psa after robodic surgery

my psa 8 weeks after robot surgery was 0.18...at 4 weeks had achieved both sexual and control of bladder,biopsy showed only 1 needle out of 12 with 15%,it was the lowest grade possible,,cant remember the numbers..going for follow up psa test on 6/27,,,pre op psa was 2.4..had surgery on 3/30...should i be concerned

Joker, the key PSA reading will be the 3 month reading. IT should have a "<" in front of it. Congrats on seeming to have made a full recovery.

thanks for the replys it calms me down some ..because the 0.18 is so close to the 0.2 that requires immediate attention ,,its going to be a long month of June,,,will post next numbers...

Joker,
I have been out of the forum loop for a while, but wanted to comment. You are doing very well and that is great news. You are way ahead of most, so early post surgery. I had RALP 3/16 and just got recent PSA results. Same as my first test after surgery, <.01 so I am very thankful. Best to you going forward.
Mack

My doctor is looking at 8 weeks for my first post-operative PSA. If we are speaking about half lives how long is one of those lives? I'm coming down from a 23 - 24 PSA. Is it unlikely I'll see something super low after that in only 8 weeks?

Peagcu said...
My doctor is looking at 8 weeks for my first post-operative PSA. If we are speaking about half lives how long is one of those lives? I'm coming down from a 23 - 24 PSA. Is it unlikely I'll see something super low after that in only 8 weeks?

8-weeks will be fine. You can plug your own numbers into the calculation methodology I did earlier and demonstrate to yourself...

The link alephnull pointed to confirmed the assumptions (thanks, alephnull; I could open the 2nd link, but not the first). First, the data showed between 2-4 days for half life (lowest was 1.72 days, largest was 3.95 days), or as alephnull said, "about 3 days." Also, one of the charts showed how some patients experience a "surge" of PSA in the blood. Some experienced no surge, however, and my estimate of Joker going from 2.4 up to 10 was an extreme, worst case hypothesis just to be on the very safe side. Most surges in the report's small sample were only about 1 or 2 ng/mL

Peagcu, let's run your numbers here:
* 24 ng/mL at pre-op; let's over-do it and say there's a surge to 30 ng/mL as your start point worst case
* Let's further assume worst case that you have slow decline of 4 days half-life.
***4 days post-op, PSA = 15
***8 days, PSA = 7.5
***12 days, PSA = 3.75
***16 days, PSA = 1.88
***20 days, PSA = 0.94
***24 days, PSA = 0.47
***28 days (4 weeks), PSA = 0.24
***32 days, PSA = 0.12
***36 days, PSA = 0.06
***40 days, PSA = 0.03
***44 days, PSA = 0.015
***48 days (still under 7 weeks), PSA < 0.01

Most men will have even lower PSA because half life in most men is less than the assumed worst case of 4-days, and it's unlikely that you really surged as high as 30 ng/mL.

8 weeks is more than fine for starting PSA of 24. For someone who's over 100 or in the 100's, I'd want a little more "margin" and go a little longer...maybe 10-weeks.

Post Edited (JackH) : 6/5/2017 12:24:31 PM (GMT-6)

do i need to move my test closer or wait and consult with a rad ocon...thanks

What is your gleason score? Really hard to respond without knowing.

Personally, I wait for the next test to confirm the number. In any case, you would be doing any follow on treatments until it's confirmed.

I think it is high for 8 weeks. In a study by Vesely (link below) they found that the uPSA 60 days after RP was a good predictor of biochemical recurrence. Anything over 0.04 predicted biochemical recurrence. If your PSA is 0.18 already, it is certainly prognostic for recurrence.

Ultrasensitive PSA can reliably predict eventual biochemical recurrence at 2 months after surgery

Other things to consider are from your pathology report (not your biopsy):
• Highest Gleason score
• Positive margins, their length and Gleason score
• Any stage T3 cancer found

I'm glad you recovered so fast from your surgery. That may translate to fewer complications from adjuvant radiation. You should be talking to a radiation oncologist ASAP.

yes it was 0.18.....never got my pathylogy report after surgery, he just told me they didnt find anything within it and everything was nomal....it was t1 with the lowest gleason score on on the biopsy report with one neddle out of twelve had cancer at 15%,,,i really cant understand this ..the cancer was in the bottom right lobe of the prostate.

there were 2 CT that found nothing,and a MRI that found the one spot,all other tissue within prostate was normal,,which led to the biopsy,,,,hoping just maybe he left a large amount of healthy prostate tissue as I have been reading about that will raise PSA,,,trying to come up with all good reasons..

I would like to be clear, Joker, that it's too early to jump to conclusions.

But, that being said, 0.18 is higher than it should be. There's a number of possible explanations, but they pretty much all involve some type of anomaly...but anomalies happen. 0.18 is too much for the typical residual prostate tissue.

Pretty much everyone here has a hardcopy (print out) of their surgical report and the post-surgical pathology report (as well as the report of biopsy results which was done before surgery). Don't leave the doctor's office on the 27th without a hardcopy of those three documents in your hand...the urologist should have all 3 in your file.

What Tall Allen says is correct. In order to try and understand what may or may not be happening you really need to get a copy of the post surgery pathology report. the pathologist will have detailed the state of your prostate after it was removed and it will contain much valuable information.
If you have a test ---- get a copy of the results and maintain your own medical file.