First Post-Op PSA - Persistent? So now what?

Greetings everyone

This is the first update since GG’s surgery on 1 July, and I’m not really sure what to make of the results.

Seems he isn’t destined to be a member of the zero club unfortunately. His first PSA at 9 weeks is 0.05 - does this classify as ‘persistent’? I can really only see this heading one way, (the wrong way), but interested to see whether any other folks have ever held steady with post-op PSA’s at this level, starting out.

I’m guessing RT would be a pointless exercise, as the ‘horse has already bolted’ so to speak, and something tells me those cells aren’t languishing around ‘sunbaking’ in GG’s prostate bed (particularly considering his negative margins and all other post-op pathology). With a pre-op PSA of over 20, methinks we’re more likely to be looking at something systemic, and not sure what the approach would generally be in this case.

Does anyone have any helpful ideas about what we should do next (apart from just sitting around and waiting for his PSA to reach 0.2)?

I’d be very grateful for any advice.

Good health and well-wishes to you all.

Kind regards
Jaybee (for GG)

GG, a 9 week post surgery PSA shows the trend. The usual mark date is 3 months. 0.05 is darned close to non-detectable depending on the method they use (my dr. has an old machine that only goes to 0.04.) In other words, don't sweat it. I expect they'll do another one in 4-6 weeks, and that will be the definitive word.

For now, get stronger, get the continence in line, start working on the potential ED......And start enjoying life. (See Island time's post above)

I vote for a retest. It's a very low PSA and considering where he started they got a bunch of it. Rather than absolute numbers you want to look at trends.

Right now I'd say it's a waiting game. Get retested and see if the PSA is moving.

What did the doctors say about this reading? That's about the only 'action' you could take, talk to your medical team and see if they have any concerns.

The only other thing I suggest is a party to celebrate a very low PSA number and recovering from RP.

Andrew

Jaybee, someone above mentioned half-life. I believe PSA has a half-life in the body of 7 days. So, let's do the math:

PSA on surgery day=20
on day 7=10
on day 14=5
on day 21=2.5
on day 28=1.25
on day 35=.625
on day 42=.3125
on day 49=.16
on day 56=.08
on day 63 (9 weeks!)=.04

Now, this is approximate, but this is why we look at the trend for now, and wait another month to see what the true bottom line is. I had a PSA at 6 weeks, and there was no surprise or concern when it came in at 0.10. My surgeon said, "that's exactly what we'd expect to see".

Hi Jaybee

It is an anxious time post surgery, and I can sympathise with you. GGs pathology looks very similar to my own, apart from his PSA was way higher than mine pre-op. My own PSA returned as .06 post op, and the surgeon was not too concerned, mentioning the fact of the half life, and also the fact that I had been tested a bit earlier than usual with the upcoming Christmas break, and he asked me to return 3-4 weeks later for a retest.

Unfortunately my PSA started to climb. Surgeon was stunned (top surgeon here in the UK, not a rushed NHS guy), as all the surgical indicators were excellent, apart from some PNI, which is not at all uncommon. His view at the time of surgery was that he had got it all, but the little buggers had started planning their escape. He described my increasing PSA as extremely unusual, and I think he was possibly more upset giving the news than I was receiving it!

Even given my experience, I think the advice you have been given by all the others is absolutely sound, wait a short while and then have a retest. The balance of probabilities is that the PSA is still working it's way out of the system. In my non medical (and totally amateur) view, with no lymph nodes, and undetected PNI and SVI, if the PSA still climbs then it is probably microscopically in the prostate bed, and Salvage Radiation (SVR) is a possibility.

I had SVR combined with hormone therapy (22 months) , and if I could do one thing over again it would have been to watch my diet and exercise hard during the whole time of the hormone therapy, as I am now dealing with having too much weight and type 2 diabetes.

Right now though the priority is recovery from surgery (it is major surgery) and recovering bladder control and all the other functions normally associated with the area affected. All the nest to you an GG

I agree that 9 weeks is too early, especially considering his PSA was very high to begin with. He had a great pathology report, so there is absolutely no current cause for concern. Let's see where his uPSA is another couple of months, and then 3 months after that. I'm sure that's what the doctor told you.