Help, I'm nervous about 1st post RALP PSA test results

My husband had his first PSA test on Wed. It was 8 weeks post op. The plan had been to test him at 12 weeks but when the path report came back and and the little piece of dead looking tissue on the outside ended up being 4+4 cancer he moved it up to 8 weeks. Well, I am freaking out because we missed the call today from the doctor's and we were left a message saying Dr. Ahlering had reviewed the results and he wants DH to be tested again in 2 weeks. What does that mean??? She didn't tell us what the results were. My mind is jumping to the results being elevated so he wants to do the 2nd test earlier than the the original plan to do it right before our appt Aug 20th. Can anybody talk me off the ledge? We went to dinner and missed her 2nd call and she still didn't tell us the PSA again. Dr. Ahlering's assistant left her cell number so we will try it in the morning. It seems if it was low she would have communicated that to us.
I have another question that has somewhat haunted me. Why didn't this small piece of cancerous tissue show up on the MRI? The report from the MRI said the tumor was contained in the prostate. We met with 2 urologists and and RO and they felt comfortable based on the MRI report that the tumor was fully contained.

PS- We met a friend's friend on the 4th who was diagnosed with Gleason 10 cancer. He went to City of Hope for a consult but ended up at USC for RT ( I'm not sure which kind) having liked the dr. there better. I just wanted to let people know that he said his experience was wonderful and he really like the team. I guess the only problem was drinking the right amount of water and driving 45 min up road to USC and keeping his bladder properly filled before be radiated.

PSA anxiety after treatment is an everpresent reality for most of us. Even those of us who are non-detectable, there is still the "Is this going to be the time I lose my <?"

To perhaps set you somewhat at ease, 8 weeks post surgery is rarely definitive. We have had numerous threads about this, but the general idea is that PSA decreases by half-life, with a period for each half of several days. So, depending on how high he was the day of surgery, he may not be a definitive low point yet.

The 8 week (or not uncommonly 6 week) test tells you which direction it's going, and gives an idea of how close to minimum you are. A second test in 2 weeks confirms the trend. It's also important to know that if (and it is a big IF) he's going to need follow up radiation, it can't start for a while yet anyway, the surgical trauma is still healing.

It's already been said, but should be emphasized. PSA Anxiety is a side effect of Prostate Cancer that is probably experienced by 99% of patients post treatment. Gotta learn to live with it. Look into some anxiety reducing actions you can take. (like i should talk). Breathing, mindfullness, XANAX, etc.

I give my cell number to all my docs as the primary number, to avoid exactly the situation you just described. The downside is, you're sitting with friends, having a nice dinner, and you get a call that ruins it.

Change the medico to one you are not afraid of to one you can be bold with...get your husband involved or just trust...it sucks...but its not gonna change...till we{human species} are all cyborgs...yuk...

As you just found out, MRIs are not all that. They are pretty good at finding areas of high grade cancer, but they are pretty lousy at precise localization and staging. The sensitivity of an MRI in finding EPE is only 57% - not much better than a coin toss. I'm confused by your signature - it says the pathological stage was pT2c - that means that it was all localized within the capsule. But it sounds like there was a high grade positive surgical margin. Either way, you'll know more when you get the PSA result.

Thanks for the encouragement. I checked the UCI Portal and Quest Diagnostics portal and there is no update.
Tall Allen we are concerned because of the amended biopsy report. Sounds like he could be T3 but she is leaving it at T2. Any thoughts?
Part C of his path report said:
Apical Margin, Left, Biopsy:
Prostatic adenocarcinoma, Gleason 4+4, involving fibromuscular tissue, span over 2 mm
Addendum 1:
The additional left apical margin shows only fibrous tissue that is replaced by prostatic adenocarcinoma (4+4);one edge of this biopsy shows skeletal muscle only which represents the true left apical margin.
In addition, the presence of adenocarcinoma in the skeletal muscle without any normal prostatic glands raises the possibility of extraprostatic extension (T3a) However, extraprostatic extension confirmation at the apex is very difficult to establish (given the anatomy of the area) Clinical correlation is advised.
Original diagnosis remains unchanged.

Dr. Ahlering said when he pulled out the tissue he thought it was some old scar tissue. He said he had rarely seen something like it turn to to be cancer. When he got the addendum he bumped up the 1st PSA from 12 weeks to 8 weeks. Now he wants another one at 10 weeks instead of 12 weeks

Up4thefight, I'm certainly with you on the PSA anxiety issue. My post-op PSA at 5 weeks was 0.94 . I just last week had a repeat that was undetectable so I can relax for two months before the anxiety will begin to build prior to my three month follow-up. Bummer, but that's how it is. I expect to get better as time goes by. Your 0.2 at 8 weeks is not good news but does not positively mean residual cancer. The usual half life of PSA is 3 days but could be longer so you don't really know at this time. The repeat in 2 weeks is a good idea, not too soon and not too long. That should give you your answer. But even if it is going up that is not the end of the story for you as you can learn from many who post here. Best wishes.

up4thefight-

Those g**d*** apex tumors! As the radiologist said, the capsule is indistinct there and there's no impediment to the tumor growing through it and into the surrounding fossa. But this is good news in a strange way - you know that the recurrence is a local recurrence, opening up the possibility of a cure with adjuvant radiation to the fossa.

I agree that it is a good idea to get PSA confirmation soon. It is also a good idea to begin discussions with a good RO ASAP. At this point, his urologist really can't do anything for him. That does not mean that radiation has to begin immediately. In fact, it's probably a good idea to start him on hormone therapy now - that will keep his GS 8 from spreading while his incontinence resolves. It may be a good idea to stay on it for, say, 7 months rather than the normal 2 months to allow for healing.

up4thefight- please keep us posted on your follow-up 2 week test. such a bummer about your first test, but maybe it's just taking its time going down? been thinking about you guys so much. our first test will be august 2nd, and i'm feeling so much test anxiety as well.

going forward- i wonder if you can tell lydia to leave the numbers on your voicemail if she doesn't reach you, or maybe put it in writing that she has permission to do so. i'm going to tell my husband to do the same!

in the meantime, i also like the idea of meeting with ROs in the area. we really liked the experts at UCLA when we were originally meeting with doctors. is that too far for you?

don't you just feel like life is a blur right now? i know it will get easier once we're used to all the waiting/testing, but right now it's hard.

sending love your way...

p.s. TA told us that he'll start to test my husband every two weeks if he's not liking our first test. and if things aren't going our way (because of my husband's rare prostate cancer: intraductal), he said we'll talk about chemo & hormone therapy. but then again, i know he's also performing salvage surgeries these days. not sure we'd be candidates though... so much to think about!