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PSA 0.34 5 Weeks After Robotic Surgery

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Posted 5/24/2013 4:13 PM (GMT 0)
Greetings - am brand new to this site.

Anywho

I don't have all my info will soon list it all.

Before surgery

psa 12
Gleason 4+3 and 4+5

After surgery
PSA 0.34 after 5 weeks
Gleason determined to be 4+3

They scheduled my next PSA test for 6 weeks, but obviously i am
concerned.

I understand anything over 0.2 - 0.4 is considered to be a reoccurance of the cancer. And so soon after my surgery, seems
to indicate if my not be local - This is what i have learned reading various articles on the internet.

thanks for any info!!
Posted 5/24/2013 5:24 PM (GMT 0)
Welcome to the forum. Sorry you need to be here but you've found a place with understanding people who can help you make sense of it all.

If you have a copy of your post op pathology report it would help us to know anything it said about margins, lymph nodes, seminal vesicles, etc..
Posted 5/24/2013 6:40 PM (GMT 0)
Doesn't sound good, but checking your PSA that soon after surgery isn't often done. My doctors want to wait till you are 3 months out, to let everything settle down. Your next reading may be the tell tale sign of recurrence. I hope not for your sake.

Good luck in the rest of your recovery

david
Posted 5/24/2013 7:17 PM (GMT 0)
Burgess, my husband had his first PSA test about 4 weeks after surgery and it came in at 0.1 (at diagnosis, PSA was 6.4 and his Gleason was 3+4). The urologist said the 0.1 was an excellent sign, and that his PSA would be undetectable when the next test was done 30 days later. A PSA of .34 seems high at 5 weeks post op but could just be that your body is not ridding itself as quickly of the PSA. Next test should tell you more.
Posted 5/24/2013 7:50 PM (GMT 0)
Doing a PSA test at 12 weeks is more typical. I'm guessing it should be lower at 5 weeks.
As you infer, cancer may be systemic.
The next PSA test will tell a lot more. Good luck with it.
Posted 5/24/2013 8:06 PM (GMT 0)
Welcome to HealingWell.

Stay on top of it. You've already read enough to know that 0.34 is not the best result. But you also know it is early. Test again at 6 weeks and 10-11 weeks to see if there is a trend difference.
There are studies that show it is best to have follow up radiation or other treatments within 18 weeks of surgery. You might want to start lining things up.

You'll feel more in control when you have a plan. In the meantime take care of the things within your control. Eat right, exercise, and do those kegels! :-)
Good luck
Jeff
Posted 5/24/2013 8:30 PM (GMT 0)
Yes, do not do any excessive worrying.

As others have noted, the reason they typically wait 12 weeks before the first post-op PSA test is that it takes a while for the PSA to filter out of the system. So, actually, your reading at just 5 weeks is probably what a typical reading would be as it continues its march toward zero.

Wait & see what the reading is after 3 months. Hopefully you will be VERY satisfied! :)

Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.
Posted 5/24/2013 8:56 PM (GMT 0)
I agree with the others,,,,too soon to get an accurate reading....wait till you reach the 3 month period then retest...that will give a better idea of what if anything you may be facing.
Posted 5/24/2013 9:55 PM (GMT 0)
Why test so soon and cause undo worry? I thought--wrongly--that 3 months was pretty standard. Is doctor it preference or is there a reason to test so early?

Best wishes to your upcoming PSA's. Hoping for a big fat zero!!

Tom
Posted 5/24/2013 10:16 PM (GMT 0)
Way too early for postop psa test. If doctor starts talking about adjuvant radiation based on that early result , get a second opinion from somewhere else that is not associated with that institution. So , in your next post or so , please get the pathology report to us , As best you can, tell us what your medical team is recommending. Also tell us where you were treated. was there a tertiary 5 mentioned by anyone. the postop downgrade of gleason is positive . Btw you are not necessarily in bad straights here,you have not passed the point of incurability based on the knowledge you have provided. I f you were a .034 on a postop psa after 3 months, I would say the surgery failed, tho I wouldn't be rushing to any flat or tilted tables yet. You are on it, you will sense if you get behind, and take action. Thats the being in control that works wonders for your physche and arguably for your total situation. Take care. ps state age
Posted 5/25/2013 2:42 AM (GMT 0)
All of you saying it is way too early for the first post-op PSA: maybe under your doctor, but my surgeon does 6 weeks post-op as standard. There is certainly room for debate, but the standards of care vary from place to place...not saying one is better, just that they vary.
Posted 7/16/2013 9:05 PM (GMT 0)
hi All thanks for your information and reaching out! I appreciate it.

- more information for PSA and pathology

Age 60
PSA 12 before surgery

has prostate removed by Robotic Prostatectomy 4/4/2013

5 weeks psa 0.34
9 weeks psa 0.52
Gleason 4+3 for a 7
PT2c (bilateral) (organ confined but extensively involved bilaterally))
No regional lymp node metastasis
No seminal Vesicle invasion

2 rising PSA tests means it has reoccured or was not all removed.

Question - from what i have rad that seems to indicate metastasis - hmmm

Meeting with my Surgeon this Friday and looking at staying local for what ever treatment is next (radiation, hormone or whatever)

peace
Posted 7/16/2013 9:25 PM (GMT 0)
Good luck, Burgess. Keep us posted.
Posted 7/16/2013 9:58 PM (GMT 0)
It in no way means the cancer has metastasized. It does not mean the cancer is systemic. It means the cancer is still there and very well could be local. if you had a positive margin, better yet . Though even a negative margin could prove local, less likely, but still. But yes I believe the surgery failed, but there is no way anyone can say at this point from the information provided, it is systemic. And people without the knowledge should not say it is, yourself included, period. Radiation is in your future and could very well rid you of the cancer. All I have written is based purely on the info you have provided. If the it does prove to be systemic, there are other weapons available to give a 60 y/o man a very full life indeed. Some times a little knowledge is dangerous on sites such as these.BTW , according to walshes book, average time, from recurrence to metastization is 8 years. There is a difference tween systemic and metastatzation. You need to study the info available, not just read it. I don't mean to sound harsh, but misinformation is a real issue on cancer sites. Im sure I contribute my share, and If I am wrong, I deserve constructive criticism and welcome it.
Posted 7/16/2013 10:13 PM (GMT 0)
Good luck, Burgess. You'll beat this beast.

Bill from Florida cool
Posted 7/17/2013 8:31 PM (GMT 0)
thanks for your feedback logo logoslidat
Yes - for sure I know i need to know a log more about the beast and am working at learning, and I do not mean to offend anyone or jump unsupported conclusions.

I did reference two articles when i was mentioning that my rising PSA at 5 weeks and 12 weeks made me wonder if it was metastasis. Obviously my Doctors/Oncologists will bring a lot more knowledge then i have. Just want to ask the correct questions about local vs distant cancer when i see my surgeon this Friday and discuss next steps.

this first one is older - 1997

the second article is from 2012

1. Management of Asymptomatic Rising PSA After Prostatectomy
2. The Natural History of Metastatic Progression in Men With Prostatic-Specific Antigen Recurrence After Radical Prostatectomy: Long-term Follow-
Posted 7/18/2013 3:25 PM (GMT 0)
Roger that Burgess, your cancer is very treatable, you will be fine long term, I believe. Keep us in the loop if schedule allows.
Posted 7/18/2013 4:08 PM (GMT 0)
Best of luck Burgess.
Posted 7/30/2013 8:54 PM (GMT 0)
Hello All:

Well both my Surgeon and Radiation Oncologist have recommended Radiation ASAP. This is just a little less than 4 months since my Radical prostatectomy.

My PSA was 0.34 at 6 weeks and 0.52 at 12 weeks.

Note i did have a focal positive on a margin.


Here is all my pathology info that I have: Appreciate any info from people with similar fast rising PSA after surgery.

Radical prostatectomy 4/4/2013:
Specimen Source:
A. Prostate
B. Right Pelvic lymph node
C. Left Pelvic Lymph Node
Diagnosis:
A. Radical prostatectomy specimen (46 g)
- Extensively involved bilaterally with prostatic adenocarcinoma (Gleason pattern 4+3, total score 7)
- Approximately 45% of prostate slides contain tumor
- The greatest diameter of tumor is 1.8cm in the left posterior inferior aspect of the gland
- The tumor extends into, but not beyond the prostatic pseudocapsule but is focally present at a right posterior mid pseudocapsular recestion margin
- Intraprostatic perineural infiltration with tumor and high grade PIN are identified
- The apical, base, pseudocapsular and soft resection margins and seminal are negative for tumor
B. One Lymph node negative for tumor
C. One Lymph node negative for tumor
AJCC stage: PT2NOMAX

Prostate Gland:
Histologic Type: Adenocarcinoma (conventional, not otherwise specified)
Histologic Grade Primary {Pattern Grade: 4
Secondary Pattern Grade; 3
Total Gleason score: 7
Primary Tumor(pt): PT2: Organ confined
Portion of lobe involved PT2c: Bilateral disease
Regional Lymph Nodes: pNO: No regional lymph node metastasis
Number of nodes examined. 2
Number of nodes involved: 0
Distant Metastasis(pM): pMX: Distant metastasis cannot be assessed
Seminal Vesicle invasion: Seminal Vesicle Invasion absent

thanks
Posted 7/30/2013 9:24 PM (GMT 0)
You my friend are a poster boy for SRT and that is a good thing in that you should not have any doubts about going forward. My only caveat is , again make sure you have the best practitioners of the ART for SRT. Where and when are you planning to have it done? Make sure, I mean sure, you have confidence in your medical team, cause tis just a phone call to a possibly more experienced team. Only you can determine your comfort level. Not trying to scare you, but radiation S/E's can go disastrously askew, if not done right. The more done by the practitioners the better. You are on the right path tho, in my opinion.
Posted 7/31/2013 12:24 PM (GMT 0)
..I agree with logo, don't play with a fast mover just fight as fast..
....Appleseed.....
Posted 7/31/2013 1:31 PM (GMT 0)
 

When I saw your post earlier this month I was one of those who thought 5 weeks was too early for a post RALP PSA. My URO believes in 3 months for the first test and he told me that too many times early testing causes un needed stress over a number. Even at 3 months for my first test, my PSA was .07 and now is less than .01.  However, 12 week PSA now indicates  that something is defiantly going on and SRT is justified.

I agree with Logo too, many guys have SRT with numbers like yours and then are home free with no further BCR's. Good luck.

Terry

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