Rapid rise in PSA only 4.5 months after Prostate surgery

Hi, John--

I'm glad you found this forum, sorry you have to be here, though. In any event, welcome.

A pre-surgery PSA in the 20s suggests a decent tumor load, so it's not super surprising to have persistent PCa post-surgery. Could you tell us the details of your pathologic T (expressed as "pT"), based on post-surgical examination of the removed prostate? E.g, was there a positive margin, extraprostatic extension (EPE), seminal vesicle involvement (SVI), lymph node involvement? Those would all suggest a higher likelihood of persistent PCa.

The important thing is to get back into a doctor's office -- either your urologist/surgeon, for a referral to a radiation oncologist, or directly to the RO -- to discuss the particulars of your case.

Best wishes,

SP.

John, it does look like some additional treatment, like RT an/or androgen blockade/deprivation/hormone therapy are most likely called for. I would think your surgeon would be rapidly pushing you in that direction with referrals. If not, you should push him in that direction. I'm not saying you should panic, but it is very likely that more treatment is called for, so you might as well get the ball rolling.

You are not alone Big John. I was at .40 six weeks after surgery. I'd recommend ADT+SRT as soon as you are well enough...but of course, I'm not a doctor.

You should get the written pathology report, for your own information and also so you can share it with other doctors. I think it would make sense now to start the process of finding a radiation oncologist you are comfortable with. It may be some months yet before you begin RT because it is good to have your wounds from surgery heal up as throughly as possible before you begin the next medical assault on your body.

Thank You for all the replies its very much appreciated.

Before this PSA test I was feeling great and have even been running albeit slowly. And now I have a burning in the middle of my back and down my legs to my knees. I think I'm my own worst enemy and feeling cancer everywhere. I liked to shut down my brain about the cancer but can't.

Thanks again for the caring replies.

Big John, sorry about your numbers, but as others have said, post surgical treatment is not out of the ordinary and there is a wealth of information here. Not to repeat what others suggested, but you really need to get a written post surgery pathology report, then share it with the forum brothers. The more information you can share then the more the forum can help.

I had a similar situation as yours and am now waiting until May to get my first post Radiation and ADT psa result.

Big John if you read the ADT and SRT journey thread i think there are 6 pages now, you will see several guys that have been in your shoes, might give you some stress relief in reading our stories and experiences. One of the things I stress is find yourself a good team that you will feel confident in and then choose a treatment. From my experience i would think that they will have you wait until you heal up enough to have radiation mainly good control of your continence then a couple of months before you start radiation they will have you start some kinda ADT. I will update the ADT and SRT thread for you and others that might going down this course of treatment

Larry

Alberta Canada

Hi LJK
Thanks for your reply as well as everyone else on this form.

I had considered external radiation with brachytherapy (high dose seeds) but decided surgery because we were still thinking the cancer was only in the prostate. And I was told if you have radiation you can no longer have the surgery.

Going to see about radiation today at the hospital.

This forum has helped me not to feel so fearful.

P.S.How do I but my personal data at the bottom of my posts?

Big John,

I had to figure out the signature thing too. 😊. You need to be logged in. Go to the menu upper left corner on your screen. Go into my profile, hit edit profile & scroll down to signature. Hope that helps. ~LjK

I think it is really terrible when a surgeon says if the surgery doesn't work we can radiate, but if the radiation doesn't work we have no back up. That is simply wrong for many reasons and has been well discussed on this forum. Surgeons should be held to higher standards when they explaining treatment options. Actually salvage surgery after radiation is possible, but very difficult and infrequently used. But, thankfully it is rarely needed.

Surgery fails about one third of the time due to PCa already being outside the surgical field. The percentages of failure go up with the risk factors. When this happens, salvage radiation therapy is the standard of care if it is suspected the remaining cancer is likely to be within the planned radiation field. If the PCa is either known (by scans) or highly suspected to be outside the radiation field, then there is no need to use SRT as it would not be curative and subject the patient to additional side effects. Then systemic treatment is pursued like ADT, chemotherapy,and immunotherapy.

The incidence of radiation failure is generally less than surgery and significantly less than surgery in the high risk cases. The reason is very simple. The radiation field can be much wider than the surgical field and can do a better job at getting the locally advanced PCa that the surgeon can not reach. Radiation can also be more effective on the pelvic and abdominal lymph nodes that are difficult to be adequately removed by surgery and more likely to be involved in high risk even though nothing shows on scans. Remember micro-mets will not show on any currently available scan, nor can a surgeon see them. . In the less frequent event that radiation fails it is most always because the PCa was already outside both the surgical field and the larger radiation field indicating that no primary treatment would have been curative. This is more common in high risk than lower risk situations. In the very uncommon event the PCa is found to still be local following radiation, there are several focal therapies that can be effective after radiation including High Dose Rate Brachytherapy, HIFU, Cryosurgery, NanoKnife, and SBRT.

Many here have complained mightily when a surgeon uses this red herring explanation and neglects to fully explain the situation and options. That is why we always advise to not listen to the surgeon about radiation because the surgeon is not the radiation expert. Only get the radiation information from the expert radiation oncologist. And vice versa.

In the nearly nine years I have been on the forum the incidence of failed surgery and subsequent SRT has been commonplace. The incidence of failed radiation that was confirmed to be still be local has been rare. Numerous studies, papers SEER reports, etc. have confirmed this. The only case I can think of is the fairly recent man that was G6 and had permanent seeds for initial treatment that suffered a recurrence when an additional tumor was found near the bowel. He is now treating it, hopefully successfully. I am struggling to remember his handle and I hope another member can help my bad memory.

So the lesson is to do your research and get information from the expert source.

LadyJaneK said...
Hi Big John,

My husband & I are still very new to this forum site, but it’s been a great resource for us & the guys here know their stuff & have been very supportive.
A special hello from Manitoba & I welcome you along w the others here.

Sorry to hear about your PSA#’s going up so soon after surgery. Not the way you were expecting things to go I’m sure. Your original PSA was quite high. I’m curious did you consider going the RT & ADT route vs surgery?

We are currently making this decision & it’s not easy. In Jan/19 my husband (56) was diagnosed w a PSA of 150! His scans appear negative too & our Prostate Center is steering us towards surgery, however we are fully expecting he’ll need Radiation Therapy & ADT therapy as well.

This is not an easy road to be on. Good luck w this next phase & your treatment decisions ahead.

~LjK

LadyJane,, With that high of a PSA and GL 9 why would you consider surgery? I only had a few gl7 with PSA6 and the cancer was (supposed) to be confined. They took all my nerves and a bunch of lymph nodes. Neg margins PSA is creeping but in the .07 area.