PSA Rise 20 months after surgery

I had DaVinci Surgery in May 2007. Pathology was excellent. Gleason 6, No Lymph node involvement, no sem. vess. involvement, all PCa confined to the capsule. Total PCa less than 5%. No trouble with incontinence at all, 100% erections after 3 weeks.

Pre-Surgery PSA: 4.92


First PSA test post-surgery: 0.07 Aug 2007.
Second 0.04 (Lowest score) Nov 2007.
Third 0.04 Feb 2008
Fourth 0.04 July 2008
Fifth 0.08 February 2009.

Has any one who reads this forum had similar scores that went back down after they went up? Also, how successful is salvage IMRT after a few years in similar cases? Has any one had both IMRT and Intermittent Hormonal Ablation? What was the long term outcome?

I greatly appreciate your sharing of your experience. I have found so much about PCa very confusing and contradictory. It helps to hear real experience.

Thank you.

I agree with mspt98. 

Anything less than .1 should be considered a zero.  The lab that reports on my blood test results doesn't even measure below .1.

Well, I will agree that .08 is less than the magic .1 for detection...but the purpose of the ultra sensitive tests is to detect a rise in the PSA level...even if small. Based on the steady readings for the last three tests of .04...a jump up on the last test to .08 maybe noise...but could also mean that this is the beginning of a recurrence. I would think that your doctor would order another PSA test before making any suggestions for additional treatment.

I would personally want to wait for another test for confirmation that the PSA is rising before proceeding with additional treatment. But that is my opinion.

Everyone,

Thanks for the good advice! I'm getting another PSA test this week and hopefully it's back at absolute zero. If not, I'll re-evaluate my options. I agree with the "Hit it Hard, Hit it Early" philosophy.

Prostate Cancer is a very hard to pin-down disease. I sure with it was more straight forward to treat.

One comfort is that while I see lots of recurrence, I don't see a alot of mortaility. Guys do live with the condition for a very long time (decades, in fact).

Thanks again.

UPDATE: Changed my PSA test to May 12th. Sister-in-law died and I don't want to subject my wife to any more bad news this week.

Clearly regular PSA's are required not only for the specific value, but the trend and to potentially identify "background noise" or lab tech error. In my case my one (1) year post RRP my ultra-sensitive came back AT (not less than) 0.01, which in and of itself is extremely low. My doctor said that he "sees it all the time"; in his experience that newer lab techs either leave off the < symbol out of laziness or fear that they had made a mistake, or that the lab equipment may need to be re-calibrated. He said not to worry about it, and to re-test in six months. I bargained him down to three months, and after anxiety took over I had my GP write me a lab request for my own test (same lab, same assay) which also came back AT 0.01. I quietly resigned myself that I would likely see 0.02 or 0.03 two months later and was actually at peace with it. Imagine my surprise and relief when the next test two months later came in at LESS THAN 0.01.

Point is there is slop in this test, as attested to by no doubt countless thousands. I don't know how much slop but it's there.

Your situation is very similar to mine as well.  I believe you need to find a good radiation guy and go the salvage route.  IMRT is so precise now that the chances of bad side effects are minimal.  Also, studies are showing that even if the radiation does not get you to .01 or below it does appear that it hampers the ability of the cancer to metastisize and therefore turns it into a chronic disease insead of a terminal one.  Just my opinion for what it is worth and good luck.

UPDATE: Got my PSA results: 0.08 again. Doc thinks that since my first and last 2 test results were that same level it may be that my blood chemistry may just evaluate to 0.08 more than 0.04. If it's not rising, and it stays below 0.1 it's not a problem. We'll just test away every quarter to see if it stabilizes.

Thanks everyone for your kind and wise advice. This is a very interesting community and I learn a lot every day.

I to would keep a watchful eye on it. It very well maybe nothing but hey it is cancer we are dealing with. For now glad you are a member of the world famous zero club. Hope you stay with us for years to come.

peace and grace

Dale