Biochemical Recurrence post prostatectomy

Let me make a few statements that I believe are generally true after a prostatectomy:

1. An undetectable PSA nadir (low) after the operation indicates no measurable distant disease at that time

2. A longer time to BCR (2 years+) indicates higher risk of localised disease

3. Shorter time to BCR (<2 year) indicates higher risk of metastatic disease

4. A positive surgical margin is more likely to indicate localised disease post BCR

Now, assuming that what I am beginning to see (a very low, but measurably rising PSA) after about six months post op, is indeed the start of BCR, what would you say based on the above statements? (It is important to note that the definition of BCR is 0.2 or above and rising in 2 and 3 above. I may take me that long to get there unless my doubling time shortens as I see more results.)

I did have a <0.008 PSA twice (which of course is not to say it was truly zero – it could have been 0.005 for example) and then it started to rise. I also had a small positive margin, which skews it a bit towards local disease.

Of course no scans can tell me anything at this stage, but the early recurrence makes me worry that I already have micromets. I am trying to prepare myself here.

Funny how, if you think you have lost the ‘cure’ after surgery, localised disease becomes your new hope...

D.

Yes Sir, Delta, I know what you mean. Localized disease and long term control by HT are my new hopes. Many hope adjustments for me on this road.

surgery doesn't cure everyone....positive margin or no positive margin. there's always the chance it was out before treatment. that said...I think it's too early to tell what's gonna happen. I'd just sit tight and let it play out. .013 is a low psa

Your uPSA is lower than anyone ought to worry about. Save your worry for when it's worrisome.

I would like to add my husband's case:

He has been having PSA of <0.008 for 4 years already.
When he did the 4.5 years (this Feb) blood test, the PSA came back 0.014.
The doctor just told us to wait and see the PSA reading 6 months later and continue his current life style.
It has been a big blow to him as he thought he has been 'cured' as it is almost 4.5 years since surgery and radiation.
We tried to review what has gone wrong in past 6 months but has no conclusion.
Any comments ?

WinnieHK,

Your husband is, of course, in a different situation from the OP because he has already had ART. But like the OP he is close to the lower limit of the uPSA with no convincing rise. I think you received good advice from his doctor to retest in 6 months.

Delta2 said...
Like WHK's husband, it feels to me that my shot at a cure is gone. (I know it might not be, and of course I hope for another chance.)

I understand where your head is at. These numbers are low and still a distance away from suggesting further treatment. But when you start to see upward motion it does get one's attention. There is still a good chance you won't need further treatment. There is also a good chance that even if you do, you may not need it for quite awhile, and then that treatment also offers a second chance at a cure.

If you look at my signature you will see I've been through a couple of rounds of hoping for a cure and then finding out it wasn't to be. But you will also see that I've gone many years - 15 so far -- since my diagnosis, which was at the same age as yours. I've had two long periods of remission -- nearly 7 after surgery (though these days I'd go for earlier SRT than was recommended then) and another 5 or so years after SRT.
Jim