HealingWell
Search Close Search
☰

First Post OP PSA

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 12/29/2011 3:48 AM (GMT 0)
Well I had my first Post OP PSA on 12/20/11, got the results this week (delayed due to holiday) it came back .05, Dr. said .02 or less would have been better. Suggest I go meet with Radiation Dr. just to discuss things. Pathology showed .5 mm from the margin and that is why Dr. is concerned, report listed a clear margin. Will test again in a month to see what the PSA is doing.

I know I should be happy as the PSA was .05, but still worried now about the .5 mm from margin, Dr said much better is a least 1 mm from the margin.

Gleason 6 before and after  

Posted 12/29/2011 5:57 AM (GMT 0)
Hi VA- I had almost the same PSA (.06) 3 months after my RP and in the next 3 mo check it went up to .16 and I have been very concerned. My Gleason before and after was also a 6. Read my story, it might give you some ideas, here is a link to that thread-

https://www.healingwell.com/community/default.aspx?f=35&m=2256051

Read the whole thing and maybe you are dealing with the same issue I hope I am having, the worst part is not knowing what is really happening.

Hang in there, lots of friends here to help you out !!!
Posted 12/29/2011 3:36 PM (GMT 0)
Trimix

I read your story and certainly understand your concern. I would get a scond opinion if it gets much higher.

I wonder if your first test that someone goofed and left off the .1 so maybe you had a .16 and not a .06 ?
Posted 12/29/2011 4:27 PM (GMT 0)
Hi Va- I have gone off the Avodart now, my PSA will go back up and hopefully will stabilize around .2 and then stop which would then establish my new baseline.

I did question the original PSA results so I had it done 2 more times just to make sure, the results over a few weeks and changing labs also came back at .17 & the last one .19. Then 3 weeks later on Avodart it dropped back down to .154 confirming the benign prostate tissue.

I will wait 3 months then have it checked again and then in 3 more months which will then confirm the story one way or the other.
Posted 12/29/2011 5:24 PM (GMT 0)
I certainly would get a second opinion on this because my reading over the past two years suggests that it really doesn't matter how close the Pca gets to the margin as long as it's margin negative.  Walsh's book goes into detail about this and discusses Epstein's opinion on this very issue. "Epstein studied men whose tumors were particularly close--less than 0.2 mm-to the surgical margin.  Even though there wasn't a comfortable cushion of tissue between the tumor and the edge of the prostate, 'those patients do just as well as if there's more seperation between the tumor and the margin.'"  (p. 367).

It may be worth asking the pathologist to re-read the slide with specific question about the measurement at issue.  I did this when I was found to have focal EPE and I wanted to know what focal meant according to the pathologist.  I wanted to know how many extraprostatic cells were seen on each frame.  The patholoigist was more than happy to email me with his opinions and seemed to enjoy talking at a higher level with me.  I learned from the pathologist's re-read that although I did have EPE, there was significant cautery artifact which means the edge of the prostate was burned during its removal.  If that occured in your case, the .5 mm measurement may be truly meaningless. 

Posted 12/29/2011 5:36 PM (GMT 0)
I say hurray. In my opinion you are in the zero club. Have a great new year
Posted 12/29/2011 5:46 PM (GMT 0)
Thank You Living 1963, you have an amazing story !, wow, how wonderful !
Posted 12/29/2011 5:55 PM (GMT 0)
Its not as good as it once was. I have not updated my signature in 3 years do to the new size limitations imposed. I am now 48. I am still doing pretty good. My current p.s.a. is 10.55. The cancer may be hormone refractory but time will tell. I worry somewhat but so many new treatments comin,g out I don't let it eat at me. Thank you. Todd
Posted 12/30/2011 4:14 AM (GMT 0)
This is what I don't understand about prostate ca. According to all the current thinking of gleason 6 prostate ca, both va copper and trimix should have been good candidates for AS, active surveillance, since they had gleason 6 with small amounts of cancer, and yet they both took questionable, aggressive, SE causing action and still their psa is rising, or is about to rise. How can this be? We have been shown stat after stat that with small amount of gleason 6 we can just rebiopsy once in a while and be safe with no SE and wait until the needle biopsies show a change. The window of cure is not lost. What would have happened to these 2 guys if they had done that? Maybe AS isn't all it's cracked up to be...just a thought..
Posted 12/30/2011 12:52 PM (GMT 0)
mspt98,

Neither one of these guys have been proven to have recurrence yet. Though some G6 people do move on to have recurrence it is very rare. The last study I read that had 3 different institutions involved in it with around 9,600 patients that were G6 organ confined, 3 died of PCa after 15 years. Another study I saw showed that "ALL" patients with G6 that had BCR and the were hit with salvage radiation all succesfully went back to being undectable. If your slides are read correctly and your surgeon gets all the prostate tissue out of you, then your chance of "remission" is according to Epstein at Johns Hopkins 99.6%. In their program with patient follow up from 1 to 25 years no body with G6 developed metastatic cancer and only 11 suffered BCR out of 2526. Originally J.H. thought that 38 had suffered BCR, but when they went back  and took another look at their slides they found that 27 of them were still G6 and a positive margin or their gleason score was actually higher then G6.

I track in a spreadsheet all the G6 cases on this forum and what is going on with them. From the data I have gathered there have been only 2 organ confined G6 people that have had BCR and of all the G6 people that had BCR none of the salvage radiation has failed so far. Unless, I have missed something, and it is possible, it appears to me that G6 does need treatment and can sucessfully be put into "remission". For how long, I don't know.....But, Epstein used the word "cured" in his article.....

Post Edited (ChrisR) : 12/30/2011 3:03:52 PM (GMT-7)

Posted 12/30/2011 2:37 PM (GMT 0)
Hi ChrisR- That is interesting information and I hope it is really true and accurate for my sake and others with a G6. You are correct in my case, it has not been determined if I truly have recurrence yet, it will be about 6 months before that can really be documented.

Thanks for keeping the stats, could be some very viable information for people on this board.

Cheers !!!
Posted 12/30/2011 2:47 PM (GMT 0)
ChrisR, I'd like you to put me in that spreadsheet. I have my 6 week post surgery check up at Hopkins on 1-3-12. If I'm not mistaken, you were the same age as me, 42, when you had your surgery. Any way to contact you? I'd be interested in being in the loop of the things you come across as I think our situations are nearly identical.

I won't lie that chasing psa's for the rest of my life seems emotionally daunting as I prepare to embark on that road just out of the gate after surgery.
Posted 12/30/2011 2:49 PM (GMT 0)
VACopper
- please celebrate this year and next for being in the zero club ( PSA <0.10 - there is no such thing as an absolute zero)
- testing in a month may be stressful - sometimes the second post-op reading is more spread out -
-until then - put the worries away and celebrate ( green tea, soy beverage, pomegranate juice, water, etc.)
holiday hugs,
Bronson

p.s. in my signature, the change from 0.05 to 0.02 was that the clinic changed machines and that was the lowest number it could now show.
p.p.s. you have a clear margin and worried - and I have a positive margin and feel good about my numbers two years after surgery - don't rush into anything - you are in control of your body - (steps off soapbox)
Posted 12/30/2011 3:05 PM (GMT 0)
dude1969,

[email protected]

Contact me anytime...

Trimix,

I think that 9,600 men is enough of a sample for me.  What I would wonder about those 3 people is that if you went back and had their pathologies redone would they be upgraded also.  Wishfull thinking I know, but the study at J.H. shows that this is a real possibilty.


chris

Post Edited (ChrisR) : 12/30/2011 9:16:20 AM (GMT-7)

Posted 12/30/2011 9:46 PM (GMT 0)
Thanks For all of the encouragement guys, I requested that the Dr. contact the pathologist and have them pull the slides and take another look at them to be sure of the clear margins and the Gleason score ! 
Posted 12/31/2011 5:44 AM (GMT 0)
Interesting info Chris R,

     I hope you are right with your history of how gleason 6 prostate cancers don't progress. I am on the fence about T replacement therapy for me, given that my T level is only 193 (normal level is from 340-800) and I have had over 3 years of 0 psas since surgery. I would like to feel better, be more interested in sex and keep my bones from rotting away, but still have a lingering fear of taking T due to possibility of reoccurrence of cancer. Your information makes me feel like I should go for it...............

Posted 12/31/2011 8:50 AM (GMT 0)
My uro and RT doc would classify 0,05 as zero club
So congratulations and don't worry too much about small numbers.
Alf
Posted 1/12/2012 2:18 AM (GMT 0)
Went yesterday to the Radiation Doctor to talk at reccomendation of my surgeon. Interesting fact I found out is that when my pathology was done there was no right seminal vessel or vas deferns sent to the pathologist. My Radiation doctor said that sometimes when removing the prostate that the seminal vessel is delicate and can tear off from the prostate, he thinks the right one may have torn off and is still inside. If it came out it has to be sent to the pathologist. SO if that is the case some prostate tissue is probably left in me. Interesting.

With a gleason 6 and 10 percent of the prostate was cancer and 90% was ok and clear margins (one tumor was .5 mm which is the thickness of your fingernail) from the margin at the apex which kind of puts me at a high risk for the pathology. Rad Dr thinks best to wait and see what PSA does.  

First one was 0.05 on 12/20/11 and yesterday they tested me again and it went down YEAH! was 0.03 yesterday ! so that makes me feel better.  

Nerve racking stuff.

 

Posted 1/12/2012 2:48 AM (GMT 0)
I just noticed that you tested 2 months after your surgery. Johns Hopkins told me that they won't test before 3 months that it can take up to that long for PSA to wash out. This was from my surgeon Dr. Partin. Why did you test so early.

Glad to see it working out though.
Posted 1/12/2012 2:54 AM (GMT 0)
Not sure, but I've seen others tested at 2 months post op. I had it done at UVA.
✚ New Topic ✚ Reply