Out of Zero Club

Well, after 3 years <.1, I am now at .14 psa.

Starting radiation therapy in January. Docs said at least one cancer cell escaped

during surgery. It took 3.5 years for psa to go up .1

I am waiting for January to start the treatments to avoid paying my max out of pocket twice.

The radioligist suggested getting a lupron shot to last about a month to surpress the psa.

I know this is something he probably has to say, but do any here think I could pass on the Lupron

shot for the 6 week wait? It went up just .01 in the past 6 months.

The side effects of the lupron shot seem extreme on many from what I read.

Any others with similar experience?

 

Here are some stats. I had more in my signature but they are gone, guess the 400 character max allowed.

Age 59, psa 4.7 in Jan. 08. Biopsy: one positive sample out of 13. 1% of one sample cancer. Prostate removed on 3/5/08. open Surgery. Nerves spared. Cath out 12 days later. Continence good. No pads needed since 6/10/08. First PSA: Less than 0.1 on 6/17/08. First erection five days post op. Update, Oct. 2010. Full natural erections. PSA, Apr 11 PSA .13, Oct 11 PSA .14

Gleason post op was 3/4 no positive margins.

I'm telling you Bob D, thats a pretty darn good pathology report, I mean real good. the upgrade if it was is a soft 7. Im assuming you had no lymph node /seminal invasion. Thats the good news. Kinda bad news is nice post op pathology like that makes it less likely that , if it is a reccurence , and I am far from convinced it is, is local. Now dont panic on that. The 2 psa . 13 and then .14 6 mos later means it really hasn;t moved. we are talking 6 mos Don't jump the gun on this. IMO. Hope fully when they all get up in the morning you will get some hits on this to either corobarate what Im say ing or not. either way more info for your decsion. We get so scared of this dis ease, that we just want it to go away.... You have continence, no ED, your surgeon did a great job. Radiation can set back results, continence/Ed. You do know that you do not have a recurence, according to the standards, set by cancer society. ........ .2 with 2 consecutive rises after that. I am sorry for this, after 3 yrs to have a scare like this . I f you search archives, yo will find men that have had psa at your range for years. post op. My instincts tell me its benign, but thats not worth much. Im curious as to what kind of feedback you will get. Aloha, Logo PS the archive search might be difficult. maybe they will respond. This is just my opinion, but I think most over treatment is done after initial treatment with PCA.

Bob, don't jump the gun just yet! My husband had surgery March 2008, final Gleason 3+4, single, small focus of EPE, 40% of prostate had PCa, no other adverse findings. PSA before surgery was 6.4. He pulled undetectable PSAs for 17 months, then his PSA hit 0.1. One month later, PSA hit 0.3! We met with a rad onc, and he had a CT and bone scan. We were about a week away from the start of SRT when the third PSA test was taken in October. His PSA: undetectable! His most recent PSA (this past September) was still undetectable. In fact, during his annual physical, his regular MD snuck in an ultrasensitive PSA test and it came back at 0.02! He is now about 3.7 years post op. As you can see, it is possible (and our surgeon told me that it's more common than we're lead to believe) that benign tissue can generate detectable levels of PSA which naturally die off.

Hope this turns out to be the case with you. Getting 3 consecutive PSA tests may truly work in your favor. And yours is going up much, much slower than my John's did.

I like Sephie's guidance - do nothing and have another PSA test before anything happens In January and than decide.
A .04 increase does not seem - to me - to be a call to action.

My two cents!

All the best

Bud

Sorry about the rise in your PSA after such a long time of being undetectable. As Sephie said, you should probably wait a while and have another PSA test before embarking on any further treatment. Best of luck.

Bob - sorry about the increase in numbers - isn't the regular routine to get three (3) PSA =>0.20 before HT and other methods of treatment?
-whatever you decide ( to take the Lupron shot or not) you have our support.

hugs,
Bronson

p.s.keep this handy for the future

if <.1 is the lowest reading how is <.14 being detected?  sorry it's probably me but my last three tests were .2, .3 and .2 and i'm told the margin of error is .1.

ed

 

I ma terrible with math, my wife teaches me like her school kids. draws the box inserts all the little boxes. Is'nt .13 to .14 a gain of .01. .13,.14......18.19,.2? I just confirmed this with Sharlyn( guess who ).

Thanks for the input all. I was told by my uro and the radiologist that it is not uncommon that at least one cancer cell
can escape during the prostate surgery. I know with nerve sparing more prostate tissue is left. My rise has been
slow but steady. I think I will pass on the lupron right now. My srt is not scheduled until January so I have time to think about it.
Ozbob I never heard that negative margins would go to advanced mets. The radiation will be targeted in the prostate bed and
nearby lymph nodes. This is where thr radioligist said it is most likely. My uro said he normally waits till it is .2 before proceding but since
I have had only increases even of slow it indicates that some psa increase is being detected.

It depends totally on the lab and the equipment they use.

 i understand that part.  but if .1 is the first detectable reading how is the test sensitive enough to read the other .04?  now i haven't been right in the head since lupron but i'm confused here .

ed

Positive margins gives more credibility to the reccurence being local, be cause we now that the cancer is out of prostate. Negative margins indicates, operative word indicates, it is contained. We do not really know if some got out possibly thru PNI. The theory being that if pathology is good and indicates contained, cancer escaped prior to prostate dissection, so cancer may be systemic, which means it is outside of local area, but not necessaryly metastic. It could be but it also may not be. So you have local area, within field of std SRT, systemic, outside of local area, and 3rd, metastasized. Note. Metastasized is always systemic, systemic is not always metastasized. According to Patrick Walsh, avg time from Recurrence to metasatzation is 8 years, this with out any treatment. this is why some , not many,but some do not reccomend HT until it has metastasized. Since knowledge is power, I will correct your assumption on prostate tissue Hopefully the psa is from healthy prostate tissue, thats my guess. BUT haveing a clean bone scan, means it has probably not Metastazed, does not mean it is not systemic,{ reason for followup psa tsts] other than just to find initial reccurence. Its complicated. Read Walshes book on it. Are you educating yourself from sources other than forums. Forums are great, this be ing the best I've seen. But the info you get should be subject to your scrutiny, a really educated scrutiny. I think this applies to any info you receive from any source, even medical, specially GP, then urologis to a lesser degree, on up the chain to a lesser degree. So a negative margin increase the chance that an escaped cancer is systemic, but does not eliminate the chance that it is local and subject to SRT. This is why the success rate of SRT is fairly dismal , IMO, I think 30%, 40% Good luck, Logo

F8,

"but if .1 is the first detectable reading how is the test sensitive enough to read the other .04?"

Again, depends on the test. My uro specifies that the test be reported at one decimal place, and the lab does not round, so 0.4 is any value from 0.40-0.4999. My GP asks for ultrasensitive, so I get two decimals.

Since 0.14 is more than 0.10, I expect that the lab used considers the test accurate for values greater than 0.10.