PSA rising after Prostatectomy- Values<0,1

Colleagues, I am a new member, I´m 59, Dx with 58, 3+3, 2 out of 12 on biopsy. After RP, histological corrected to 3+4, negative margins, negative seminal, lymph nodes not checked.

3 months after laparoscopy RP, first PSA = 0,03ng/ml. Uro said it´s normal, let´s see progression. After 6 months PSA = 0,05ng/ml. I´ll visit the doctor this week, but I´m concerned with this rise. Some friends in other forums , adviced me to be patient and see more tests before any decision of salvage treatment. Do you guys have experienced this progression? Do it reach some stable values, or the progression will continue up to the biochemical failure value of 0,2? And if is the case how long it took?

 

Hi Carlos- I also had my PSA rise after surgery but it was from the benign prostate tissue my Dr left behind after surgery that caused the rise...

You need to ask your surgeon how he separated your prostate from your bladder and if he left any prostate tissue attached to your bladder.

What we found was that the prostate tissue left behind started producing PSA over time as it reconnected to my blood vessel system, my PSA finally leveled off at about an average of 2.6 which is now considered to be my new PSA base reading.

I had negative margins, neg node evolvement and a 3+3. My Uro/surgeon really believed that I was not having a recurrence so we investigated further.

He put me on Avodart and we watched my PSA go down to zero from a high of 3.6, confirming it was tissue and not Cancer causing my PSA rise. Then, after going off the Avodart, we watched my PSA go back up and then finally level off...this took quite some time but now it has been stable for a long time.

As has been said, every case is different but you need to look at all the possible variables before pulling the trigger on SRT.....

Hope everything works out for you.

Let me know if you have any questions, I have a lot of information to share.

Cheers,

Curt

Thanks guys for your advices. PSA six months after RP 0.05 is not a good signal, but I learn from you to stay calm. Thanks John by the links. I will keep you informed of my visit to Uro/surgeon outcome, this thursday evening.

Not yet. I will discuss with Uro/surgeon. I will ask him if it makes sense to repeat the test on same or other lab.

Curt,

Your case is a surprise and good news for me. I had in mind that when PSA reaches 0.2 (2 consecutive readings) means a biochemical failure. As you refered I also asked surgeon if some tissue was left, what he told me that nobody can guarantee 100%, but he considered the intervention as a sucess with no surprises. The intervention was nerve-sparing (both sides) by manual laparoscopic meaning more complexity.about hydrate before blood sampling I will take it for next test.

Carlos

Hi guys, just to update my visit to Doctor.
He did not considered relevant this increase from 0.03 to 0.05. He just said that at these low values flutuations are "normal". Only after some continuous rising there is reason to concern, and this requires at least two more tests. Also, he did not agree with immediate tests, he recommends next in three months at same lab, to avoid noise. He refered that by the PSA and GS before RP and by the pathologic results (no margins,no extra capsular,no vesicule seminals) and the surgery with no problems, he is not expecting failure, even considering that there was no extraction of lymph nodes. This option was done, because the biopsy GS was 3+3, and 2 MRI done before with 2 months difference did not showed any signal on lymph nodes (I doughted of the resolution!).
So, I will go back to lab in late November for another PSA reading and I will take Curt recommendations on hidrate.

Carlos, wanted to wish you luck with your PSA test. Your situation is definitely a good illustration of the negatives of an ultra-sensitive PSA test. With your surgical stats, and a PSA of 0.05, I would not worry much (I know, easier said than done). As your doctor mentioned, with these ultra-sensitive tests, the PSA will bounce around jumping up a bit, then down a bit. The conventional wisdom - barring any adverse findings on the pathology (which you didn't have) - is not to worry until your PSA hits and breaks the .1 mark.

A key issue with any medical test is to decide what you're going to do with the results. If there should be a rise in your PSA (even a miniscule one such as to 0.07), you'd be no where close to making a decision on a secondary treatment.

Hope you get good news from your blood test.

I received today the result of my third PSA test, 9 months after RP and I got a yuge relief.

The value came down to the same than initial and nadir 0.03 after bouncing on the second test to 0.05.

I just came from celebration dinner with my lovely wife, daughter and grand daughter (my princess).

Let me enjoy the moment

I will include this third value on my signature.

Wish you the best

and this story of stress , worry, anxiety, and relief, just keeps on keeping on pretty much every post I have read on this same issue. At least Carlos has a doctor that does not capitalize on it and start SRT. If he had, then 2 years later Carlos would still be undetectable, due to no cancer before or after the SRT and possibly be included in a study that said , see, its better to start SRT/HT earlier and earlier, as new technology brings detecting down to the nth degree, more studies, more so called SRT success stories, of course, with accompanying S/E's. Of course I am using Carlos's story as an hypothesis, but who really can say that this is not happening and quite frankly in more cases that we would like to think, in this new paradigm of money driving every facet of our existence or if not that , then a lassiez faire attitude toward the patient, as the doctor " seals the case " that possibly had already been decided. The post fits the thread in that it is food for thought for those with ultra/test anxiety and, hence a " rush to judgement"

Great news Carlos!

Now I am even more convinced than ever that I will not subject myself to the ultra-sensitive PSA merry-go-round. The standard test will do fine for my first 6 week post-op PSA. A little too much information...becomes counter-productive.

I agree. Out of curiosity, I asked one of my doctors at Mayo Clinic about the ultra sensitive test -- and was told it is essentially useless and only serves to trigger unwarranted anxiety in many cases.

Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.

Great news Carlos, thanks for the update.

Bill from Florida

This thread should be required reading for all who are caught up in the silliness of the ultra sensitive psa test, which feeds the OT monster of PCA. With all humility{NOT!}, a big loud razzberry and told you so. When yo make a machine a use will be made of it.Reminds me of a Navy story, where a new recruit in the tower was asking about all the obstruction lights on poles around the airport. The realist in the group, not me , but template for my later self, spoke up and said. They over ordered the obstruction lights, so…….. built obstructions for them.