Six-month PSA results - bad news

Just got back from my dr. appt.  Wasn't good news.  My PSA doubled from .05 to .10 in just 3 months, and this was the six-month post surgery test.  He did a DRE, which I didn't think I would ever have again, and found nothing.  He's 99% we have reaccurance already, but he's scheduled another PSA in 6 weeks, if there is any movement upward, he wants me to hook up with the Oncologist and Radiation people.  He will use my former Oncologist, one of the best in the state, who took care of me ten years ago.

My dr. did comment, that is the trouble with Gleason 7, and why men shouldn't play around with them.  Even though my post surgery pathology was "clean", doesn't take many cells to have escaped to start all over again. I am proof of that.

He told me some utter horror stories of salvage surgeries he had to help perform when he was a resident, one reason he said he would never do one himself.  He still feels strongly, despite today's news, that I am doing things in the correct order.

If we have to do salvate RT, then he said without the prostate in the way, they can really do a focused and targeted attack on the prostate bed, and in most cases, that will finish off the cancer for good.

Now I have to let this bad news settle in.  Shows that some of the pre-surgery info is accurate, about PSA velocity and doubling times can give you stronger chances of reaccurance, even after having surgery.

All for now, this will just add to my depression.

David in SC

Hi David,

Sorry to hear the news. I hope your oncologist can get you on a treatment plan soon. You are in my thoughts and I'm rooting for you.

Mike

Purgatory:

There's a relativly recent VA study that talks about "small and fluctuating" PSA levels caused NOT by PC, but just by small amounts of benign prostatic tissue

left behind.  I coudn't put my fingers on the study, but it's out there somewhere.  It was a small study, 750 men who had undergone RP.  If I find the link I'll post it.

Good luck.  Hope for the best, but plan for the worst.  It's bad enough to have to go through this once.

Can the Proton Beam be used for the salvage radiation, to avoid the side effects of conventional radiation?

David-
I am so sorry to hear the news. It's not that there are not options, because we both know there are. Unfortunately, my family knows all too well the feeling of accepting the diagnosis, preparing mentally and physically for the surgery and recovery and starting to feel like life can get back to normal and then getting a bad report. It definitely takes the wind out of the sails. However, it sounds like your dr has a great plan and you will get through this. Take a day or two to be down if you need, but know that you have the support of many and we will be the wind in your sails if you need us. You can still knock this out, it just might take two rounds. Thinking of you.

Hi David, Sorry to hear about the new PSA levels, I hope that this new schedule of treatment will help.  From reading your message I know that you are a fighter and I hope to send you my wishes that you fight as well this time as you have done in the past.  I once again wish to thank you for your messages to me, I will be here for you as well. Joseph age 46 CT Scan: clear for now Bone Scan: clear for now Chest X-ray: Compressed fractures in Thoracic Vertebrae

Thanks TC, Doting, and Pirate, just hard right now trying to put a positive spin on bad and unexpected news.

Squirm - despite surgery, microscopic cancer cells could have already escaped, too small to be detected by any scans. With a PSA above 12 and a Gleason of 7, plus strong PSA velocity, I knew all along that I was in a much higher risk group for reaccurance after surgery, just didnt expect it this soon.

Joseph, kind of tired of being a fighter, that's all I have done the past 10-12 years of my life with one medical crisis after the next, that's why I already look 65-70 instead of my natural age of 56.

I had such a terrible time of going through radiation in the year 2000, I fear the thought of having salvage radiation for the PC if needed. This is why I wanted surgery over radiation in the first place.

If I didn't have a good wife, kids, and family, I would know just how to end this nonsense and save everybody a lot of trouble and money being wasted.

David

Dear David:

I am SO sorry to about your latest results...it seems that you just can't catch a break and that seems very unfair.  Having, said that, I know your story includes many issues over the years that you have overcome and I pray that you will overcome this problem as well.

Now...I am going to give you some advice that I think you would give someone else with these issues.  That is, to immediately seek another opinion from another urologist.  I know that you have a lot of faith in your current doc, that he is convenient, etc, etc.  However, let's examine the facts as you have presented them over the past months: 

1.  Major catether issues that were finally fixed after you asked about treatments you learned about on this forum.

2.  First he said he had not spared the nerves then, oops, I guess they must have been spared after all.

3.  Everything was clear post-surgery but, oops, PSA is up...guess we didn't get it after all.

Maybe this latest jump is residual per KeyWestPirate...maybe not.  But, don't you owe it to yourself not to wait 6 weeks?  I'm not trying to be a doc-basher, just trying to honestly help you consider your options.

Good luck and please keep us posted,

Tudpock

Hi David,
I am sorry to hear this for you. Maybe it will be lab error or residual tissue. I am glad you and your Doc are proactive in wanting to get things lined up. As my signature says I had to go this route and the radiation was not that big of a thing other than just getting there everyday and trying to work at the same time. Now there is the waiting to see whats up. I am going to have a PSA drawn next week for an appointment with my URO/Surgeon on the 20th. My last PSA reading was in September and was 0.1. I did cheat a bit and had blood drawn a couple of weeks ago at a health fair and was glad to see it come back at 0.0. It wasn't an ultra sensitive test but I will take it. I wish you the best and you will be in our thoughts and prayers.


David

dsmc - hope your results match what you found out early, hoping the best for you too.

les - today's experience is why I hate PC so much, its too unpredictable, too uncertain of its paths and turns, too mean and can be too agressive as you well know. Sometimes, I and I know this is not logical even saying it, I swear I feel I am being punished for something. I don't know what, I am not a bad person, I am a sinner as much as the next man, but I try to live a clean decent life, and treat others fairly as I would like to be treated. I don't see it as a flucuation, and not a flaw in the test. The original post surgery psa of .05 was actually on the high side to start with, so I have been nervous all along. If I were 75 years old, I would probably take this more in stride (no offense to our elder brothers), but I am only 56. It is what it is, so all the wishing in the world won't make this go away. Going to be a long 6 weeks to the next test.

If I go the salvage rad route, I already know my oncologist, and he is the best of the best. If I hadn't had such a terrible time with previous radiation, wouldn't be as worried or concerned, but it really did a number on me.

Thanks for your care and concern, that I know is real, and I can feel it from SC

David

Hi David:

OK...this is my last post on your doc.  I'm not blaming him for the recent PSA rise.  I'm just saying, from a totally objective party who has read almost all of your posts, that I would get another opinion.  Maybe he is ""very, very good" but, leaving everything else aside,  how in the world can he not know whether he spared nerves or not?  C'mon...

If you were my brother, son, best friend...all I'm saying is that, after objectively reading your posts, I would advise seeking another opinion and not waiting 6 weeks.  But, your body, your decision and now I'll shut up...except to say that I feel horrible about what you are going through and really hope for the best.

Tudpock

Sorry to hear the bad news Dave, I hope your next step will kill what ever cancer is left there. RT after surgery seems to get good results and that is what I will pray for you. Hang in there.

Words fail me, Purgatory. I assure you that you will be in our prayers tonight and that all will be well.

Please don't feel you're being punished for something - I know this is much easier said than done. You are a strong and extremely kind man who has done so much for so many. You will get through this.

You are not walking this path alone - we are all with you, every step of the way!

Hugs and kisses from The Big Apple!

Joanne and John

Hi David,

First let me tell you how sorry I am about your increasing PSA. I know exactly how you feel because a few short month ago I was in a similar situation as you. My timeline was a little different, but I had a recurrence and opted for salvage radiation as soon as I felt sure that the cancer had returned. I had very little difficulty with the RT and my PSA dropped by 50% only 6 weeks after completion. My 6 month checkup is in July and I'm hoping for the best.

Life is not always fair, but like it or not, we have to deal with it as it unfolds.

I'm wishing and hoping that we will both be around for many years to come.

Magaboo