PSA 6 weeks post surgery

hi all,
i had robotic prostatectomy 9 weeks ago. i just received PSA results of blood tests 6 wks post surgery and it came back 0.04.
Is this a good sign or doest it mean i will need radiation or is it too early to tell?

cjeff

What was your PSA before surgery? 12 weeks is the test that matters as JayMot indicated. Early results under 0.10 are good whereas over 0.10 is generally not encouraging but still early.

Posting your particular stats in your signature would help all of us help you with your journey.

Theoretically your PSA should be undetectable at six weeks, but in the real world it doesn't always work that way. 0.04 is pretty dammed close anyway. Don't stress, you have a great chance of being undetectable at 12 weeks.

We have many guys on the forum who were detectable at six weeks, and then went to undetectable at 12 weeks.

Good luck!

thank you. yes, need to wait...
will post when i get new PSA results.

This is my histology report. Any idea what this means in English?
Good health to all

cjeff,

Welcome. First, the 0.04, while non-detectable is darned low at 6 weeks, so expect your 3 month reading to have the valuable "<" in front of whatever number it is. Depending on which lab you use, and which version of the test they run, you may see a < 0.006, or a < 0.04, or anything in between. The important thing is the "<"..which means that you have a value below what they can measure with the test.

Your histology report gives some important information:

Your primary gleason score is 4+3 with a little gleason 5. This means you are at a somewhat elevated risk (high intermediate) for future trouble. It says you had seminal vesicle involvement, again indicative of possible spread outside the gland. More concerning, you had both edge margin involvement and apical margin (at the pointy end just above your bladder).

All in all, not a bad report--but not a great one either. Your 3 month PSA will be really important. If you get the less than, you're good. Be prepared for a lifetime of PSA tests, and with your higher risk diagnosis, be ready to take action sooner instead of later if it (a) doesn't go to non-detectable or (b) moves off of the non-detectable. The dominant G4 with a touch of G5 makes you at higher risk for future metastisis--and acting as soon as it appears will be important.

If you go into your profile, there is a place to 'add signature'--in there you can put down your treatment dates, what your biopsy showed, what your final pathology is, etc. Where are you located? Feel free to tell us a bit more about yourself, we're interested.

Hi cjeff and welcome to the Forum! In terms of risk, your Gleason 7 (both 4+3 and 3+4) with tertiary* (or focal) pattern 5, is considered to be Grade Group IV by some researchers (for example see Table 3 here). This will be academic if your PSA becomes and remains undetectable, but, coupled with your pT3b staging, does mean you and your docs will be paying very close attention to your test results.

As you know, PSA is a fairly crude diagnostic tool for PCa in men with prostates, but after a RP it becomes an exquisite indicator of any remaining healthy and/or malignant tissue. When PSA persists after surgery, adjuvant therapy is usually recommended after a healing period. Just how much PSA qualifies as "persistent PSA" is a matter of debate, but you can discuss this with your docs.

Wishing you the very best for a lifetime of undetectable readings!

__________________
* When Gleason pattern 5 accounts for a small amount of the cancer (usually <5%), it is listed as a tertiary 5 after the primary and secondary patterns. The three score that may have tertiary 5 are 3+4, 4+3, and 4+4.

Djin

cjeff - It pains me to read your history, very similar to mine of a year and half ago so I understand what you are going through now (read my signature for similarities) You hope for great news after surgery that the beast is gone to find out you don't know anything for sure and waiting for the next PSA.

In my opinion, you need to productive between now, your next PSA, and your doctor appointment. Regardless of your next PSA, your doctor will be explaining adjuvant and salvage radiation options to you given that your post-op pathology was less than what you hoped for. Some things you can be doing now remotely:

1) Contact your doctor and ask about having your cancer tissue sent for Decipher genomic testing that helps establish future cancer risk potential separate from Gleason scores (another piece of data).

2) Consider getting a second opinion on the post-op pathology slides from someone like Epstein's group at Johns Hopkins to make sure you have agreement on the actual cancer assessment. Your doctor should be able to arrange this with the pathologist.

3) Ask your doctor for some radiation oncologist recommendations to get their opinions on future treatment options while you are waiting. Seeking out a well know cancer center might be a good idea as well to make sure you are getting the best advice.

4) Obtain copies of all test results, scans and procedures for your files and future reference.

Having this information before your meeting with the urologist will be helpful and not materially affected by the current Covid restrictions.

Good luck with your recovery and ask any questions as they pop up in your mind. I did not enjoy this time at all in my recovery.

Jeff - Did you have your work done in Malta? Just noticed your location.

I am doing fine, thank you for asking. Time heals all except the periodic PSA testing which is a constant reminder that life is a little different now.

It takes a long time to sort all this out in your mind as you revisit your life and wonder how you got to this point and what to do next. You will get used to it after awhile and become more at peace with your situation. Until such time, ask questions and try to assimilate all the info you read.

Jeff - Sounds good, my recommendations are still valid but based on a US medical system. Not sure how you go about getting the genomic testing and second opinion assuming a national health care system of some sort. The samples and slides are small so FedEx is pretty good at getting them anywhere. The genomic testing can be expensive but the JH second opinion is under US$300 so not so bad.

Hope Malta is nice and not a crazy place.

Post Edited (Mumbo) : 5/16/2020 8:23:59 PM (GMT-6)

Cjeff, ive been MIA on this thread, and have nothing to add, you’ve gotten great feedback from the guys here. Just want to wish you good luck on your future tests, let’s hope you are done with this beast, aside from the anxiety related to PSA tests.

cjeff, you got some great feedback here. Good luck on where this takes you. No need to reprioritize your bucket list but I’d scratch off any cruises and not because of the prostate issue.

cjeff, not great news, as you would have liked to see a "<" in front of the number, meaning below the detectable limit. But it did go down a bit, and its possible that it could remain around this level for a very long time, if not forever. So not time to act, IMO.But keep a close eye on it. You'll need at least two consecutive rising PSA results, to clearly establish a trend. Once that happens, and hopefully it won't, you'll likely need treatment, and with your pathology, you probably wont want to wait until the traditional definition of biochemical recurrence, or .2, that many urologists use.. .

Good luck, and keep us posted.

hi and thank you,
no not what i was praying for but it is what it is. got PSA bloods at the end of next week and i hope it will go down a notch again.
will be back with news when i get it.
take care