8 Weeks post Surgery

Hey Guys, Had a PSA of 2.2 on Jan 16th. Prostatectomy was 11-26, was hoping for a better result.
after the PSA of 3.9 ten days out. I am guessing it probably went lower and is on its way back up ?
taking another PSA in a few days to see what the trend is. Will probably start hormone therapy soon....Bladder function is coming along ok. wearing light pads, twice a day. getting up once a night...Rad/Onc says we'll see how my system reacts to Lupron, probably start RT in a few months.
Still trying to stay optimistic. ... Thoughts.

Hang in there, John! Give your remaining PCa the triple whammy! Report back to us as your PSA drops on therapy. Although a low 3-month PSA is good for its prognostic value, surgeons often want a 6 to 8 week PSA to be on the alert for persistent PSA in high-risk men after RP.

All the best,

Djin

That is a bit high even for 8 weeks--it should have been less than 1.0, ideally less that 0.5. So, yea, adjuvant therapy is in your future, I believe. "Triple Play" is surgery + hormones + radiation. Have you visited with a radiation oncologist?

JOhn,

Some of the guys who have been through it can answer better than I. What is generally accepted is that adjuvant radiation will pause your post surgery recovery--or even turn it back some. This is why holding off as long as possible is important.

I agree with Stephen, if your PSA is truly up to 3.9 post-op, a scan might give you something to aim at. ADT might be premature until a scan is done. There is clearly something else going on that removing the prostate did not materially affect. The next PSA will be a key indicator.

Sorry John, I misread your first post and signature. Your PSA at 10 days post-op was 3.9, down from 12.2 pre-surgery, then 2.20 on Jan 16th. Your 3 month PSA (Feb) will be the key value before making any decisions. If your PSA is still greater than 1.0 as an arbitrary value, I think you have to consider a PET scan to look at lymph node, bladder, etc. There has to be a significant amount of something left or existing that would keep the value high at 3 months. ADT would begin after the scan in my opinion but what do I know....

Half life of PSA is about three days. If all the prostatic tissue and cancer was excised you should be undetectable by about 30 days. The reality is that no RP excises all the prostatic tissue, thus there may be some small amount of PSA and a cure or remission can be as high as a stable 0.20 PSA. Thus, most urologists rely most on the 90 day test after surgery, but if a test is done sooner, I am sure most would want to see it lower than what you are experiencing.

While another test will tell more about the trend, it appears obvious to us lay people, that something is still expressing more than expected PSA. Is that benign prostatic tissue that was not removed, PCa, or both, is not yet known. Djin makes excellent points about the bladder neck and particularly seminal vesicles and how difficult some situations are regarding excision. In your case, these could be areas that may deserve more scrutiny via scans.

It is time to get serious with a RO and scans. While SRT generally will halt the improvements after surgery as Hal noted, you can start ADT months before the SRT starts. This will halt the cancer and give more time for surgical rehabilitation and starts protecting you against the potential of systemic disease, which is a real possibility given the significant amount of G4 present. The scans can be valuable if they show suspicious spots and can be pursued in the next coupe of weeks. I would not be playing any kind of waiting game to see what any PCa left behind might do.

You might also discuss the value of a genomics test like Decipher on your RP tissue. In addition to a score for the metastasis risk of your particular cancer, the accompanying GRID report provides a theoretical estimate for your response to post-op RT, ADT, one immuno drug, and one chemo drug. There are case of PCa that are locally aggressive, but do not metastasize.

Djin

Post Edited (DjinTonic) : 1/22/2020 8:37:51 AM (GMT-7)