Please help clarify my 1st 2 Post Op PSA readings

You might want to get a second opinion. Current thinking is to contact an RO at .03 and plan for SRT when you get to .05. The older standard was see RO at .1 and start SRT at .2.

HT is often combined with SRT to make the radiation more effective. HT is given before the radiation to weaken the PC cells.

You might want to retest the PSA and confirm that .04 reading.

Andrew

Nick, I'll share my experience at the Mayo Clinic. They wait for 3 months for the last psa test then when I came in at .13 they had me come back in a month for a retest it was .12. I had a consult with the RO who likes to wait for 6 months for 100% in continence control and time for everything to heal up before radiation. Went back in 21/2 months psa had risen to .16 so went on Lupron with a 6 month shot and if I can tolerate it at least 2 yrs or more. I will be starting Radiation in December for 35 or 37 sessions. Hoping that you won't have to go down this road as your post pathology was quite a bit better than mine and psa was pretty low.

Larry

Also, I was wondering...the post op biopsy of my prostate showed I was a Gleason 8, not the 7 they had thought. To me that means it's the fastest growing variety therefore I need to get on top of this possible recurrence sooner rather than later, correct?

Just received a prescription for an ultra sensitive PSA test from Hospital #1 so I can compare results from the same lab. I will take it 6 weeks from now so I don't have to wait the full 3 months and if it is over .03 I think I will look around for a doc who doesn't wait until it gets to .2. Make sense? Or, is this an insurance thing, where one must wait until it hits .02 so the insurance company will pay?

Doesn't the Gleason Score mean anything in terms of speed of treatment for a recurrence? After all, the higher the score the faster it grows, right?

Thanks,

Nick

Nick,

Actually, Gleason 8(4+4) isn't the fastest-growing variety since it doesn't have a significant percentage of the more aggressive Gleason type 5 cells which jack up the risks significantly. But you're right that Gleason 8 is fairly aggressive and that the tendency of recent research is to suggest that faster and more aggressive treatment of higher risk disease is justified.

You might want to talk to a Radiation Oncologist for your second opinion. It never hurts a man in your situation to have a RO in his Rollodex. ROs, on average, are more likely to favor faster and more aggressive treatment for lower levels of PSA after prostate surgery. Talking to a RO is more likely to give you a second opinion to noodle over -- rather than getting the same opinion a second time by talking to a different urologist.

Here, by the way, is a study on the differences of opinion between urologists and radiation oncologists. Discord Among Radiation Oncologists and Urologists in the Postoperative Management of High-Risk Prostate Cancer. It supports my observation that Urologists and ROs don't always agree.

Nick, i believe the study you refer to that indicates to act at .03, refers to men with unfavorable post op pathology. In your case, even though you are G8, which yes, is aggressive, you had negative margins. Unless you had Extra Prostatic Extension, or positive lymph nodes, which are not mentioned in your signature, i dont think your pathology is considered unfavorable.
I agree that it would be good to have an RO in your Rolodex, just in case. Thats what i did when my PSA hit .02, then .033 (AFTER being <.02 for 2 years). He told me to wait for a clear trend. But at least i am in his system.

From what I've read here, and from a good conversation i had with HW member Garyi, i am going to want to be very convinced that i am recurring, before i start nuking my prostate bed, especially since at these levels you and i are talking about, no scan will show mets, and you will never be sure if recurrence is in the prostate bed. What a clown show it would be to do 6 weeks of radiation, and later find out they were radiating the wrong place.

I'm not saying wait till .2, or even .1. I'm just saying be very deliberate about this, don't rush into anything. I've seen guys here slowly rise to .06 and then come back down, or level off.

Hi Nick,

I had RP 3/16 and my first PSA was .01 and it's been rising since, my Uro was not concerned until it reached .07 then it reached .09 he prescribed finasteride (no help) and then it reached .12 now I'm in the care of the RO who did say I have a recurrence and prescribed 6/months Lupron and 37 SRT treatments. (doubled in 6/mths)
No problems with Lupron so far..my injection was 10/20/17 and I'm having an Aximun PET Scan 11/14/17 to see if there is anything to target or just spray the pelvic lymph node area and prostrate bed. Some people on here may disagree with spraying with no target, but I'm looking for a cure and I want them to throw it all at me including the kitchen sink...not f-ing around with this!!
See my signature for history.

Best wishes,
James

Nick2017-

I'm taking a break today and saw your thread.

I agree with what Pratoman wrote. You have to look carefully at the "setting" described in each study. A confirmed uPSA of 0.03 or greater is enough to warrant a meeting with an RO only if you had adverse pathology. Otherwise, there are just normal variances which may mean nothing. For your specific situation, the following is a more relevant study:

/pcnrv.blogspot.com/2016/08/low-detectable-psa-after-prostatectomy.html

As you see there, in men who did not necessarily have unfavorable pathology (some did, some didn't), a uPSA over 0.03 only went on to become a problem (in 63% of such men) when one of the following two conditions were met:
· Two subsequent increases in PSA, and/or
· PSA velocity of 0.05 ng/ml/yr or greater
(make sure that they are from the same lab)

I also agree with PDA that, although you have time to wait for a clearer signal one way or the other, that meeting an RO is a good idea. ROs are the ones on the front lines of salvage treatment - they follow patients and understand how things typically work out. Urologists don't. You may want to hold onto your Uro if you have urinary problems, but in terms of oncological control, his job is over. Look at the table at the following link that shows how differently Uros and ROs think about these issues:

/pcnrv.blogspot.com/2017/03/conflicting-messages-after-surgery-for.html

I agree with you that Gleason 8 merits serious attention, but checking uPSA every 3 months will give it the attention it merits.

Thanks all! I feel like I can exhale...