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Posted 6/26/2020 2:29 AM (GMT 0)
Looking for some help on this. I had RP almost 3 years ago and since then have had all undetechtable PSA tests. I had to go to the ER this week due to shortness of breath and they discovered that I have blood clots that started in the leg and broke off and traveled to the lungs. They are trying to determine the cause and with my cancer they have done all kinds of testing that has all come back good so far. The bad is that I had a CT scan of the abdomen and they said they found a spot near the surgery that looks like a lymph node, but they don't know for sure that is suspicious. My most recent PSA test was April and they also ran it again while at the hospital and again they are undetechtable. Is it possible to have a recurrence with my PSA's the way they are? Also, when I had my RP, they tested lymph nodes during the procedure. Thanks for the help on this!
Posted 6/26/2020 11:22 AM (GMT 0)
I can’t imagine that being cancer if the psa tests are ultra sensitive. (Especially enough to cause clotting).

Good for you for heading to the doc with the shortness of breath.

I’m assuming your post op path was clean.
Posted 6/26/2020 11:29 AM (GMT 0)
It’d be good to know the exact number of your psa.

These words get abused somewhat, sometimes.

My psa is technically “undetectable”....yet, it’s measurable.
Posted 6/26/2020 12:29 PM (GMT 0)
What IT said.
I’d have another opinion on the scan, then decide how to proceed. If second opinion says it could be a malignancy, then maybe ask if the lymph node is in a place that can be biopsies.
Posted 6/26/2020 1:51 PM (GMT 0)
Thanks for the replies. My Post Op was negative margins: Pathological stage pT3aa NO Mx
PSA's were as follows:

12/29/18 <.01
4/5/18 <.01
9/1918 <.01
3/18/19 <.01
10/21/19 <.05 (The labs testing parameters changed)
4/27/20 <.05
6/23/20 <.05

Post Edited (Mrbaseball220) : 6/26/2020 8:35:43 AM (GMT-6)

Posted 6/26/2020 2:30 PM (GMT 0)
Hi MrB. Your signature leaves out the most important information: the findings in your path report after your surgery. It would be of help if you update your signature. Specifically:

(1) Your biopsy staging was G7 (3+4); was this confirmed in the path report or was there an upgrade?

(2) You say the margins were negative and none of the lymph nodes removed were positive, both of which are good; however, your path staging was pT3a. This means the cancer grew out from the prostate. This is usually in the form of growth through the prostate capsule -- extraprostatic extension(s) or EPE. If you look at your path report, it probably has text that specifies the location(s) and the degree of the extensions, e.g., focal, multifocal, nonfocal, extensive. EPE is a risk factor for recurrence.

(3) Your path report should also have a estimate of the percentage of your prostate that was cancerous.

(4) Where there any other negative findings in the path report?

Where were your actual post-surgery PSA values?

A lymph nodes that appear enlarged on imaging may or may not be malignant.

Keep us posted and best of luck!

Djin
Posted 6/26/2020 2:47 PM (GMT 0)
Djin: here is the full report. Thanks for the help.

A: Peri-prostatic fat, excision
Mature adipose tissue with no specific pathologic change
Negative for carcinoma

B: Prostate and bilateral seminal vbesicles, radical prostatectomy:
Invasively poorly differentiated adenocarcinoma. Gleason score 3+4 7 Gleason grade 4 component is
prominent
The carcinoma involves both the r ight and left lobes and has a greatest nodular diameter of 1.6 cm.
The carcinoma shows focal extracapsular extension in the left posterior baes of prostate
Bilateral seminal vesicles are free of carcinoma
All examined surgical resection margins are free of carcinoma
Pathological stage pT3aa NO Mx

C: Left iliac internal/external obturator lymph nodes, excision:
No evidence of carcinoma in nine lymph nodes examined

D: Right iliac internal/external obturator lymph nodes, excision:
No evidence of carcinoma in nine lymph nodes examined

The tumor was approximately 20% of the prostate with the greatest dimension 16mm

Extraprostatic Extension - Present, focal left posterior base

Seminal Vesicle Invasion: Not Identified

Margins: Margins uninvolved by invasive carcinoma

Treatment Effect on Carcinoma: Not Identified

Lymph-Vascular Invasion: Indeterminate, focus suspicious for angiolymphatic invasion noted

Perineural Invasion: Present

Lymph Nodes: Examined 18 Number Involved 0
Posted 6/26/2020 2:57 PM (GMT 0)
It's interesting (and good) that your surgeon chose to remove so many lymph (negative) nodes for your G7 (3+4) -- most would have removed fewer. It's also good that your Gleason score wasn't upgraded (however, while your pattern 4 didn't exceed 50%, it was "prominent." I assume the double "a" in your staging, pT3aa, is a typo. The EPE was limited, also good.

Do you have your post-RP PSA values? An "undetectable" reading of <0.006 is more reassuring than <0.05, which, in turn, is more reassuring than <0.1.

Djin
Posted 6/26/2020 3:01 PM (GMT 0)
Djin:

here you go:

12/29/18 <.01
4/5/18 <.01
9/1918 <.01
3/18/19 <.01
10/21/19 <.05 (The labs testing parameters changed)
4/27/20 <.05
6/23/20 <.05
Posted 6/26/2020 3:43 PM (GMT 0)
It's good that you remain under the tests's limit of detection. That said, everything is relative. When they move you to a less sensitive test, you lose information when the results are undetectable.Your PSA could be steady, or, to play devil's advocate, it may have increased from, say, 0.001 to a current 0.049. What are your docs recommending? Wait and watch and then repeat the imaging?

I would consider monitoring your PSA with Labcorp's ultrasensitive (3-decimal) test. As a high-risk guy, I want to know what my PSA is, not what it's below.

Djin
Posted 6/26/2020 3:49 PM (GMT 0)
They said in the scan of the abdomen/lower body there was something suspicious, that looks like a lymph node that is near the site of my procedure. They want to biopsy that lymph node to be sure. They do not even know if it is a lymph node, but still want to biopsy the area. They did also say that it could be fluid that build up after the procedure.
Posted 6/26/2020 3:52 PM (GMT 0)

Mrbaseball220 said...
They said in the scan of the abdomen/lower body there was something suspicious, that looks like a lymph node that is near the site of my procedure. They want to biopsy that lymph node to be sure. They do not even know if it is a lymph node, but still want to biopsy the area. They did also say that it could be fluid that build up after the procedure.

I understand your concern, and I, too, would want to investigate. For the little it's worth, my guess is that it's not PCa.

Djin
Posted 6/26/2020 4:40 PM (GMT 0)

Hello, MrBaseball220 - - -

You are being proactive and doing your research.

I applaud you for being thorough, and hope you can get everything assessed.

That peace of mind is priceless.

As you await further imaging, diagnostics, and perhaps a biopsy, have you been prescribed a medication that dissolves, and perhaps even prevents, future blood clots?

Wanting all the best for you. Stay in touch with us here, and let us know how you're faring.

Hoping you can get the blood clotting situation resolved soon.

With my best,
Cyclone --- # Iowa State University
Posted 6/26/2020 4:43 PM (GMT 0)
Cyclone, thanks for the message. Yes they put me on Xarelto to thin the blood and helps dissolve the current clots both in the lungs and one still in the leg and prevent future ones. Hopefully I can get in and get his biopsy done quickly and get some results!
Posted 6/28/2020 11:29 AM (GMT 0)

Thankful to hear that update --- medication to dissolve the blood clots you described.

You are taking informed, decisive, proactive "let's get this resolved" steps! That approach encourages others with medical issues to make that call, and rally their medical team.

Stop by again for a visit, and keep us updated. Hope you are feeling your best!

Keep us posted on your progress!
Cyclone ••• # Iowa State University
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