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UROLOGIST UPDATE Dull ache returns 9 months after surgery

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Posted 1/18/2019 6:49 PM (GMT 0)

Dharmacolm said...
Island Time. Im also being educated by your psa stats after surgery!!! I notice they have went up past my latest reading and back down again. Did you have any other treatments? In any case its encouraging and congrats on your path.

I've had no other treatments. I did have a positive margin. The cancer at the margin is G6 (JH). I'm going with it being indolent. My personal trigger point for more treatment is 2 consecutive tests above .1

If I were you, I'd be asking my urologist....

"Have you ever seen a pathology like mine, with no positive margin and PSA, where the lingering PSA remained stable?"
"How could this PSA be in the prostate bed with no positive margin?"

And then of course....(in your case)…."I want to know that cancer isn't causing my pain. Whatever we have to do, that's what we have to do".

You may be in the same waiting game as a lot of us. But no one knows what he'll say until you get there. It may be that he'll test you again in 3 mos. When, or if, to treat is something that you, your uro and an RO would need to discuss.

That .03 cutoff is a recent development. There's some studies out that show some benefit to catching at that low a level. But, at least for me, the percentages gained by treating at .03 do not outweigh the negatives.

Edit: You might also have them send your post operative slides to John's Hopkins for a 2nd opinion on your pathology. It's possible that Epstien might find a small margin that your local pathologist missed. That's what I'd do anyway.
Posted 1/18/2019 8:06 PM (GMT 0)
Thanks again Island Time. I'm taking notes.
Posted 1/19/2019 4:49 AM (GMT 0)
This is a post by Tall Allen on 2/16/17:

BCR is defined as a confirmed PSA ≥ 0.2 ng/ml. But it is a definition from the turn of the century when conventional PSA tests were all that they had. On those tests, 0.1 was the lowest detectable PSA (anything lower was "undetectable"), so the urologists arbitrarily decided that 0.2 was a convincing indicator that the cancer was back. There's nothing magical about that number.

The decision about what PSA to treat at is a different decision point than when BCR occurs. I laid this out graphically:

/pcnrv.blogspot.com/2016/08/how-soon-after-surgery-should-salvage.html
Posted 1/19/2019 2:08 PM (GMT 0)
Is there another way to get that blog GoBucks? Its saying that the page doesn't exist.

I also found this study very helpful and it seems to relate to your path Island Time.

https://prostatecancerinfolink.net/2015/01/14/low-detectable-psa-after-prostatectomy-watch-or-treat/
Posted 1/19/2019 2:51 PM (GMT 0)
Dharma....
First, at a PSA of .04 it is way more than highly unlikely that you would have symptoms related to cancer. So get that thought out if your head.
Second, you have no trend. Yes need one, probably two more tests a couple of months apart to establish a trend. Nobody will treat you without a proven trend
Third, no scan will pick up anything with a PSA of .04
Fourth, as you well know, PCa moves at a glacial pace, especially a g7(3+4), so no need to rush into anything.
Fifth, this could be lab error

If you get anotherrise, then I would seek out a good radiation oncologist so that if you do have proven BCR down the road, you can hit the ground running.

.2 + 1 or 2 rises after that is considered BCR according to standard of care. But more and more , studies are pointing towards earlier treatment is better.

So bottom line, keep a close watch on it, but try as best you can to stop stressing out until you know more, because
1. That will not change anything
2. Every day you stress is another day in your life that you will never get back
3. Stress is bad for you
Posted 1/19/2019 4:10 PM (GMT 0)
the only symptom of PC at PSA of .04 would anxiety...
Posted 1/19/2019 4:59 PM (GMT 0)
So you don't think my month long discomfort in my testicle and lower abdomen is linked either InTheShop? Its encouraging to hear these opinions I must say. I have read that Epididymitis is a fairly common develop even months after surgery brought on by latent infection. For those who don't know, the epidiymis is a bundle of veins on top of the testicle. It kind of feels like a small brain on top of an egg (yes, that's my best description). Mine is very tender to the touch on my left testicle. It almost always presents on the left side. The collection of veins on each side of the testicle are different. The pain for this can be acute or dull chronic pain and can radiate into the abdomen as can a varicosele which is a swelling of the veins also usually on the left side of the scrotum. I've never wished for a medical condition more than wishing I have Epididymitis. It can be treated with a course of antibiotics. I'll be running that by my Uro on Wednesday.
Posted 1/19/2019 5:06 PM (GMT 0)
Just seen your post Pratoman Thank you AGAIN. I will try my best not to crack up.
Posted 1/19/2019 8:53 PM (GMT 0)
you got something, but PC aint it.
Posted 1/20/2019 4:29 AM (GMT 0)

Dharmacolm said...
Is there another way to get that blog GoBucks?

https://pcnrv.blogspot.com/2017/07/how-soon-after-surgery-should-salvage.html

Try that.
Posted 1/20/2019 8:42 AM (GMT 0)
Great, thanks GoBucks
Posted 1/26/2019 5:12 PM (GMT 0)
Well Pratoman and others you were right. No incentive or pointin doing anything at this stage.

Could my 0.04 reading be a mistake? "Not likely but possible"
Could it be stable psa from benign tissue that just popped above undetectable? "Yes"
Could it be recurrence? "Too early to tell. Your next PSA is important. Come back in 4 months"

Says my symptoms are definately Epydidimitis which is very common in men and treated with anti inflamatories and or antibiotics. This was confirmed by my GP. He says to just try the anti inflamatories first. Many cases go away by themselves.

Im very aware how erratic I have been throughout these posts but I suppose its fairly normal. I wont lie Im still worried as a detectable psa this early after surgery is not good as far as the stats go but Im going to get on with my life until the next test in May. Ive booked 2 weeks in the Algarve with the family in May. Havent decided if I'll get my next PSA before I go or after I come back. Any thoughts?

Could be Im in this for the long haul could be Im not. Gotta learn to walk with that dragon and I will. I've thought a lot about it and if its a creeping rises Im gonna go with Island Times outlook and have 0.1 as my cut off for further treatment. Thanks for everything guys. Any questions or advice appreciated in advance.
Posted 1/26/2019 6:05 PM (GMT 0)
Put this all aside for a little while. Enjoy your family time and then get your PSA done.

It's scary - we all get that. You've got a lot ride on the results.

Rest a bit from this PC world and come back and hit it fresh then.
Posted 1/26/2019 6:12 PM (GMT 0)
Thanks. Great poem. Happy memories can hurt like hell.
Posted 1/26/2019 8:06 PM (GMT 0)
“I’ve worried about a lot of things in my lifetime , a couple of which, actually happened.”

I’m glad ya keep to keep your nut Dharma. That’s always a good thing!

Buddy, your worryin’...you wear it well. If you could’a seen me....(and may still. lol)

Have a good trip man.
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