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First PSA AFTER SURGERY COMES BACK AT 0.04

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Posted 8/4/2018 3:04 PM (GMT 0)
just got my first psa score after surgery. pretty devastated that it is 0.04 as hoping to be under 0.02.

supposedly was all contained and surgeon was majorly surprised when pathology came back with tiny positive margin.

Meeting with surgeon Monday but already feeling will need radiation. Anybody get a similar sore after surgery or thoughts.

thank you
Posted 8/4/2018 3:24 PM (GMT 0)
A number of us were still detectable at 6 weeks but undetectable by 3 months. I was 0.13 at 6 weeks but <.05 two weeks later. Albeit I’m not the best example to give comfort — my PSA rose again later, but never above 0.10. So despite the clearance rate of PSA (2-3 day half-life), either mine was still going down at 6 weeks or there was lab error.
Retest in 2-3 weeks. Don’t make any decisions about further treatment unless you get confirmation that some significant PSA production is still going on.
Posted 8/4/2018 3:26 PM (GMT 0)
Tom, that sucks. You did have what looks like a fair amount of cancer with 10 of 12 cores positive. Did the path report say what % of the prostate was involved by tumor?

I would try to stay calm, which I know is tough to do, and test again in a few weeks or a month, to rule out lab error.
The good news is your g7(3+4) puts you at low intermediate risk. And with a positive margin, you increase your chances of adjuvant radiation therapy being successful.

I’m sure there will be others commenting who’ve had experience similar to yours.
Posted 8/4/2018 3:36 PM (GMT 0)
Devastated?

You're just 4 weeks from surgery. Retest in another month before doing anything.

Way too early to panic. Rest, heal, party, retest. That's my suggestion.

Andrew
Posted 8/4/2018 3:44 PM (GMT 0)
it is 6 weeks Andrew but will see what surgeon says Monday but not what hoping for

Pratoman - good luck with your decision - mostly 3+3 with 5 to 40% on orig pathology - on surg pathology - the positive margin was microscopic focus of gleason pattern 3 block 14 right posterior mid prostate.

thanks all
Posted 8/4/2018 4:04 PM (GMT 0)
Absent any other adverse pathology, you could certainly be comfortable waiting at least several addl months to see whether or not the PSA continues to rise and at what rate. This will allow maximum time to regain the full continence you would need in the case that SRT is indicated.
Posted 8/4/2018 4:09 PM (GMT 0)
Ye wait a bit Tom.

My surgeon said he used to test at 6 weeks earlier in his career and "the biochemist in me KNEW that the PSA would clear the system by then - it only led to a lot of retesting and anxiety for my patients."

Retest in another month or two - I will bet you a beer it drops down then.

Waaaaaaaaaay to early to be thinking about radiation - if for no other reason than you need to heal and regain continence before radiation.
Posted 8/4/2018 4:24 PM (GMT 0)
With your margin a G6, I agree, you’ve got time to let things heal before doing anything.
Please, let us know what the retest shows
Posted 8/4/2018 4:32 PM (GMT 0)
I agree that you should retest in a month or so.

Bobby Mac
Posted 8/4/2018 5:55 PM (GMT 0)
How are you doing otherwise? Are you recovering continence, or leaking like crazy? I know that psa reading is really discouraging, but there is nothing to do right away, anyhow. The important thing to do now is recover from surgery and do your best to regain continence. With your generally good pathology (MUCH better than mine) it seems very likely that the psa will continue to drop. Wishing you the best of luck!

Post Edited (fiddlecanoe) : 8/4/2018 12:39:45 PM (GMT-6)

Posted 8/4/2018 6:07 PM (GMT 0)
Thanks all continence getting better but still
Way to go. Good if not too active. Generally pad and half
Still no erections
Will let all know what surgeon says Monday
If anyone has similar score post surgery interested
Here. Much thanks
Posted 8/4/2018 6:50 PM (GMT 0)
Tom:

Who was your surgeon at Brigham?
Posted 8/4/2018 8:06 PM (GMT 0)
Hogo, do you want talk, maybe we
Can help each other
Posted 8/4/2018 8:08 PM (GMT 0)

tomobrain said...
Thanks all continence getting better but still
Way to go. Good if not too active. Generally pad and half
Still no erections
Will let all know what surgeon says Monday
If anyone has similar score post surgery interested
Here. Much thanks

I did, but it turned out to be an issue with Siemens assays used for the PSA test. Subsequent tests on other machines showed an undetectable reading and it continues to be so 1.5 years later. If I test on any Siemens machine, it will show somewhere between 0.029 and 0.059. I panicked just like you and was unable to calm down, so I had an immediate retest at another lab. That calmed me down...
Posted 8/4/2018 8:34 PM (GMT 0)
Mine was also a siemens machine advia centaur
Posted 8/4/2018 9:56 PM (GMT 0)
Tomo,

Two things:

1. Many surgeons test at 6 weeks (mine did), and it is showing the TREND, not the final. I was detectable at 6 weeks also. The 3 month test will be determinate.
2. Even if you need radiation, it can't start for a while..like at least 6 months after surgery. Healing still has to happen.

In other words, don't panic.
Posted 8/5/2018 8:00 PM (GMT 0)
Hogo dr trinh at DF
Posted 8/6/2018 4:50 AM (GMT 0)

tomobrain said...
Mine was also a siemens machine advia centaur

You can get a test at Labcorp on a Roche Cobas machines for about $109 using those online scrip sites like walkinlab. That assay will produce "<0.006" if you are undetectable. I'm not the only one. There have been about 4 healingwell members that I have noticed with low detectable PSA after surgery on a Siemens only to have it undetectable after testing on a different assay. Two others whose nicks I remember are "Worried Guy" and "Wilderness". You can search for their accounts.
Posted 8/6/2018 10:24 AM (GMT 0)
We've been around this merry go round many, many times. The consensus here is that for most patients, doing PSA at 6 weeks after surgery creates more anxiety than it alleviates. It's just too early. Period. You're not going to DO anything about it anyway: Even if there is persistent PSA, the guidelines say to not act until you have 3 readings in a row at least a month apart, AND that follow up radiation should wait a minimum off 3 months after surgery, preferably longer-like 6 months-to allow healing to finish. Early radiation is linked to both worse continence and ED.

It doesn't really matter what the biochemists say--THEY aren't patients. My straw poll in here is that at least 25% of guys who have surgery have a 6 week PSA that is detectable--low, but detectable--and they freak out. A follow up PSA 6 weeks later is non-detect in most of the cases. WHY DO THEY KEEP DOING IT?????????????
Posted 8/6/2018 1:07 PM (GMT 0)
FWIW, and my case is far from typical (whose is?) but I was tested at four weeks post-op and my urosurgeon declared me undetectable at <0.1 ... He stated that he was "not a fan of all the zeroes" but re-emphasized what he had told me immediately post-op, that I would require radiation in about six months.

Perhaps the "undetectable" statement might have been some reassurance, but the whole scenario thus far and looking forward was unsettling. My PSA was tested about every five weeks thereafter using the ultrasensitive assay and did indeed come back as very low but gradually rising nonetheless.

Other factors yet to come yielded far greater anxiety than just the PSA. But it is a tremendous relief that the value of PSA screening has now been reinstated as an important diagnostic tool, and not as I had been initially told "nothing to be concerned about".
Posted 8/6/2018 2:13 PM (GMT 0)

halbert said...
The consensus here is that for most patients, doing PSA at 6 weeks after surgery creates more anxiety than it alleviates. It's just too early. Period. You're not going to DO anything about it anyway: Even if there is persistent PSA, the guidelines say to not act until you have 3 readings in a row at least a month apart, AND that follow up radiation should wait a minimum off 3 months after surgery, preferably longer-like 6 months-to allow healing to finish. Early radiation is linked to both worse continence and ED.

what he said, twice.
Posted 8/6/2018 3:51 PM (GMT 0)
For what it's worth...
I was 0.04 after 6 weeks and have been undetectable ever since.
Hang in there, recover.
All the best.
Posted 8/7/2018 2:51 AM (GMT 0)
Just a quick update that i met my surgeon
At Dana Farber today. Long discussion but basically
Going retest in a few more weeks as he said sometimes
Can go down from 0.4 at more than 6 weeks as others have pointed out

Thank you all for your advise
Posted 8/7/2018 2:51 PM (GMT 0)
Is your PSA 0.04 or 0.4?
Take care.
Posted 8/7/2018 4:20 PM (GMT 0)
Sorry correct 0.04, thanks Samster
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