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Posted 3/18/2015 3:13 AM (GMT 0)

PeterDisAbelard. said...
Zeddy,

I've been through radiation. Mine was adjuvant, not salvage, but the experience is pretty much the same. It wasn't a big deal for me. It isn't one for most guys. Not something it makes any sense to go around dreading. Some of the studies we've been talking about here suggest that radiation works better if you do it early. A PSA of 0.03 is early. Really, really early. A PSA of half that is just nuts to worry about. Could it be that this time next year you'll need to start thinking about radiation? Maybe. If your PSA keeps creeping up. But, like I said, the radiation is not that big a deal and may not be needed anyway.

Your dad's doctors took their eyes off the ball. It sounds like you are not going to let that happen to you. You should certainly keep on top of things, but at the same time, the main risk that PCa poses to you right now is that it will make you worry yourself to death.


Hello Peter,

I feel rather ashamed that am talking about my worries again. You gave me good advice previously, and I tried to forget about the PSA and get on with my life, but it seems that PSA anxiety is stronger than me.

Thank you for explaining about radiation. My problem is that I don't trust these guys in our health system. To be honest, I had no fear about having the operation, but I am terrified of radiation, and it's consequences.

Yes, I agree with your comment. I'll try again. I'll run a few more miles a week to see if that takes my mind off the subject.
Posted 3/18/2015 3:19 AM (GMT 0)

Rigby said...
Zeddy,
I just got back from my checkup with Dr Myers. I was concerned about my psa creeping up too. My numbers are small but way higher than yours. Doubling time is all that matters at this point. You should plot yours using a semi-log chart with the vertical axis being logarithmic and base 2. This way every line is double the one below. I did this with your numbers and it looks like yours will double (to 0.025) in a few years. Detectible might be in 10 years or so. Myers would tell you to relax and just have PSA testing done to make sure it stays slow. You won't die of this.


Hi Rigby,

It is so kind of you to take your time and work out my doubling time. I read that in super sensitive levels, doubling time is inaccurate. Is that true?

Could you please give me the link to your chart? The one I have will not accept any number below 0.1.
Dying is not my main concern, but becoming disabled as the result of radiation is ...

Thanks
Posted 3/18/2015 5:18 AM (GMT 0)
Zeddy,

I probably should not have mentioned seeding to you, but having let that cat out of the bag, I may as well give it some milk and some kibbles.

No, you would not see anything about seeding on a pathology report. Seeding or inoculation occurs when microscopic bits of cancer are transferred from the surgical scalpel to surrounding tissue or the serum. No one really knows to what extent it occurs, but it seems to be small, and most importantly, it seems like the immune system often gobbles up such stray cells. If you want to understand this phenomenon, read:

Can invasive procedures spread prostate cancer?

I should also rush to add that it is highly likely that some healthy tissue may be putting out those kinds of tiny amounts of PSA that seem to be worrying you.

If you read that, I hope you will also read the following, which I hope will have a more calming effect on you:

Low detectable PSA after prostatectomy – watch or treat?

- Allen
Posted 3/18/2015 4:15 PM (GMT 0)
Honestly, you have nothing because you essentially had nothing.  Your small PSA must have a non-malignant reason likely benign tissue. I have  a 0.05 PSA 29months after prostatecomy and it is falling.   I think I may have benign tissue as I had pretty good path but not as good as yours.  I hate to say it but your numbers reassure me in that your PSA must almost assuredly be from benign tissue.  I have learned to live with some worry but if I was you I would seriously consider not getting any more PSA levels.  You are not going to die of this disease and your worry will probably lead you to do something destructive like SRT or it will harm you in other ways.  Your dcotor shouldl be reassuring you.
Posted 3/19/2015 9:01 AM (GMT 0)

Tall Allen said...
Zeddy,

I probably should not have mentioned seeding to you, but having let that cat out of the bag, I may as well give it some milk and some kibbles.

No, you would not see anything about seeding on a pathology report. Seeding or inoculation occurs when microscopic bits of cancer are transferred from the surgical scalpel to surrounding tissue or the serum. No one really knows to what extent it occurs, but it seems to be small, and most importantly, it seems like the immune system often gobbles up such stray cells. If you want to understand this phenomenon, read:

Can invasive procedures spread prostate cancer?

I should also rush to add that it is highly likely that some healthy tissue may be putting out those kinds of tiny amounts of PSA that seem to be worrying you.

If you read that, I hope you will also read the following, which I hope will have a more calming effect on you:

Low detectable PSA after prostatectomy – watch or treat?

- Allen

Thank you Allen for the links, and thank you for feeding the cat !

Regarding the seeding of G3; my understanding is that the surgeon has to cut through the cancer, or get very close to it. In my case, the cancer was right in the middle of left Apex, and according to my surgeon, there were a lot of tissues around it.

Is it possible that the G3 were seeded during the biopsy?? ... but my biopsy was negative, and that means the surgeon didn't go through the cancer. Am I correct?

The last possibility is that the cancer cells got out of prostate on their own before the operation. Is this possible in G6 ?

The second link is more reassuring, but I am a pessimist when it come to PC :(
Posted 3/19/2015 9:15 AM (GMT 0)

HCV said...
Honestly, you have nothing because you essentially had nothing. Your small PSA must have a non-malignant reason likely benign tissue. I have a 0.05 PSA 29months after prostatecomy and it is falling. I think I may have benign tissue as I had pretty good path but not as good as yours. I hate to say it but your numbers reassure me in that your PSA must almost assuredly be from benign tissue. I have learned to live with some worry but if I was you I would seriously consider not getting any more PSA levels. You are not going to die of this disease and your worry will probably lead you to do something destructive like SRT or it will harm you in other ways. Your dcotor shouldl be reassuring you.



Hi HCV,

Thank you for taking the time to write. I love your sentence saying:
" you have nothing because you essentially had nothing". It is very reassuring.

I am very glad about your results .. please accept my congratulations. Hope soon you will be undetectable.

Thank you for your advice. I really love to do as you say and give up on checking PSA forever.

Unfortunately, my oncologist's knowledge is far less than many people on this site. I am only a number in our National Health System, and "numbers" don't need reassurance!

Thanks a gain. It was a great help to read your post.
Posted 3/19/2015 9:20 AM (GMT 0)
http://www.dailymail.co.uk/health/article-86890/Why-Germany-France-lead-way-health-care.html



Why Germany and France still lead the way in health care
The Wanless report compared Britain's health service with those in France and Germany.


It concluded that an NHS funded through public taxation was the best way to provide fair, efficient and economic health care.


Yet it acknowledged that NHS underfunding had failed to deliver a system fit for the 21st century, and in key areas including life expectancy, cancer survival and infant mortality, Britain is the sick man of Europe.
Posted 3/19/2015 4:41 PM (GMT 0)
Zeddy,

Prostate cancer is multifocal. That means there are microscopic cancer cells throughout. It's not always apparent even on final pathology. In some of those studies about G6 and metastasis, they found G4s when they did finer slices.

The surgeon has to scrape prostate tissue away from the urethra if he is doing any bladder neck sparing at all. He also has to scrape tissue from the urethra at the apex to avoid the urethral sphincter. He also leaves tissue at the neurovascular bundles. The tissue is not all that cleanly scraped and some small amounts are inevitably left behind. That benign tissue may be the source of low PSA after RP. If it's benign, the PSA will probably stay about the same or go down over time.

If there was inoculation, and I'm not saying there was, it can occur if there's a G3 cell in that scraped tissue, and even a microscopic amount is left on the blade. The same blade cuts through the urethra in order to extract the prostate, where it can seed the urethral tissue.

Recurrence is almost always at the site of the anastomosis.

- Allen
Posted 3/20/2015 10:20 AM (GMT 0)
Thank you Allen,

Last night I watched the video of my operation again. It was really bloody and messy. I don't know how the surgeon can recognise what is he cutting?

Yes, I agree that in that amount of mess, and blood, anything could happen. Operation was my only option, because I didn't have positive biopsy (even with 30 cores).

The worry will continue ...
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