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post-op psa non-zero but consistently low

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Posted 6/27/2015 4:27 PM (GMT 0)
For the last 18 months since my RP or so I've been up and down under 0.2 and recently dipped a bit.
My urologist tells me that given the pattern he suspects prostate remnants are producing PSA but that they are not cancerous. Given the aggression of my cancer he would expect a consistent and fast rise.

Opinions?
Posted 6/27/2015 5:00 PM (GMT 0)
My Urologist told me that some of his patients have had a PSA that's elevated after surgery, but as long as it doesn't rise, there isn't a problem.
Posted 6/27/2015 5:32 PM (GMT 0)
I understand that it would be unsettling to ever see a PSA that is detectable after RALP. But if it's been stable, I would think that would indicate that there is nothing going on that would indicate a progression.

On the other hand, with the exception of the first post op PSA test, you've been above the .1 threshold that would I think, indicate SRT be considered.

I also don't quite understand your Dr.'s comment. "Given the aggression of your cancer" considering that you are a 3+4 which is considered low intermediate risk.
I'd be interested in hearing what others have to say, (particularly on the fact that you are stable but above .1), especially Tall Allen, who I'm guessing will weigh in at some point soon.
Posted 6/27/2015 6:01 PM (GMT 0)
I've been to two urologists and am currently with the head of the local college. He asked if my first surgeon had ordered SRT, and when I told him no he agreed, seemed relieved that I had not been subjected to unnecessary procedures. "I don't think we need to intervene. These readings are consistent with benign prostate cells attached to the urinary tract." (Loosely quoting)
Weird because I hadn't heard any talk like that at all.
Interesting because, if he's right, it adds some grey to the black and white values we use to measure 'progress' on this forum.
Posted 6/27/2015 6:15 PM (GMT 0)
Well then, that's good news. If you got it from two. Different urologists, it's music to our ears. I guess it's a good example of not jumping the gun, and why they look for multiple readings before considering a PSA result "actionable"
Posted 6/27/2015 6:41 PM (GMT 0)
Because of the pT3a, it's possible that the cancer is outside the prostate but in a quiescent state. Cancer often goes quiescent after initial therapy for poorly understood reasons. However, I understand that you would not want to overtreat this if it's not ever going to progress. On the other hand, you want to treat it at early as possible if it is going to progress. Unless, you know for a fact - from a CT or MRI or PET - that there was a big hunkin' piece of prostate tissue left behind, your PSA is well higher than most doctors would feel comfortable attributing to benign tissue.

I have two suggestions to discuss with your RO:
- using a CT or MRI to see if there's indeed a hunk of tissue (did the surgeon's report mention there was significant tissue left behind?)
- ask for a Decipher test to see what the probability is of metastatic progression in the next 5 years.

- Allen
Posted 6/27/2015 8:12 PM (GMT 0)
Thank you Allen
My doc has me on a three-month schedule for PSA readings. He thinks that is enough of a window to alert us in time to head off catastrophe.
After the RP and a recent triple bypass I'm fit as a rusty worm-eaten fiddle - that can still play a tune.
You may understand that I'm predisposed to avoid precautionary intervention. I'll wait for the PSA to make a scary jump and in the meantime will remain encouraged that the jumps so far look to be twitches.
My personal analysis was that there has to be metastases producing the PSA but my uro brushed that aside.
He has post-op patients who maintain low non-zero PSA until they die of something else.
Maybe he's just soothing me? Maybe.
It's interesting how often doctors use anecdotal evidence in support of their diagnosis.
Even so I'll stick with it. I'll wait for a jump in the PSA.
Thanks for your comment.
Posted 6/27/2015 10:21 PM (GMT 0)
I am in the same category. My first psa was <0.1 and the every other psa was 0.1.
It has been 20 months since surgery and I am still at 0.1. My oncologist urologist told me not to worry until it hits 0.2 with a confirmatory followup then I should look toward radiotherapy.

The good news there is still remnants of cancer the doubling time is long.
Posted 6/30/2015 9:31 PM (GMT 0)
In discussion with my first uro after my first post-op PSA reading he said he wouldn't start hormone or radiation therapy until PSA went to 0.4. If I'd started with a lower PSA reading he would start that treatment sooner.

I'm sure this will strike many of you as very strange, if not irresponsible.

Perhaps his opinion may have been different if I were in my forties?
Posted 6/30/2015 9:39 PM (GMT 0)
havanon,

You are talking to doctors who are not experts on this subject. It's like you are talking to plumbers about an electrical problem. I suggest you talk to a radiation oncologist.

- Allen
Posted 6/30/2015 9:40 PM (GMT 0)
His opinion would have been different if you were younger and had a higher Gleason score. I'd think avoiding follow on treatments is a good thing for the moment and .4 trigger is good to have in your mind.

Andrew
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