psa post prostatectomy not zero

Time to return to responding to the original post.

Melg,
I dont think you have to worry about that. Mortality for G6 is very low up to 20 years out.

I would worry more about a heart attack then anything. My PCA was a wake up call to me and I cleaned up a few other minor health issues I found after my diagnosis. I am healthier now then I was in my 30s.

Melg
I was also 0.1 after surgery, but my pathology was Gleason 7 and I had SVI too, so the uro was kind of expecting that my PSA was not going to be perfect. However he still said that there was no need to do anything if it stayed around that figure.
He did not define a threshold for declaring a BCR, what was more relevant was that he said my PSA needed to go above 0.2 before I'd have to consider further treatment. ie so while a rising PSA along the lines of 0.10 > 0.12 > 0.14 would be a BCR just as much as getting a first reading of 0.2, he would still wait for the 0.2 line to be crossed.

So he/we had no doubt where we stood when my next PSA was up to 0.4. (He went straight to the receptionist and asked her to make me an appointment to see the RT doc the next week, and I was starting SRT within a month. And note that the SRTv got my PSA down to "Less than 0.1", where it has been for nearly 2 years)

So I say no need to do anything at this stage. Wait till next test result, but then if you have another rise I think it is likely that he will be recommended for SRT.

Meaenwhile. Use the most of the time available to get on top of bladder control and ED as it is reckoned that once you have RT you cannot make things any better than they were before the RT started.

Alf

Hi Melg,

With such a small % of prostate cancer in his biopsy and your husbands young age I would not be surprised that significant amounts of benign tissue was left behind. I remember my husbands very experienced surgeon looking at my husband and me, I was 39 and my husband 52, and him explaining that with the very low amount of Gleason 6 in the biopsy he was going to do a very very careful nerve sparing operation as we had a long life of sexual activity in front of us. He explained how he was going to cut on the inside of the capsule where the nerves were, the impact of this would be leaving some tissue behind.

The result of this was that the first results were 0.02 and then 0.03 on a test that went to <0.01 consistantly for another HW member. Your husband is a lot younger than mine and the biopsy was even more innocuous. It wouldn't be surprising for your husbands surgeon to be even more careful in nerve sparing and leaving "safe" benign tissue behind as the perceived risks in your husband's case were even lower. The fact that your husbands surgical margins were negative supports this as with a Gleason 6 it is unusual for a cancer to jump a clear margin.

Regards,
An

While some of these posts have helpful information, i suggest the OP be wary of some recommendations here. Seems like some posters are giving advice outside their area of expertise.

Starr,

The generally accepted reason for dectable levels of PSA in a male humans blood stream are one of two reasons.  Either benign prostate tissue or cancerous prostate tissue.  Yes, supposedly some other organs produce PSA but they are not usually suspected in this situation.  So, since Melg's husband has had his prostate removed and still has a detecable PSA, and he was not expected to, then obviously an explanation is in order.  With organ confined Gleason 6 it is a real possibility that the PSA is from benign tissue and not cancer.  We have seen that happen here before and I have seen it on other forums.  If his Gleason score was higher I would lean more towards the possibility of the PSA coming from cancerous tissue.  But he seems to have a stable PSA and based on his post op pathology benign tissue left behind is the typical explanation for this, even from doctors.  Again, I am not saying what it is either way, even the doctors don't know.  Everyone is just sharing their experiences based on what we have all observed in the past.  That's what doctors do to. 

I am not sure what "expertise" that you supposedly have which would lead you to make the statement you did.  If you know something nobody else here does please share it with us.  And without being specific as to which posts Melg should be "wary" of you are calling the entire thread into question for her.  Your post is doing nothing more then trying to create needles fear and doubt with Melg and her husband without offering anything to back it up.

I am a relatively similar case, diagnosed at 42. The first three or so years my PSA was belo 0.2, the lab could not measure with greater accuracy than that. Then I changed the lab, and got a 0.14, and after that it has been about 0.06. Next test in may hopefully it stays the same.

My doctor has basically told me that sometimes there is relatively benign tissue left in the prostate bed, which is causing the positive PSA. As long as there is not an increasing trend, all is well. I hope you have this situation too, the follow up will show what kind of case it is. If I recall, there was a case called Sephie on this forum, whose PSA increases suddenly stopped at close to 1, but I expect that that is quite rare. In case the PSA of your husband starts to increase, then the doctor will probably recommend radiation treatment.

All the best to you.

Melg:
I have reviewed this thread and I see nowhere that you mention that your man has reviewed the full pathology report. There has been mention above of possible remnants of the gland remaining and this should have been identified in the report, if it occurred. If not mentioned, then the slides can be reviewed by the original pathologist, or/and another pathologist. I think more about this since you said that the surgeon used manual laparoscopic technique and I know from reports from surgeons that this is much more difficult to master than robotic, not that robotic is easy. A second opinion on the post surgery path slides may be in order before further treatment.

Hi Melg- Your husbands path is almost identical to mine, the DR might have purposely left benign tissue behind causing these results. Here is what mine looked like-

PSA: 8/1/11-.06, 10/26/11-.16, 10/31/11-.17, 10/31/11-.19
11/24/11- Started for 22 days
PSA: 12/16/11- .154 Stopped Avodart

My next test in June will validate if I have a true raising PSA due to cancer. The Avodart test proved that some or all of my PSA raise was caused by benign tissue left behind. This could still be the case for your husband. Talk to your DR about trying the Avodart test, it might give you more insight on what might truly be happening.

My Dr and I decided that we would pull the trigger for SRT if my PSA ever reached .4 since it seems my true baseline is around .2

Good luck, keep the faith

Curt

Hi James- My Uro/Surgeon was so convinced based on my situation that he would be very, very surprised if any cancer was present at this point in time.

He said, "Curt, here is how I can convince you that I might be right". That is when he explained the benign tissue, why he left so much behind and how Avodart works.

Everything he said made total sense to me. The Avodart test did prove his point but not completely. The true test is over time, do I level off at a new base PSA reading for myself. That base will be established by the long term production of PSA only by my benign tissue.

My Dr believes that my PSA will level off over time at a point at or below .2. Once we have actually established that point then that number will become my new base PSA reading. If then in the future, my PSA starts to rise then we would pull the trigger on SRT at .4.

My PSA high point was .19 after Avodart it went down to .154 then 3 months later it was up a little to .157 which was expected. He told me that it takes a good 3 months + for the effects of Avodart to clear the body.

If my PSA stays below .19 on my next test in June then I will feel pretty good about it and then I would expect to see a documented level period on the next test in Sept.

I hope this helps with understanding. To really figure this out on a personal level, you need to understand how it all works and how to document the trial.

Part of my documentation is the fact that my Uro was also my Surgeon and his eyes saw what I looked like inside during surgery, that, along with my Path report further gives me hope that this theory is true for me.

I really hope others like you can gain from the information I am trying to put on this site.

We need open minds and open hearts and support from one another.

Cheers,

Curt

Thanks trimix, we'll keep in touch to compare future paths. got this one bookmarked.

Please help - am looking for anyone with any information about anyone in a similar situation. As noted above, my husband had SRT in June 2012. PSA result in October 2012 was < .1 (the machine calculates but they do not report anything less than .1). Result in May 2013 was < .1. Today's result is .11. I am so confused and upset. I have never heard of results anything like this in everything I've read. Especially with gleason 6. What happens next? I assume nothing and that it's monitored. Or maybe new scans.