Rise in PSA (BPR, or, benign glands)

Hi All,

I am interested in feedback from any of you regarding my rise in PSA.

Here are my stats.

10/12/2011: PSA “0.12”
7/7/2011: PSA “0.10”
1/27/2011: PSA “0.07”
10/11/2010: PSA “0.05”
7/14/2010: PSA “0.04”
3/26/2010: PSA “0.03”
11/12/2009: PSA “0.01”
7/27/2009: PSA “<0.01”
4/8/2009: PSA “<0.01”
2/24/2009: Robot Assisted Radical Prostatectomy.

I have read that "technically" a BPR starts at 0.2 (some even say 0.4) but the numbers sure seem to show a consistent rise.

I am getting ready to schedule an appointment with my surgeon's office.

I emailed the PSA results to my Surgeon's office. On the initial email, they offered one (non-cancerous) possibility for the rise.

"The slow rise in PSA may be due to benign glands that are sitting near the bladder neck"

They recommended a re-test, and if the retest was still high, then they will schedule an appointment with the Ultrasound expert.

I believe that the next steps, after Ultrasound, will probably be some type of targeted radiation. That is my assumption.

I am not sure what an Ultrasound will show, at this point, after surgery. But they are one of the best facilities in the country, so i will go with their recommendations.

I am curious what any of you think (about my numbers, the Ultrasound, the benign glands, the next steps, etc.).

thanks!

in my opinion, you are in the process of having BCR established. while the official standard may mention .20, many radiation oncologists view any 3 consecutive rises in your PSA above .10 as evidence, and would more than likely suggest early radiation treatment.

good luck

david in sc

Post Edited (Purgatory) : 11/22/2011 4:24:05 PM (GMT-7)

I was totally continent at the SRT start and luckily, I'm still as dry as ever. I had however some anal issues with some minor bleeding in the later stages of the RT, but that mostly cleared up within about 6-8 weeks after completion. I took public transportation to and from the hospital.......about 45-50 minutes each way, so, fatigue was not really a problem for me.

ED is also not a problem with the help of some little blue pill. I'm 75 now, so, it's probaly related to age rather than the RT.

You should remember, however, that every man reacts a little different to RT. You may do better or worse.............there just is no way of knowing in advance.

Wishing for a positive outcome in your journey.

Mag

I had no ED or incontinent issues prior to SRT, and have had none in those areas in the now 2 years since it was completed.

Bump, just curious if any other people have any thoughts or comments? thanks.

FiftiesMale, welcome to my little world of sweating whether I have had a BCR or not. Like you, It has taken us upwards to 2 years or so to get a doubling (or close to it). Mine has been all over the place, but with a steady rise, really slow but steady. My SRT guy says he does not start treatments until I hit the second above .2 reading. Mine now seems to have settled into floating within a range of .09 and .14. He says this is a good sign, and has also explained the theory of benign tissue remaining after my open surgery. He tells me that even if I have cancer returning, that it appears, at this time, to be relatively non-aggressive and there is a possibility that, either benign or otherwise, if they are still in the prostate bed or nearby they may not spread anytime soon. He counsels a wait and see approach, stating that the dangers of some form of radiation damages probably would be worse than waiting to see now. So we wait....it's nerve racking, for sure, but I am willing to suffer now than to possibly suffer later from an early or over aggressive SRT plan later. As we know, we only get one shot at any one treatment method and I want to make sure that I have a target before going off half-cocked, so to speak.... So I get PSA testing every 3 months and monitor it closely. My approach differs from some others who have offered their experience here, but one of the first things we learn here is just how individual we each are in our disease and our reactions to treatments we may take, don't we? Good luck with your plan, whatever form it may take.

Hi Guys

I'm just curious; can I ask FiftiesMale and Magaboo whether they had positive surgical margins in their post-op Path reports?

I have read that if you had no positive margins and then experienced a subsequent rise in PSA, the cancer is unlikly to be localised and thus hard to know where to target the radiation.

Any views on this from others?

you had six successive rises in PSA?  i'd say hit the cancer while you have a good chance for a cure.  good luck to you!

ed

 

Margin status = Negative. (full information below).

Directly from Pathology Report:

(report is two pages long, including measurements of all portions and descriptions of all parts).
Comments at end of report:
Type of tumor: small acinar adenocarcinoma.
location of tumor: Left posterior mid gland, slices B9, B10, and B11; right anterior mid gland, slide B5.
Estimated volume of tumor: 1.4 cc.
Gleason score: 4+3=7
Estimated volume of tumor > Gleason patter 3: 70%.
Involvement of capsule: Tumor invades capsule (left posterior quadrant, slide B10).
Extraprostatic extenstion: None.
Margin status for Tumor: Negative but is <0.1 cm from left posterior margin (slide B10)
Margin status for benigh glands: Benign glands present at linked extension margins; right posterior apex, slide B1.
Involvement of seminal vesicle: None.
Perineural infiltration: Present.
Prostatic intrapithelial neoplasia (PIN): Present extensively.
Lymph node status: None present.
AJCC/UICC stage: pT2cNXMX

Hi FiftiesMale

All my margins were negative and my psa's have been good so far!
At this point I am 3 years out on my SRT.
I did not have any side effects.

Good luck and keep an eye on things!

David

FiftiesMale - I know I tend to differ from most of the crowd here in terms when to start SRT. My PSA is at 0.38 and I have not yet started SRT. You can see my signature below. As you noted, BCR is usually defined as 0.2 or above (sometimes 0.4). I have just started taking Avodart with the "thumbs up" from my Uro, Med/Onc and Rad/Onc, to determine if some or all of this reading may be due to benign tissue growth. I admit, I am walking a fine line here as far as missing the opportunity for a cure. I am willing to take that risk. Others may not be.

Best of luck in whatever you decide to do.

TB

I found this, but it does not really clear things up for me.

Benign prostatic glands at surgical margins of radical prostatectomy specimens: frequency and associated risk factors.

R Shah; N Bassily; J Wei; N R Mucci; J E Montie; M G Sanda; M A Rubin (Profiled Authors: James E Montie; John Thomas Wei)

Department of Pathology, University of Michigan Medical Center, Ann Arbor, Michigan, USA.
Urology 2000;56(5):721-5. PubMed
Abstract

OBJECTIVES: Elevation of serum prostate-specific antigen (PSA) after radical prostatectomy for prostate cancer is considered a surrogate marker of therapeutic failure. The most likely explanation for early PSA failure is considered to be due to local recurrent disease, provided the patient had a nondetectable PSA level after radical prostatectomy. Others have recently suggested that benign prostatic glands located on the surgical margins may often lead to detectable PSA levels. We examined the frequency of benign prostatic glands at the surgical margins of radical prostatectomy specimens and the factors associated with this finding. METHODS: One hundred nineteen consecutive radical prostatectomies were performed by two experienced oncologic surgeons. Whole-mount sectioning of the prostatectomy specimens was performed at 3-mm intervals. Bivariate and multivariate analyses were used to determine which clinical and pathologic factors were associated with benign glands on inked surgical margins. RESULTS: Of the 119 cases, 13 (11%) had benign glands on the inked surgical margins. Four of these 13 had tumor on the inked margins. The remaining 9 cases (8%) were organ confined (pT2), with negative surgical margins. Benign glands were most often seen to involve the apex focally (7 of 9 cases). On bivariate and multivariate analyses, a high Gleason score and prostate gland volume were significantly associated with finding benign glands on the surgical margins. Only 2 of 86 patients with follow-up had PSA recurrence at 59 and 67 days and neither had benign glands on the inked surgical margins. CONCLUSIONS: The presence of benign prostatic glands identified on inked surgical margins was an infrequent occurrence in this consecutive series of 119 whole-mount prostatectomy specimens. When benign glands were identified, they most often consisted of 1 to 3 glands at the apex margin. These findings suggest that benign glands on surgical margins are an unusual cause of postoperative detectable PSA.

FiftiesMale said...
and i found this:


"Benign glands on biopsy after radical prostatectomy imply that the prostate was not removed in its entirety. It remains unknown whether and how frequently the presence of only benign prostate glands left after radical prostatectomy can give rise to an elevated postoperative serum PSA level and the false impression of recurrent prostate cancer."

http://www.nature.com/modpathol/journal/v13/n5/full/3880091a.html

I was going to suggest that as an explanation. When tumour extends outside of the prostate and the surgeon cuts across it while removing the gland the result will be a positive (for tumour) surgical margin. Logically if there were benign glands present at the margin then the surgeon must have cut across the gland at its edge, leaving a healthy and normal portion of the edge of the gland behind. You would assume that it would have to be a very small portion though so the increase from <0.01 to 1.2 is a little disconcerting. You would expect to get a PSA reading of 0.066 ng for each cubic centimetre of benign glands left behind and I would have thought it would remain somewhat static. But that is just my amateur analysis which of course could be entirely incorrect. (and has been known to happen )
Bill