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help me understand, post surgery psa level

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Prostate Cancer
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Posted 4/30/2013 3:41 PM (GMT 0)

HI All,

I am wondering, with prostate cancer in the early stage, a man can opt to do active surveillance, right?

 

So let’s say the prostate is removed, and then the PSA levels are checked… and I understand that we want to see it be undetectable, and then we watch for a rise in the PSA.

 

But what I don’t understand is, why do we need to re-treat when the PSA is still so low.  Example, let’s say pre-surgery PSA is 4.5.  Post-op gleason is 9.  First PSA is undetectable, and then down the road it is .1 or .2. 

 

To me, that still seems like such a low number, so why do we rush in with the ADT and SRT?  Is it because those rogue cancer cells will grow/spread faster than what they did when they were in the prostate?  I guess I am wondering why this post-surgery active surveillance focuses on keeping the PSA at an undetectable level when it seems as though pre-surgery AS allows PSA’s to be 4, 5, 6 points.  Why wouldn’t post-surgery surveillance allow for higher PSA’s before resorting to ADT and SRT?

 

My dad is in his early 70s and he had surgery in April and is due for his first PSA in May.  I have read that with gleason 9's, some docs will even want to do hormone dep and radiation before the PSA rises.  I really don't want to see my dad go through more treatments.  I really want the doc to say that we'll just watch the PSA and see when/if it rises.  But even then I got to thinking, why do we "have to" treat with such small numbers like .1 or .2? 

Posted 4/30/2013 4:05 PM (GMT 0)
That's an aggressive cancer. PSA measures how many prostate cancer cells are alive. Post surgery, with the prostate gone, any detected PSA is either from some small prostate tissue left behind or PC cells - possibly already metastasized. A post surgery rise in PSA is most likely due to PC growing somewhere in the body - either in the prostate bed or bones. At G9 most docs would want to aggressively attack any cancer growth.

The other thing they'll look at is what is known as the doubling time - that is how long does the PSA take to double. The faster that happens, the more aggressive the cancer. So, if you go from .1 to .2 in a few months, you've got something to be concerned about.

More treatment isn't fun and there are side effects. If I were in that situation, I'd be discouraged but I'd take the HT treatments.

All the best,
Andrew
Posted 4/30/2013 4:09 PM (GMT 0)
I have to agree 100% with our shop buddy. That is an aggressive cancer and you don't want to fool atound with a G9 . . . Q
Posted 4/30/2013 4:19 PM (GMT 0)
You have to remember that your pre-surgery PSA number was large because it was being produced (a) by your normalprostate gland cells, and (b)by by the cancer tumor cells.

After surgery, any results of the PSA test are produced ONLY by prostate cancer cells, as mentioned before, either in the prostate bed or elsewhere in the body.

In other words, your pre-surgery number of 4.5, or whatever it was, derived from a combination of non-cancerous prostate gland material, and also from the cancerous tumors.  The bulk of that number, though, certainly derived from healthy prostate material, not from the cancerous tumors.

I've seen a formula that relates healthy prostate gland size to anticipated PSa number.  An 80cc over-sized prostate gland, even with no cancer present, will reveal a much higher PSA number than a healthy gland of the normal 25cc size

Posted 4/30/2013 6:43 PM (GMT 0)
Thank you for the posts. And now I think I do understand, especially when you said to think about how the psa was with the prostate intact, so yes it makes sense that after it is removed, we want to see it as a zero.

I also just finished reading Southern Comfort's report on his hormone therapy and it makes me less worried for my dad to read that yeah, it's not fun, but it is manageable.
Posted 4/30/2013 7:17 PM (GMT 0)
I am one of those GS9 guys where my doctors scooted me off for hormones and radiation without waiting to see what my PSA would do. My surgeon took one look at my post-op pathology report and immediately made me appointments with a medical oncologist (to get me on hormones) and a radiation oncologist (to zap my prostate bed).

And, while I yeild to no one in hating the hormone shots, they are doable. And, if they are talking about radiation for your dad, that is doable too.
Posted 5/2/2013 7:28 PM (GMT 0)
PSAs of .1 and .2 may seem small, but they are not small numbers after a prostatectomy. They indicate that cancer cells have left the prostate but may be in the prostate bed or local area where they can still be killed by HT+SRT. Chances at a complete cure go down after the PSA rises that high. In a recent analysis, Dr. King found that with a PSA level of 0.2 ng/mL or less before SRT, the relapse-free survival approached 64%, but that it decreased by 2.6% for every .1 increase in PSA.
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