psa post prostatectomy not zero

I am looking for anyone who knows of a similar situation that had a happy ending.  I am very worried.

My husband - only 41 - had a prostatectomy after a biopsy showed 1 of 8 cores had 1% cancer, gleason 6.  Pathology reports were - clear margins, gleason 6, no evidence of lymph node involvement, some perineural invasion.  Tumor was 20% of prostate.

9 weeks post prostatectomy psa was .10 (not less than .10).  10 weeks later psa was .11 (from a different lab).

Any positive thoughts?  I'm thinking probably he's going to need radiology.

Melg:

Your man has a rare situation, indeed. At biopsy he had the very barest minimum disease. Many would have ignored it. After surgery he has, apparently, some escape from the tumor. 20% is a rather large tumor particularly for such a small biopsy result. There may be several reasons for this psa persistence. Examine the pathology report closely and see if there is any suggestion of prostate tissue yet remaining. A retest is certainly in order, preferably with the same lab and using the same test protocol. A re-examination of the surgical specimen may provide another opinion on the G score, though psa is the telling instrument at this time. His doubling time, if, indeed he has a rising psa, will also help to tell if this is truly a recurrence and if the G6 score is reflected in the acceleration of psa.
This is a puzzling case and no one doctor or specialty can pronounce on him, at least with only the factors you present here. Time is necessary. This is when we should wish it to move slowly, but with great haste.
I agree with the recommendation to move on from urology to other oncology practitioners.

Hey Melg

Sorry, about your husband . Let me first say that you have come to a good place here because

healingwell can help give you the knowledge that you need to move forward. All good advice so far from the others but I can definitely say I know how you feel. I had a higher psa (6.9) after RP than before. We were

in shock even though our pathology report told us SVI and lymph node invasion. We have come a long way though. We have now an excellent medical ONC. and are presenetly on HT. In my case, radiation was not recommended (except by the radiologist- different docs have different opinions) You most likely will have more options. Regardless, 4 months after my first 4 month Lupron shot, my psa just last week read 0.043!!

It's not a cure for us and I most likely will live with this forever (I'm 63) but I have confidence that I will

live a good long life. I am otherwise healthy, feel great with exercise every day, and have had NO side affects at all from the HT. I know how lost you feel right now but things will get better and better. There is so much good news out there about the latest treatments, new drugs etc. You will be fine and your husband is fotunate, like I am , to have a wife that will take good care of him. If you have any questions feel free to e-mail us. (address in on my profile)

Take care and stay positive

Jim and Marie

 

Hi Melg- Check out my thread, it might give you some ideas- https://www.healingwell.com/community/default.aspx?f=35&m=2269227

Good luck with all this and keep digging for information

Curt

ChrisR hit it on the head. There's nothing of evidence to say that he has had a reoccurance---yet. You need a few more tests, to build the data up and see if a rising trend is developing. There's at least 2 threads on here about benign tissue and how there can be a higher than statistical zero reading and still be cancer free. That's a possibility, as is the time since surgery may be a factor. My suggestion? Continue with 3 month tests, use the same lab, and see what it is doing 9 months to a year from now. With 3 month testing, any sudden rise in PSA gives you more than enough time to recognize and respond to that. There's no rush and no need to panic. Time will tell, so relax for now.

It is not unrealsitic for it to be benign tissue. Did the surgeon who did the RP have a lot of experience? If not, he very easily could have left tissue behind.

 

I agree with ChrisR- The waiting is something that you just have to do, in my case I am having to wait almost a year to finally get to the bottom of my personal situation.

My PSA was .06- 3 months out and then .19- 6 months out and now 9 months out it is .157 and we think this PSA is being generated by Bengin tissue left behind after surgery.

Hang in there Melg, the jury is certainly not out on your husbands prognosis.

 

 

There is a reason why a surgeon would leave benign prostate tissue behind.

As explained to me, if there are no signs of cancer outside the prostate and to keep the entire bladder intact, when the surgeon is surgically seperating the prostate from the bladder, he will cut on the side of the prostate leaving prostate tissue behind instead of cutting into the bladder.

This totally makes sense to me and a reason why this happens. Asking the surgeon about this is the best way to get an idea of what really happened.

Curt

Thanks Curt. We will ask the doctor that.

Melg and Hubbie:

As posted by others, the jury is not out on what is occurring with the PSA results with your husband.

Please do keep in mind this is a patient to patient support forum - we are not doctors - we are just responding and reacting based on our own life experiences.

The possibility of deliberately leaving prostate tissue behind is new to me and I will be researching that. If that is the case that would certainly affect all of his readings from now on.

The course for further treatment is as others have said, after three or more consecutive readings about 0.20 and that has not happened.

You will have to wait until the results from the next reading ( 3 months time?).

It may seem to be a long stress time, but you can use it to your advantage but rediscovering and strengthening your support system - and what makes each day special.

Do try to have some non-cancer days. Having PCa can be like ( to borrow other posters' phrases) a roller coaster a times, a virtual Twlight zone of conflicting messages and recommendations - and best of all -> remember that "every day is a bonus."


hugs to one and all,

Bronson
...........

p.s. special thanks to ChrisR and JamesC and trimix
........

Melg,

I'm in agreement with the observations of Bronson, James C., Casey, Chris R., and crew.

My uro did radiation immediately, but because my post-op pathology was far worse than expected. His normal plan is to follow the standard of two rises above 0.2.

Also, 0.10 and 0.11 are so close that I would be beyond happy to see them.

And the biopsy result is not as "wrong" as it might appear. If I had allowed only the 6 cores that my insurance company would pay for, I would have appeared to have a fairly simple case. My uro did 12 regardless, and those added "hit the mark" so to speak.

Welcome to HW. I'm sorry I didn't get to your post early, but I was off getting a CT scan (argh) again.

Melg,
I am not the guy to give you any feedback on this. I know nothing of what these guys are talking about. I just wanted to chime in and say as hard as it is not to worry, dont worry. You husbands condition is one of the least agressive. .10 and .11 from two seperate labs are the same number. You hisband can easily live another 40 years. It may or may not be a recurrence only time will tell. Live for today. That really is all we have. No man can add a day to his life by worrying. My wife crys in her sleep. I know how hard it is. I believe that under the most dire scenario that your husband is not going anywhere for a long long time. Best regards Todd

Chris R -

In a sense there are two different definitions of BCR -- the researchers' definition and the clinical definition. The researcher's definition is as fixed as possible and not based on judgment of other factors in individual cases. That's what it should be so that different studies from different medical centers can be compared.

The clinician's definition is subject to judgment; the same doctor might not treat Patient A until the textbook definition is reached but might decide to treat Patient B earlier, based on speed of increase, time since surgery, pathology report, gleason, age, comorbidities, etc. This too is as it should be. Clinical decisions should be made on the basis of the individual patient.


That said, by any reasonable standard, it would premature to assume BCR in Melg's husband's case, given the similarity of the two readings, the fact that we're really not seeing any move up above the nadir yet, and the favorable pathology and gleason. It would be reasonable to continue to monitor at this point.