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Psa 0.04 4 and a half y after RP

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Posted 3/1/2018 10:46 AM (GMT 0)
Hello,

My dad had rp at age 57 in 2013 Sept, pt3a I think and I think Gleason 7 (dont know if 3+4 or 4+3). Dont know the details, but there are no seminal vesicles and node lymph involved...
Psa has been for the first one or two years below 0.02, after that 0.02, then in Autumn 2017 0.04. three months after that 0.02, then two weeks ago 0.04. all were from the same lab (beckman coulter access 2 machine i think).
Now i am worried sick about my dad. How long will he live (he is 61 atm)? Will salvage RT at some point save his life? Can he live until at least 75 or does he has ončy 5 y or so? I so scared for him and dont know what to think anymore, we thought he would be cured after rp but now i fear for the worst...
Some kind of encouraging news would be much appreciated.
P.s. sorry for my english it is not my native tongue
Posted 3/1/2018 11:34 AM (GMT 0)
You would start salvage RT when the PSA value reaches 0.1 or 0.2. In most cases this will be curative.

If NOT there are statistics that your Dad will probably live for at least 15 years. Chances are higher that he will die from a heart attack or accident.

So please stop worrying or you will have to do that for the next fifteen years. My own children seem to have forgotten that I have prostate cancer since I have no symptoms.

George

Post Edited (George_) : 3/1/2018 4:38:57 AM (GMT-7)

Posted 3/1/2018 2:18 PM (GMT 0)
Internship, there have been several discussions on this forum on when to start salvage radiation therapy. Most of the recent studies point out that it is important you seek Salvage RT at your fathers current PSA level as he has adverse post op path ( pt3a and Positive SV and LN). There will be more knowledgeable folks coming in shortly but while pelvic region RT is what the studies have shown to give highest chance of cur. What would help others is to give more information - pre op psa , and more detail on post op path report.
Posted 3/1/2018 2:22 PM (GMT 0)
Thank you for the replies.
Sv and Ln are negative , not positive...
My dads pre op psa was below 10... I cant remember the exact number.

Ive read somewhere that he is very likely going to get metastase in the next 10y and am worrying
Posted 3/1/2018 2:26 PM (GMT 0)
I apologize, I misread the LN and SV. Its great that those were not involved. Do you know anything about Margins? The pathology report would have information if Margins were involved or if they were clear.
Posted 3/1/2018 2:33 PM (GMT 0)
Hello I41,

Welcome to the forum. Sorry you are worried about your dad but glad you found us. Hope we can help.

Chances are that your dad's life expectancy with prostate cancer is about the same as his life expectancy without it. If he follows his doctors' advice about treatments his cancer probably won't shorten his life. He's not guaranteed to live to 75. None of us are. But if he doesn't live that long it probably won't be prostate cancer that kills him.

As for radiation "saving his life," that's not the right way to think about it. If his PSA continues to rise there may come a point where he ought to do radiation to try again to cure his cancer, but the radiation won't be saving his life, it will be making the rest of his life more comfortable and enjoyable. Uncurable prostate cancer can be managed for a long time. With his fairly low Gleason score your dads prostate cancer could probably be managed for years and years -- for decades. But those treatments have side effects that men don't like. So if he does eventually need salvage radiation it won't be to save his life, it will be to spare him from putting up with years and years of scans and tests and hormones and bother.

Your English is excellent, by the way. No need to apologize. Your English is better than average for this forum.
Posted 3/1/2018 3:03 PM (GMT 0)
Welcome to HW.

You have nothing to worry about. That's a very low PSA and the trend isn't all that clear. You need to see a rising trend over three consecutive tests before doing anything. SRT is the next step and is possibly curative. If that fails, HT and other treatments will keep him going for a long time.

Personally, I'd say your father has 20 to 30 years left - even if he needs more treatment.

PC is on of the most treatable cancers and he's at a stage where they can start treatments early, which is the key to success.
Andrew
Posted 3/1/2018 4:03 PM (GMT 0)

PeterDisAbelard. said...


...Chances are that your dad's life expectancy with prostate cancer is about the same as his life expectancy without it. If he follows his doctors' advice about treatments his cancer probably won't shorten his life. He's not guaranteed to live to 75. None of us are. But if he doesn't live that long it probably won't be prostate cancer that kills him...

Excellent advise from Peter, and others. Where are you located?

In my opinion, the most help you can give your dad, difficult though it may be, is to stop worrying! He is probably sensing your concern, and that will not help his condition.

When to have salvage radiation is a hotly debated topic. You dad is probably not at that point, and the side effects of hormones and radiation are nothing to be taken lightly.

RELAX, please!
Posted 3/1/2018 5:25 PM (GMT 0)
garyi,

With her dad's lowish risk category he can probably avoid hormones if he needs radiation. Adding ADT to radiation shows a benefit mostly for higher-risk cases. For favorable risk recurrences radiation alone is usually sufficient.
Posted 3/1/2018 6:50 PM (GMT 0)
Thank you so much for the replies everybody.
I am a little relieved because of your helpful comments.
I do hope in 2-3 months, when next psa test is due, that it will be the same or maybe lower than 0.04.
I know i should stop worrying so much and i know that it can be felt by people around you, but im only human and i love my dad so much.

@garyi i am from Croatia, a beautiful mediteranean country which i invite all to visit during the summer

May the good Lord bless everyone of you!
Posted 3/1/2018 8:07 PM (GMT 0)
Avoidance of hormones is a worthy goal for all, except perhaps radiation oncologists.

Having been to the Med more times than I can count, I'm very familiar with the splendor of where you live.

Best wishes for a beautiful and calm three months, and for a low PSA.
Posted 3/3/2018 7:43 AM (GMT 0)
My good people.

I have obtained my dads pathologic report, or brief summary of discharge letter to be exact and have found out the correct data regarding the ilness.

It says (in brief): pT3a, no lymph node involvement, no seminal vesicles involvement, pre-OP PSA 5.6 , Gleason score of 7 (3+4).

But it says something i fear is not good, and i cant get to translate it from my language so the raw english version should be something like: apically right margin positive.

Does this means the surgical margin is positive?

If so, is it dangerous regarding my dads situation? Is it something i should fear more than anything?

Please tell me it is not something horrible...
Posted 3/3/2018 1:38 PM (GMT 0)
Positive margin, yes. But it is not too bad, similar to T3a. Moreover, in the case he has to have radiation (what is far from sure right now) positive margins seem to give a higher probability to be cured just by this treatment. It is not good that PSA climbs a bit, but, in my opinion, he is still in the category of those people who probably will die of something else, hopefully many years from now.
Greetings from another southern European, though unfortunately far from the seashore.
Posted 3/3/2018 2:02 PM (GMT 0)
He had a positive surgical margin (PSM) at the apex (bottom) of the prostate. The surgeon didn't got all, sorry. The apex is the most common place to have PSM. Men with PSMs has a higher risk of BCR than men with negative margins. At 4.5 years post surgery with apex-only PSMs and no BCR yet, it may be clinically indolent. Future PSA tests will tell if he need further treatment. If he need more treatment then salvage radiation can still cure hime.
You can use this nomogram to see probability of remaining cancer recurrence-free
Post-Radical Prostatectomy Nomogram
Probability of prostate cancer survival at 15 years will be high if you fill in your dads data.
Posted 3/3/2018 2:24 PM (GMT 0)
I41,

It is confusing to understand why positive margins seem to be a good thing sometimes. Maybe I can explain.

When a man has his prostate removed he will follow one of three paths:

1) He will not recur (his cancer will not return). This is the best of the three. Positive or negative margins don't matter to him.

2) He will recur with positive margins on his post-operative pathology report. Men in this category are highly curable with radiation since the recurrence is usually local to the prostate bed.

3) He will recur with no positive margins. Men in this category are harder to cure since the cancer will often have returned in some other part of the body.

Hopefully your husband is in the first type and won't recur. Lot's of guys with positive margins after surgery don't recur. But if he does recur there's a good chance that radiation will cure him.
Posted 3/3/2018 2:35 PM (GMT 0)
He may need salvage but - regardless - he will likely be alive many years. After PSA relapse there is a median of 14 years of life - half get more time than that. Also - salvage XRT is not that bad - I personally would get a couple of more PSA test and if it moves to .1 pull the trigger. I waited longer but I had better pathology.
Posted 3/3/2018 3:08 PM (GMT 0)
Thank you all so much for the replies!
Everyday I learn something new and you really add a little confidence to me.
You guys are truly wonderful.

Kind regards,

Intern
Posted 3/3/2018 3:09 PM (GMT 0)

Internship41 said...


Does this means the surgical margin is positive? Yes, most probably

If so, is it dangerous regarding my dads situation? Not at all

Is it something i should fear more than anything? Absolutely not!

Please tell me it is not something horrible...It isn't, so PLEASE relax! You know your angst isn't helping your dad at allnono

Posted 3/3/2018 5:46 PM (GMT 0)
It’s great you found the pathology report! As others have said Positive Margin is not the best news but since PSA has been good for so long after surgery may mean those cancer cells at the margin may not be the most aggressive kind and may well be the indolent (meaning they may not spread) Gleason 3’s.

But as you wait for the next PSA, I would start conversation with a radiation team and start researching where you might seek radiation treatment for your father if needed. As others have said this is a hotly debated topic , hope TA can chime in on this.
Posted 3/4/2018 6:42 PM (GMT 0)
If the PSA value rises after surgery there are basically two options: either it is caused by metastases or by tumor not removed by surgery i.e. positive margins. The salvage radiation is usually directed to the prostate bed so it will only work if there is tumor left in the prostate bed, which is indicated by positive margins.

So chances are higher that the salvage radiation is successful in case of positive margins.

George
Posted 3/4/2018 11:05 PM (GMT 0)
There are no guarantees, but I was younger than your dad when I was first diagnosed - I had surgery and a pathology report of Gleason 7 (3+4) with seminal vesicle involvement -- PT3b. I'm now 72 and going strong. I've had some setbacks - salvage radiation 8 years after surgery, and I now have active cancer again and will need to start further treatment soon - either a clinical trial for the Prostvac vaccine, or else Lupron. But either way I expect available treatments to keep my prostate cancer under control for another 8, 10 or maybe more years. I'm physically active. I'm stripping paint and wallpaper, repairing plaster and repainting my wife's home office while she is away for a couple of weeks -- pretty much the same kind of projects I was doing 20 years ago. Your dad will probably do as well as I have. Best wishes to you and your dad.
Jim
Posted 6/4/2018 3:27 PM (GMT 0)
Hello everyone,
just wanted to report the latest PSA results for my dad, and its back to 0.02 woooohoooo

Have praying for that, and am so relieved and I wish all of you here the very best!
Posted 6/4/2018 4:40 PM (GMT 0)
Doesn't get much better!

Congratulations!!!

Andrew
Posted 6/4/2018 4:47 PM (GMT 0)
Internship, if the next PSA is a rise, then it may be time to look at radiation, but until then, i dont see a clear trend. Its been bouncing around between .02 and .04, back and forth. If a clear trend does develop though, better to treat earlier than later with your dads PT3 status.

As everyone has already stated, this is not threatening his life in the near or intermediate future. Probably not in the distant future either.
Posted 12/7/2018 12:19 PM (GMT 0)
Hello people.

Just wanted to inform you that my dad went on to a annual company's exam and slightly after 5 years of RP (Sep 2013) the results on a different machine then regular where my dad always goes is back again 0.04.

My dad's Dr said in June this year, after it went back to 0.02 (from 0.04 that happened for the first time since RP), that he come back to him again in 1 year (as usual).

Should I be worried? This is not what I expected for this Christmas :/
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