the gland, it's considered localized. When the PC is found in the capsule, it's considered regionally localized (also called invasive because it has invaded tissue around the gland). Extraprostatic extension means the cancer has extended outside the gland into the capsule; extracapsular extension means the cancer has broken through the capsule into surrounding tissue.

When cancer extends into the capsule, it is usually identified as single foci (one area) or established (several areas). I would assume that capsular proliferation means that more than one area of cancer was found in the prostate capsule.

With cancer surgery, the intent is to remove the tumor as well as any stray cells. This is called the surgical margin, and the goal is to obtain a clean surgical margin. Sometimes the surgeon has to cut a wider margin than usual because the cancer is very close to the outer edge of the gland - this was the case with my husband.

The pathologist examines all tissue removed. If cancer cells are found in the "extra" tissue removed by the surgeon in an attempt to achieve a clean margin, you have not achieved a clean surgical margin. I believe this is what your path report is telling you.

If cancer cells are left behind, they will generate PSA hence the importance of regular monitoring of PSA levels post surgery. Generally, PSA is checked every 3 months for the first year, then every 6 months up to year 5. If you still have an undetectable PSA in year 5, the PSA is then checked every year.

My husband's surgeon wants to check his PSA every 3 months for the first 2 years because of his T3a status even though the surgical margins and seminal vesicles were clean.

If you can, chat with your surgeon to get a very clear understanding of the capsular proliferation and margin status. T3a is not an uncommon stage for prostatectomy patients.

Hi, Mugaboo.  I logged onto the forum this morning to report almost the exact same experience and to ask the very same question you have.  I had DaVinci surgery in June 07.  In Sept 07, my PSA was undetectable at <.01.  In March 08, it was .02, and dr said nothing to worry about.  Last Friday, the latest report came in at .07.  Dr again says he is not overly concerned and that people with my profile have only a 6-8% chance of recurrence.  My post-surgery path was clear margins and Gleason was 3+3=6, a non-aggressive form of cancer confined to the prostate, and final stage of T1c.  He told me that other tissue can create PSA -- including the pelvic bed where prostate was, the penis itself, even the pancreas, and that any inflammatory process involving those sites can result in a minimal spike.  He told me to wait another 6 months to check again.  I requested three months, so I will try again in mid-December.  I'm trying to remain "unconcerned" and positive, but it is a bit difficult to put this out of my mind completely. 

I appreciate the information you all have provided.  My dr didn't say anything about .4 being a threshhold, but did say that unless and until the level rises to .1, he will remain unconcerned.  ('Course that's not too far from .07!)  At that point, he will consider radiation.  I guess we're on a similar journey, Mug!  Let's keep each other positive.

I'm off on a two-2week vacation out of the country. I'm going to take the dr's advice and put this out of my head -- at least for that long!  

Hi Mag,

I hope you don't mind my thought but, why would a Doc want to do more than just radiation at this stage? With all that I've read both in the journals and of your bio, a recurrence is local probably local and early radiation may be all that is required. Your PSA isn't screaming systemic. A scan of the porstate bed perhaps???? A prostascint? I'm not sure what tests might tell a clearer story.

Good luck to you :>)

Swim

I am amazed when an oncologist does NOT provide all the options. Even though HT is a systemic treatment, it also helps shrink tumors so that they can be better radiated. And there are studies that show using HT when doing radiation has a better result than radiation alone. It is a tough call, though, to put yourself through what HT does. I have lived on it 18 months and will get another blast from the harpoon Wednesday. Even though my "odds" are only improved by 11% preventing biochemical relapse according to the Harvard and Stanford studies (as much as 35% in the RTOG 94-13 study) I still am hopeful that we have knocked it down enough to stay away a long time.

I think age is also a factor as to whether to decide to start HT or not. Whatever you decide, you know we will be here to support you.

Tony

Good luck, Magaboo.  I'll be thinking about you this week, wishing you the best.