1st PSA results since RP on 12/16/15

What was your gleason score on surgical path? Were there any positive margins, EPE, or lymph node involvement? Yes that is high for after RP, however, the first PSA can sometimes have a false high reading as some tiny microscopic pc cells can still be roaming about (they eventually die out most times). Do not panic. They will probably follow up at 3 months post op and it will give a clear view of what's going on. The more experienced guys will be along shortly who can tell you all the details. ~Miki~

adjuvant radiation, should put you back in business. you are still in a curable space. .25 right at the cusp of 6 weeks+ offers a teensy bit of hope. I would ask fro another psa in 2 weeks to assure definiity.
Less anxiety as you will know where you are and proceed accordingly. gleason 7? 3+4 or 4+3? Was the positive margin at the bladder neck. That could account for the .25. Im on shaky ground with my next comment. If it is in the bladder neck that could complicate the radiation tx reference damage to the bladder/urethra. negative nodes and
SV bode well for local pca, tho tainted if bladder affected. I do not understand a positive margin with specimen contained. I hope it is not medico double talk to save medico face for small time. apologize for a tad of cynicism in that regard. bottom line your chance for a cure is high in my view.

@logoslidat, EPE was not identified on Bob's surgical path but he had a positive margin. I've wondered about that myself. Could it mean the cancer was right at the edge but hadn't escaped? That's the only thing on Bob's path that has concerned me. ~Miki~

F8 said...
pardon me if i'm wrong but isn't that a little early for a PSA test?

wow - just looked at the dates (didn't register before).

Yeah, less than two months.

It's likely the PSA could still be dropping. Takes awhile after surgery before the PSA hits its lowest. Retest in a couple of months and I'll bet it will be lower.

Andrew

If I remember right, you had GS of 3+4 with a PSA of 3.49 and 60 years old.

You are less than 2 months out from surgery and even though if you figure out the PSA half life, it does not drop following that scale.

I would request a PSA at the 3 month post surgery before going crazy.

Don
_______________________________________________
Age 61 @ DX, 62 Now
DRE: enlarged w/"ridge"
Pre-Op PSA: 6.8
Biopsy: 5 of 14 positive, 12%(3+3),11%(3+3),20%(4+3),5%(3+3),4%(3+3)
da Vinci: 10/17/2014 Both Nerves Spared
Cath: 17 days
Post-Op Path:
Histologic Type: Adenocarcinoma
77gr - 4.5cm x 4.7cm X 4.2cm - 10-20% Involved by tumor
Largest module: 1.6cm Bilateral Lobes
Gleason Grade: 3+3=6 (down from a 4+3=7 in biopsy)
TNM Staging: pT2c pN0 cM0
EPE: Absent, SMI: Absent
Margins: uninvolved, Lymph Nodes all benign
Bladder Neck Negative for Carcinoma
Perineural Invasion - present, Vascular Invasion - present
PSAs: (Roche ECLIA Meth.):
01/22/15 - <0.1 (Three Month test!!!)

Is not unusual for a surgeon to want a PSA test in six weeks. My surgeon has instructed me to do that as well. So I am bracing for a positive meaning something higher than undetectable

As others have said I will retest before jumping to conclusions (if you can )

I kind of enjoyed my radiation. The techs were mostly attractive young women with whom I got to joke as I dropped my trousers, climbed on the machine, and tried to lay still while they spread cold ultrasound goo on my lower belly. The side effects ( mostly fatigue and 'rhoids ) where quite managable (with naps and cortisone suppositories) and I made friends with the patients ahead and behind on the schedule. Not a bad experience at all.

That's the good news...

The reason that most Uros don't test earlier is that no one knows what to make of it. When a surgeon hacks away at a prostate, it releases all kinds of PSA into the bloodstream, and it takes awhile to dissipate.

I recently wrote about a study where the authors tried to read something meaningful before 3 months. They were able to push it to two months and still maintain predictive accuracy. One month would be wrong a quarter of the time, and less than that was no better than a coin toss.

But a PSA of .26 six weeks post-op is certainly concerning. Because you had adverse pathology (positive margins), that puts you at high risk for clinical recurrence. If you retest within a couple of weeks, and it stays elevated, that would be deemed a biochemical recurrence. I think it's a good idea to talk to an RO immediately. If you have adjuvant radiation even w/o ADT, there's a good chance they can clean up what was left behind.

- Allen

Haven't heard about infections of other organs causing PSA to rise and I really doubt it, especially in your case. Most of the non-prostate-cancer things that make one's PSA go up do so by bothering the prostate. If you still had prostate some of the drugs you probably took for the symptoms of your pneumonia might have affected your PSA (decongestants do, for instance) but since you no longer have a prostate I don't see that happening. Sorry.

Johannes,

That PSA test at 7 weeks was a little early but it is still far enough after surgery to know that 0.25 is high. The Uro will likely order a retest but you should be prepared for similar results. Sorry.
Radiation within 18 weeks of surgery has a better chance of success that later. Please start lining up an RO soon. Your Uro will likely have suggestions when you meet next week.
Don't dawdle. You need to be on top of this.

Let us know what happens.
We'll be here for you.
Jeff