psa post prostatectomy not zero

Melg,

Sorry for your situation. I have read and read and read study after study and I can't find anything like what is happening to your husband given his current pathology. The only explanation I have seen when this does happen is that the person's post-op pathology is re-read and then it is upgraded because they were originally mis-classified.

However, even then with such a small amount of PCa found I have never seen or read about this situation.

I am at a loss. I don't know where you are, but you might consider a consult at Johns Hopkins.

Melg,

I am a big cynic as well. I also don't trust "the system" either very much. That is why I insisted on everything being read at least twice by different doctors and I always insist on a copy of any test results so I can see them for myself.

You are correct. This is extremely odd. Not saying that makes it any better, but I have never read or heard of a case like this. That doesn't mean anything good or bad though.

Also, I would imagine that your next step besides just watching and waiting would be hormone therapy.

They only reason I suggested Johns Hopkins, although I am sure Mass. is very good, is that J.H. has seen everything and might have an explanation...

Please keep me updated...

Dx @ 42 PSA 2.76 GS6
open RP 10/08
pT2 Organ Confined GS6
4.5 Year PSA <0.03

Hi Melg,

While I am not an expert, I can offer some educated speculation. It seems like there are several possibilities:

• Some benign prostate tissue was left behind. Notwithstanding the fact that the surgeon told you that he did not intentionally leave any behind, he still may have nicked into the prostate capsule or left some tissue at the apex or bladder neck. This is relatively common (10% or more for many good, high volume, surgeons) and is probably more likely with a non-robotic laparoscopic approach vs. RALP or open RRP. This recent study addresses this phenomenon, which it refers to as "insignificant biochemical recurrence". This would seem to be consistent with partial PSA response to salvage radiation as benign cells are not be as sensitive to radiation and are not entirely ablated by it.
  
• There was local recurrence of the cancer in the prostate bed after surgery but, for whatever reason, the salvage radiation was ineffective. This seems unlikely for G6 as the Donin et. al. study linked above found that G6 had a durable response to salvage radiation in 100% (14 of 14) of patients. In any event, if this is the case, other salvage therapy (e.g. cryo ) might still be available.
  
• There was metastasis. This would almost certainly imply that the G6 reading was wrong, as G6 does not generally seem to metastasize (again see Donin et. al. linked above).

If you would like a 2nd opinion on what might be going on and what, if anything, can or needs to be done, one of the best guys in the world to see would probably be Anthony D'Amico at Dana Farber. Part of what he may do is arrange for a 2nd pathology reading on the surgical specimen, which could confirm that it was really a G6 and perhaps identify any iatrogenic capsular incision suggestive of benign tissue being left behind.

Best of luck to you and your husband...

Oh - and thanks for the Dana Farber recommendation. If necessary, I want to get a second opinion there but did not know any names in particular.

Melg,

Here are some long term survior stories of G6 guys that had similar post-RRP detectable PSA.

http://yananow.net/display_story.php?id=139 17-Years and still treating it.

http://yananow.net/display_story.php?id=205 12 Years

http://yananow.net/display_story.php?id=738 6 Years. This is interesting...

http://yananow.net/display_story.php?id=826 7 Years.

Good news is no mortality.......I will keep searching for cases like your husbands. It is possible his PSA could level off sometime like most of these guys. Only one had it rise continually. He was the 17 year out guy....

I completely understand.  I was 42 when diagnosed in 2008 and had a 2 year old and a 6 year old.  I was devastated for my children.  I looked a lot more yesterday and I can't find any studies about rising PSA from OC G6.  SRT in all the cases I have read was effective.  I am wondering if/hoping his PSA will just level off eventually.  It has happened.

Like I said keep us updated. 

njs said...

Regarding the benign tissue theory, one hypothesis I recall hearing is that it make take a few months for any tissue left behind to reestablish a blood supply, during which the PSA will rise but then stabilize. Hopefully that is what is going on for your husband, Melg.

I've been following this thread for some time and this is not the first time I've heard this statement.  I wonder if I'm one of those lucky few that has benign tissue in my prostate bed.

After my surgery in June 2011, the only time I was truly undetectable was six weeks after the operation.  The pathology report downgraded my gleason to Gleason 6 but with a focal positive margin. 

Three months after surgery, my PSA started to slowly rise.  That is, until January of this year when it reached .07.  Since then, my PSA seems to have stabilized.  In fact, it actually went down to .06.  Here's a link to my PSA history.

I am really curious to see where my PSA is at when I go in for my next test in January.