Dr tests PSA 4 weeks after robotic surgery

Is this a normal protocol?  Dr. J Smith out of Vanderbilt says that he will want a PSA test done 4 weeks after robotic surgery.  Anything over .1 will require a followup treatment most probably radiation.  (I thought 3 months was the standard protocol and that PSA testing earlier may not give an adequate PSA reading)

Any comments?

 

Without digging through my paperwork, I'm almost certain that my first PSA test was 3 months after the Da Vinci removal.

4 weeks post surgery? never heard of one that early. some men had psa's done 6 weeks, and many of us thought that was too soon. most that I have heard of in my travels, is at 12 weeks (or 3 months), takes a while for everything to clear out and settle down. sure wouldn't want to make a secondary treatment decision based on a psa reading only 4 weeks out. just my take.

david

My first was at seven weeks. Uro said it was a bit early (he normally does eight weeks). But it was undetectable for Christmas, so that was good.

When I had surgery at Mayo Clinic 21 months ago, they scheduled my first post-op PSA for 3-months afterward. I believe this is pretty much the standard.

It can take several months before all of the remaining PSA works its way out of the system. So, as others have suggested, I would NOT go with any treatments based on whatever the 30 day PSA is.

Not unless there are specific, unusual reasons your doctor would have.

Good luck,
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.

A radiation oncologist would possibly give a different opinion about the follow up therapy plan. You don't have to do what they tell you to either. If you want the PSA test at 3 months, and believe that to be the right timing, do it then. You have to be your own advocate. It would certainly be appropriate to ask the doc what he's basing that recommendation on.

This forum has helped me a great deal in asking good questions, and knowing if the doctor's advice seems sound or not. It's great you're seeking support here!

Of course, most everybody here is just another dude with some experience in this area, so take even this advice with a grain of salt. There aren't many clear cut answers with PCa.

My first was 4 weeks post op for the same reason you descibe, and was .03.

My first test was at seven weeks. There's nothing wrong with testing at four weeks as long as you remember the context when you evaluate the results. It's too early to consider the results a nadir but it can show which direction things are heading. Mine was 0.01 (lowest detectable value with my lab) at seven weeks. It was undetectable at three months but I was already on ADT by then so that isn't a comparable value I dunno what my result would have been at three months w/o the hormones. I like to think it would have been undetectable but I can't know.

My decision to do adjuvant radiation and ADT was based on my post-op Gleason score (9 4+5) and my positive margins, not on my PSA.

So the test is OK at four weeks -- just don't get too anxious about the value because your PSA will not have hit bottom yet.

Thanks for the responses

 

kdeinv -- My first post op PSA test was 3 months out. From what I understand, 4 weeks is too early to get a good number, but perhaps your Doc just wants to make sure your PSA is headed in the right direction.

-- Tigerfan

4 weeks is earlier than most do as I understand it, but it is still something like 9 to 14 PSA half lives, which means the level should have decayed by a factor of somewhere between about 500 to 16000 from pre-op.

My local uro with whom I have been following up since my surgery, wanted to do it at 4 weeks but by the time I got in it was 6. It came back as .01, which both he and Dr. Burnett at Hopkins say is excellent, but frankly I think someone in the lab may have forgot to transcribe a less-than sign as it should have been down by at least 14 PSA half lives and, while it is possible that there is still PSA coming from Cowpers glands or a bit of benign prostate tissue that is still in there, it just seems unlikely that it would be exactly .01.

My local uro wants to do another in Oct (about 20 weeks) but I believe that is just his standard policy not because mine was not undetectable.

While anything over 0.1 (by contrast to 0.01) at 4 weeks would be a real concern (but very unlikely unless you have positive margins), I still don't think you would rush into radiation without further testing over time. Sometimes tumor cells at positive margins die off in the aftermath of surgery.