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Posted 11/17/2013 1:09 PM (GMT 0)
I recently had rp and two weeks after surgery psa = 14.5 psa after 4 weeks psa = 15.6 prior to surgery I had ct scan and mri and both negative for metastatic cancer, after surgery dr. said margins were clear, one lymph node had 1mm spot of metastatic adenocarcinoma. as soon as catheter was removed everything worked fine, now five weeks after surgery, reduced flow and pain. wonder if dr. botched the operation? that is the only way I can think of that the PSA was so high.
Posted 11/17/2013 1:17 PM (GMT 0)
I'm not one to speak of surgery results, but shortly the experts here will certainly chime in. It sounds like you have some legitimate concern, but with this twilight zone disease the true cause may take some effort to find.

Sorry you have to be here, but very glad you found us. While obviously not "medical advice", this forum is a great resource.

It will help the group to help you if you could provide some more information. Look at people's signatures, and you'll see things like age, biopsy results in # of positive cores, Gleason score, staging, the history that led you to your decision on treatment.

All the best to you scrappydo. You're in the battle, for sure.

Fight on!
Posted 11/17/2013 3:09 PM (GMT 0)
Welcome. A lot of times they wait for 9 weeks or 12 weeks after surgery to do PSA.
Lymph node involvement is a minus. There may come a time when you need radiation treatment to augment the surgery.
about the flow and pain, the urologist might be able to answer about that.
There are a lot of supplementary treatments available if the PSA stays high. Good luck to you.
Posted 11/17/2013 7:10 PM (GMT 0)
Scrappydo,

My urologist said first PSA test will be at 6 weeks which gives everything enough time to settle down.

Nick
Posted 11/18/2013 1:54 AM (GMT 0)

scrappydo said...
I recently had rp and two weeks after surgery psa = 14.5 psa after 4 weeks psa = 15.6 prior to surgery I had ct scan and mri and both negative for metastatic cancer, after surgery dr. said margins were clear, one lymph node had 1mm spot of metastatic adenocarcinoma. as soon as catheter was removed everything worked fine, now five weeks after surgery, reduced flow and pain. wonder if dr. botched the operation? that is the only way I can think of that the PSA was so high.

Welcome scrappy. Sorry to hear this.

It would help to know your pre-op PSA and other stats (Gleason score, number of positive cores, clinical stage) but positive nodes do correlate with higher PSA. Unfortunately CT, MRI and bone scan are not very sensitive. F18 or C11 PET scans are more sensitive:

jnm.snmjournals.org/content/52/1/81.full.pdf
www.youtube.com/watch?v=co4FIkDHsJc

At this point you should look for a good medical oncologist who specializes in PC who can discuss next steps -- both diagnostic (including, potentially, such scans) and therapeutic.

The reduced flow and pain are concerning (could indicate stricture) so you should talk to your urologist about those.
Posted 11/18/2013 2:33 AM (GMT 0)
scrappydo - sorry you are going through this confusion - my surgeon had me wait 6 weeks after surgery for testing to let the stuff filter its way out .
-keep in mind you are healing still and things will settle down - take care.
Bronson
Posted 11/18/2013 2:42 AM (GMT 0)
My instructions given to me after the surgery had 6 weeks crossed out and replaced with 8 weeks to get the first post op PSA test, which seems to confirm the guidance above that it takes more than a couple of weeks for things to "settle down".
Mikey
Posted 11/18/2013 3:08 AM (GMT 0)
Scrappy
I'm surprised you had PSA test so soon also. Mine was at two months due to my poor pathology ( gl9, SVI, EPE, pos margin) stage pt3b n0m0 . Maybe yours was poor also? My PSA was .1 though which I'm happy about. Next test in three months.
If I were you if get retested. If you chose your surgeon based on his experience, the RP should have been successful. What did he tell you about your pathology and surgery results?
Good luck.
Bob
Posted 11/18/2013 4:10 AM (GMT 0)
Mine 6 weeks post surgery...coz I m GS 9

Posted 11/18/2013 1:25 PM (GMT 0)
scrappy,

4 weeks post-op may be a bit early to ensure an undetectable result but, assuming a PSA elimination half life of 2-3 days, this is still between 9 and 14 half lifes or a reduction by somewhere between 600 and 16000 so it should be way less than 14 albeit perhaps still detectable with ultra sensitive test.

The fact that it actually went up between weeks 2 and 4 post op is a concern. This seems to indicate a doubling time of about 4.5 months.

Again we don't have the whole picture (e.g. pre-op PSA, Gleason score, how many nodes were dissected), but given the one known positive LN, I would urge you to seek out a good PC medical oncologist to discuss next steps.

Post Edited (njs) : 11/18/2013 4:27:40 PM (GMT-7)

Posted 11/18/2013 5:42 PM (GMT 0)
I know how your feel. After RP in 2011, I had a higher pSA than before surgery. You sometimes feel like your are the only one but you're not.--and things will get better for you. My pathology report was similar to yours. I did the HT for one year and the psa became undetectable and stayed that way for several months. I've been off Lupron for over a year now and yes ,the psa is increasing-- but we knew it would and we have plans to move ahead with various options for treatment. Probably back on Lupron at some point--- the side-effects were not tha t bad for me. Welcome to this forum but sorry you have to be here-Please keep us informed. and ask any questions. There are some smart folks around here!

JIm and Marie in Illinois

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