*UPDATE w/full pathology report* 2nd Post Op PSA is RISING!

Breathe in, breathe out.

You've had your prostate out right?

I have too, my PSA is only ever recorded as being less than 0.1 and I'm told that's great.

Not an MD, but I think there is range that is much higher where you start to be concerned, like maybe in the single digits to the left of the decimal point.

Now you are feeling the disadvantage of labs that report ultra-sensitive results. If you doctor used a lab that had an 0.1 cutoff the nurse wouldn't have had such a hard time convincing you that your results are "normal". Your two post-op PSAs would both be <0.1 (undetectable).

If your next result comes back at, say, 0.11, or any other number >=0.1 then you can start worrying.

So, my suggestions:

1) Change you screen name to "home stretch" or something else that suggests being almost done. Inchoate means "just starting out" and it might be too much temptation for the gods.

2) Dig the business cards for the radiation oncologists you talked to out of the trash can. It is too early for you to worry about recurrence, but you might want those cards someday.

3) Don't worry. That's your doctors' jobs.

4) If you have trouble with your insurance, pay for everything by spinning straw into gold. It's impossible, of course, but no more so that item "3)" above.

G6 Post Op... rest of report as clean as could be. p2n0mx

However, on my bone scan they found a small spot of questionable origin. Uro told me if the spot in my left orbital was cancer it was "game over" and "we would give you shots to keep you comfortable".

I have been taking a bunch of herbal supplements which I know can affect PSA when you have a prostate but I don't know if they can affect it when you don't?

David...thank you...I found comfort in your words. God bless you, brother.

is your next PSA test in three months? with what I know now I'd have a plan and a line in the sand in place ASAP. i.e., if my PSA were to increase another 25% in three months I'd push the button on SRT.

I'm not trying to worry you any further and I hope it doesn't come down to that but I wouldn't miss that optimum window for further treatment should it be needed. good luck to you.

ed

BillyBob@388 said...
Well Incho, I sure hate to hear that. Sorry, Bro! But, seems like I have seen a few examples where the PSAs went up slightly for a while, then stabilized or even went back down. Am I imagining that? I guess they will get my 1st one on 4/7. And like Peter said, with these new ultra-sensitive tests, can't quite compare with the older, and still used technology. If you were using that, as some still do, you would not even know there had been an increase, as both would be undetectable.

That spot on your orbit, know way to diagnose what it is?

Billy Bob...

I was assured this was nothing and to do nothing about it. However, I wasn't content with that so I was sent for some skull X-rays back in July 2012. I still haven't gotten the results from the X-rays but have seen the uro since and he never said a word to me about any issue so I just assumed it was nothing, especially given the nature of the pathology report at G6 and no spread detected, I figured it was all good. Obviously, now I'm not entirely sure of that, but I'm not in any defcon stage by any means. Will be a white knuckle ride when next test rolls around. I have NEVER had ONE PSA test I was happy to hear the result from. Here's believing the next one is the one!

well it's your call, but that's what I would do. having had both radiation and hormone therapy I find it interesting that you'd be more game for chemical castration. but I'm sure you mean if the cancer does ever metastasize, which with a G6 may never happen.

ed

I am a big believer in Walsh's thinking about early intervention. Why risk potential damage (like I suffered greatly and still am suffering), to rush into a secondary treatment such as SRT, when they can't even guarantee you that any remaining cancer is even in the prostate bed? Like you said, why damage tissue for good, if its not going to prove anything.

If you ended up with a solid proven case of BCR somewhere down the line, then you have to be willing to consider all options.

That's one of my oncologists big pet peeves, is how men are too quick to pull the trigger on SRT, just because of small rises in their PSA.

David

Incho, your approach to SRT is exactly the same as mine. I'm getting my first post-op PSA in a couple months. My Uro says 0.03 is when consideration for the next step should be taken, ok, I'll consider. I also, will not consider SRT for the same reasons you stated. To me, PSA tests provides data points only and specific to individual cases. A PSA rise in a G6 is different than one in a G9, as a G9 "should" produce less PSA than a G6, everything being equal. To me, this could be the reason for the difference between a 0.03, 0.1 and 0.2 trigger pull and also a reason for me not to be worried about PSA tests. Accept the things you cannot change, and change the things you can. I really am not concerned with being "cured", I'm concerned with having the best QOL I can have for the remainder of my life. I seem to think to you, I and Purgatory are more or less on the same page. Best of luck to all of us!
Cheers, Doug

Oh yeah, thats good!

That is my thinking, ed... Perhaps, nothing will ever happen other than the concern this can cause. I may choose to just stop all PSA testing, period, as it is counterproductive with what it does bring. I might roll with the idea that I was G6 with clean pathology and believe there are benign cells left behind somewhere.

To even PSA test again, or not is my big decision... that test will be huge in what it potentially could mean should I take it. I read a Hopkins piece from Walsh, or Cadeddu that said it made absolutely no difference if you chose therapy early or if there were symptoms. It went on to say early intervention very well could be more damaging than helpful with the side effects vs. potential success.

I'm not much of a numbers or percentage guy. I respect data but within any range are actual people and I will endeavor and choose to believe that favor is smiling on me and that I will walk healthily until old age takes me.

Purgatory said...
I am a big believer in Walsh's thinking about early intervention. Why risk potential damage (like I suffered greatly and still am suffering), to rush into a secondary treatment such as SRT, when they can't even guarantee you that any remaining cancer is even in the prostate bed? Like you said, why damage tissue for good, if its not going to prove anything.

If you ended up with a solid proven case of BCR somewhere down the line, then you have to be willing to consider all options.

That's one of my oncologists big pet peeves, is how men are too quick to pull the trigger on SRT, just because of small rises in their PSA.

David

I have not read this info from Walsh you guys refer to, got a link?

But when speaking of "early intervention very well could be more damaging than helpful with the side effects vs. potential success.", does this apply to surgery also, or only cautioning against jumping too quick to secondary treatment? Probably does for the less aggressive PCs, but what about the higher G scores? Because, there are clearly no guarantees with the surgery either, though we have seen these recent encouraging studies showing excellent long term survival with G8-10s and RP. Although, survival does not = no BCR, so some of these may be going through lots of extra treatment or dealing with advanced disease. ( still, one of those studies with excellent long term survival only had 13% receiving salvage RT).

One thing I have found since my diagnoses: this disease is dominated by tough- nearly impossible- decisions that no one can make for you. Lots of "between a Rock and a hard place". Starting with the decision to have another PSA in the 1st place, knowing the decisions that might lead to. And it looks like the decisions don't go away once you have opted for a life changing procedure.

As a newcomer to this group, I can tell you I have already benefitted a great deal from all the "testimony" you guys have given. Gems like the one given by David yesterday;

"Hold steady, and continue to recover, and resume your normal life as well as you can. Don't let these readings get into your head, that's a slippery slope, and will keep you more anxious than the numbers actually warrant."

are worth there weight in gold to me!

I am 65, 3 month post DaVinci surgery (9-12-13) psa= 0.013, 6 month= 0.041
I have a third test scheduled in a little over two weeks from today; at 7 months due to the increase.

I am very fortunate to live just two hours away from the Seattle Swedish Hospital group. I have had regular checkups at Swedish for more than 10 years. They are a "not for profit" hospital and accept Medicare and the supplemental insurance I have.

Urologist is DR Torgerson
Surgeon is DR Porter

All the information regarding these two guys tell me that they are truly among the "rock stars" in their field.

Again, "testimony" is a good thing; even knowing that there are no two of us with identical situations.