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PSA 0.1 after two years of robotic RP

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Posted 5/30/2016 8:24 AM (GMT 0)
Hello all,
My father was diagnosed with PC on 2014, his PSA was 13,
he underwent robotic RP same year, cancer cells were in both lobs but larger in left lobe (2 cm) Gleason score 7 (3+4), his surgeon told us that this score is better than (4+3),
PSA Nadir after surgery was 0.006 then it grows up steady every three months to become 0.1 this year that means after two years of surgery,
his surgeon told me that still nothing to do before PSA 0.2,
i am worried if this is a recurrence, and do we need to proceed to Radio therapy?? or is there any other thing to do? or is there any accurate scan to make sure if this is a recurrence?

wish you all good health,
Thanks
Ahmed
Posted 5/30/2016 11:33 AM (GMT 0)
Hello Ahmed,

I am not an expert but others will chime in later who will give you better insights but it looks like your father is headed for salvage radiation.
Posted 5/30/2016 11:37 AM (GMT 0)
As I understand it, 0.2 is considered the accepted level to define recurrence. Some doctors in the US are starting to go earlier. There have been some studies mentioned in this forum that show that early salvage treatment has long term benefits.

How old is your father?
Posted 5/30/2016 12:02 PM (GMT 0)
My father is 62 Years old
Posted 5/30/2016 1:35 PM (GMT 0)
welcome to HW.

The older standard of care is .1 is the trigger point to discuss RT and by .2 they want to be starting it. More recent studies suggest early treatment it better.

so it's likely you father should be talking to a radiation oncologist right now to discuss options. As long as the remaining PC is confined to the prostate bed, he could still be in the cure area.

They can do scans, but at the low PSA levels that's unlikely to see anything. PSA after surgery is an accurate measure as the only thing that will generate PSA is prostate cancer cells that have been left behind.

Hang in there,
Andrew
Posted 5/30/2016 7:05 PM (GMT 0)
Hi Ahmed,

I agree with Andrew. Talk to a radiation oncologist, and don't wait. If he is going to have salvage radiation, earlier is better. If you want to do a test, ask for a Decipher test (imaging won't tell you much - it's not accurate enough at that PSA.) Decipher shows the risk that the recurrent cancer will or will not metastasize in the next 5 years.

- Allen
Posted 5/30/2016 10:02 PM (GMT 0)
First off, I would get another ultra-sensitve PSA done. Second, did your father have positive margins? The standard has been when PSA hits 0.2 before radiotherapy. Statistics show that there is little difference between starting salvage radiation before or at 0.2, and having positive margins greatly enhances the chance of a cure.

Your father is like my cancer. I went two years before I had IGRT. My doubling time prior to surgery was around 50 months. BTW, I did have positive margins.
Posted 5/30/2016 11:42 PM (GMT 0)
Thank you All for your helpful replies,
Thank you Howard3569, halbert, Andrew, Allen, lapilot. wish you all good health.

It's my first time to hear about Decipher test i would need to read more about it and how to do it, but it looks great if it can show the risk of recurrence.

my father has positive margins, no vascular or seminal invasion and pathology classification is pT2C pN0.

Post Edited (aswtheb) : 5/30/2016 6:58:50 PM (GMT-6)

Posted 6/1/2016 10:16 PM (GMT 0)
aswtheb,

It seem contradictory, but positive margins are good in your father's case. The logic behind this is that the positive margins are generating the PSA. If your father did not have positive margins and his PSA were increasing that usually means that the cancer has spread i.e., metastatic disease.

So in your father's case radiotherapy has a greater chance of success.
Posted 6/2/2016 2:48 PM (GMT 0)
aswtheb, My psa just went to .3, three years after surgery. MD Anderson (MDA) did not recognize anything under 0.0 as detectable. I am curious as what my hundredth digit has been over the last 3 years. I only had one test done at a local lab, it was 0.01. All of the other test were done on 6 month intervals at MDA. They are going to check my psa in 5 weeks, if it over .5, they will probably put me on hormone therapy for 1 year, we'll discuss that in 5 or 6 weeks. They were very reassuring, that everything is going to be ok. I have learned as a patient, and visiting with other MDA patients, that they don't pull punches, they give it to you straight. I don't know if this helps, because everyone is different. I do pray things will be ok with your father.
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