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Posted 8/3/2009 4:05 PM (GMT 0)

This may be a stupid question but I cannot find any information on it anywhere.  If my path report which has been reviewed by 3 separate Pathologists all state the my cancer is a Gleason 8 but was contained within the prostate no sign of it getting out anywhere, margins all clear and lymph nodes all clear stage T2a.  Why would there be a possibility of the cancer recurring.  My PSA after 9 months went from 0.0 to 0.1 and all the doctors say not to worry still undetectable but why would PSA still be in my body if the cancer was contained.  I understand it is possible to have cancer in a different part of my body but not prostate cancer.  Am I right or am I missing something.  How would the PSA cancer cells get out if everyone including John Hopkins say it was all contained?  I would appreciate any insight to try and understand what I may be dealing with.

Thanks,

Jerry1   

Posted 8/3/2009 4:28 PM (GMT 0)
…”10 percent of radical prostatectomy patients whose cancer appears to be confined actually have microscopic metastases that were not detected…” (Scardino & Kelman, p. 265). So even though everything looks good in the pathology, some of the stuff may have escaped and taken up residence elsewhere.

PSA may also be generated by non-cancerous prostate cells that have been left behind.

As it was explained to me by my surgeon, while the pathology report is a useful indicator, the only way they really know that they got it all is to watch the PSA.

Good luck.
Posted 8/3/2009 4:38 PM (GMT 0)
It is not quite right to think of PC as some sort of creeping vine that always has to be connected to its roots. Loose cancer cells can drift out of the prostate. The most likely place for them to lodge other than the lymph nodes is in the prostate bed which is why that is the most frequent target for salvage radiation.

You are correct that a good path report like yours suggests a lower probability that any cancer cells have escaped.
Posted 8/3/2009 5:13 PM (GMT 0)
I think I have read somewhere that there are other glands that contribute to PSA, while of course the predominate one is the prostate. That is probably why most doctors use the 0.2 as the determining factor of recurrence and other docs use the rule of thumb of three consectutive increases. So while you rose to that 0.1 mark only after 9 months, I would watch to see what it does closely to see if there will be an additional rise in the coming months.

Factors to consider if you have subsequent rise in PSA...the velocity and the doubling time along with the amount of time since surgery. Those factors can often determine if the recurrence is local or distant and what the best treatment plan should be.

Keep us informed...
Posted 8/3/2009 5:22 PM (GMT 0)
Gleason 8 is the other big reason. Gleason 8 ,9 and 10 ( if there is one) are particularly agressive. A couple of cells wandering around csn start a whole new colony somewhere, and apparently statistically do.

That is why many oncologists are recommending adjuvant radiation within 4 months if the gleason is 8 or above, based purely on reocurrence rates of those groups with agressive Gleasons.

I am in that class as well. Having a hard time convincing myself that radiation is worth it with a 0 PSA. I am getting rechecked every 3 months for now.
Posted 8/3/2009 5:38 PM (GMT 0)
 

Thanks to all of you for the information.  Like I tell my wife once you have cancer it is always there no matter what they say.  My doctors do not recommend radation at this time unless my PSA continues to rise.  I will be going again in 2 months for my 12 Month PSA and hope it stays at 0.1.

Jerry1

Posted 8/3/2009 6:43 PM (GMT 0)
Jerry your current stats are much like mine, except for I am a Gleason 7, not an 8 like you. I don't want the radiation unless reaccurance is really there. Rather hold off on that "gun" until when and if it is really needed.

Good luck to you.

David in SC
Posted 8/3/2009 7:45 PM (GMT 0)
Since the sensitivity of the test is 0.1, a jump from 0 (or <0.1) to 0.1 could be very insignificant. If it keeps rising beyond 0.1, then you can start worrying, but not yet... I hope you will not need to... Best of luck!
Posted 8/4/2009 2:21 AM (GMT 0)
Could be a dyslexic lab tech too !
Posted 8/4/2009 3:08 AM (GMT 0)
Hey Jerry,

Most doctors will never profess that they have cured a PCa patient. Microscopic cells do sometimes find their way out even in a "contained" pathological situation like yours and mine.

My PSA took a little jump as well (as did Purgatory's), so I understand your concern. In my case, the doctor believes that some benign tissue was left behind. Time will tell. In addition, a good doctor will watch you carefully and help with additional treatment options if necessary.

My PSA rise really bugged me for a few weeks, but seeing the strength of many good folks I've met through this forum has really helped me.

I hope you find comfort and I wish you the best in remaining cancer free.

Kind regards,

Barry
Posted 8/4/2009 9:44 AM (GMT 0)
Greetings, Jerry.  Unless you are having the ultrasensitive test and it is done by a very good lab tech, small changes can simply be changes in how they do it and no actual change in your PSA.  I think you are wise to continue to monitor closely and I know I would raise the red flag if mine went up even though I know that since my doc doesn't use the ultra sensitive that most likely it is nothing.  As we all know, once you have this disease you look at that PSA test every 3 months a little differently.  Please keep us posted on how the next one goes.  David

Posted 8/4/2009 6:57 PM (GMT 0)
The basic problem is balancing risk. On the one hand, treating when it is not necessary and exposing the patient to the risks of treatment and additional side effects. The other side is treating too late and exposing the patient to metastasis and much less successful and more aggressive treatment and harsher side effects. Short of having a crystal ball, no doctor can advise you accurately on what to do or even the probabilities that you as an individual face.

Listen carefully, seek multiple opinions, and weigh your own preferences.

For the present -- watch your PSA and hope that you don't have to confront this.
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