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Orgasmic Pain and a Detectable PSA Level after Radical Prostatectomy

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Posted 2/24/2014 4:15 AM (GMT 0)
Some have been complaining of pain at orgasm post prostatectomy. So have I, but its getting better.

Here is a report that might shed some light on the subject... note its a reason!

www.ncbi.nlm.nih.gov/pmc/articles/PMC1477581/

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Posted 2/24/2014 7:28 AM (GMT 0)
It is interesting that they keep stating that a "PSA level of 0.02 is a detectable level, raising concerns that the patient was not free of cancer." These are specialists in their field saying this in a respected peer reviewed magazine.

Yet if we have someone with a level of 0.02 post RP coming here and expressing concern our collective reaction is that they have an undetectable reading as it is under 0.1, nothing to worry about till their levels reach 0.1 and beyond and then typically the following article written in the year 2000 when ultrasensitive testing was in its infancy gets pulled out. www.phoenix5.org/Basics/psaPostSurgery.html

I think that the correct reaction is that your reading is detectable, however that by itself does not mean anything as there can be a variety of reasons that it is so, including tissue left behind by the surgeon. It is a trend upwards to 0.2 which typically results in the pulling of the trigger for further treatment.

Just an observation.
Posted 2/24/2014 8:03 AM (GMT 0)
I suppose that is correct to say that it is "detectible." But it is still zero -- and that is the big difference.

Fluxuations on the micro level are always possible, but are meaningless as long as it is <0.1.

Mayo Clinic says that these ultrasensitive PSA tests can cause a lot of needless anxiety and that is why they only believe in the standard PSA test.

So, for those worried about a detectible reading through an ultrasensitive test, remember that places like Mayo do not believe in using this test.

Hope this helps. :)
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.
Firm erections now briefly happening in early mornings, 2 years post-op.
Posted 2/24/2014 10:41 AM (GMT 0)
In this article the urologist acted on his suspicion and , using another method, confirmed cancer in some left behind tissue (just sloppy work!)

Whether the PSA was reported as .02 (then) is beside the point; the individual had some remaining cancer and they intervened accordingly.

if I did not insist on a DRE I would be in dire straits right now with my G9 and 3.7 PSA which is below the 4.0 cut-off for DRE.

My take on this adventure (and the reported case study, albeit 2005) is, it saved or prolonged the individuals life.

PSA levels remain controversial as this article suggests www.medscape.com/viewarticle/494379

Just my experience ... in fact I think I was "lucky" and extremely fortunate that my cancer was detected EARLY!

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Posted 2/24/2014 12:28 PM (GMT 0)
In this article it states remnants found.

This goes back to how I ended up here and many others. These labs do not do completely accurate work by any means. Which is why many urologists put so little faith into the test. Mine is a perfect example as I didn't pop any flags with my readings at all and yet in the end had a 4+3 in a 1/4 of my thing and I edned up moving on it because I had a "feeling" no symptoms nada.

Plus if remnants were left first obviously the doctor blows and maybe someone can find out who failed so badly. And second as in my pathology report there is incredible detail about the size and integrity of the various removed parts. So did that person get a clean report? In which case the lab doing the follow also is really at fault.

It's really kind of a slippery slope with so many humans involved in the process... any process.
Posted 2/25/2014 12:12 AM (GMT 0)
How exactly did they determine the "remnants" were cancerous? Was it an assumption based on a .02 psa, which only indicates{maybe}, that some prostate tissue were {maybe}, left. Maybe, I didn't read the article well, or maybe it wasn't written well, or maybe the "author" needed to get something published to stay in "the program". PS. if you are going to start sending vibrations thru a system after one of the most complicated operation on the books,… well you know……..
Posted 2/25/2014 3:57 AM (GMT 0)
I agree with Highlander, that technically, any PSA present is "detectable", but in the bigger picture of things, I hardly think a .02, assuming it stays well under .05, would be no reason to be concerned or to put a patient into any kind of anxiety over it.

In my own case, my first PSA post open surgery, 3 months post, was .05. My surgeon shook his head, and said that was bad news, and that I would be headed for trouble. He was right, 3 month later, it doubled to .10, and then the rest was history.

From my readings, a 3 month post reading of .05 or higher, by many doctors, could indicate early BCR, but even saying this, doesn't mean it will happen. We have men here, whose PSA wander in the range of .05 up to .08, yet never rose above that, thus avoiding BCR.

Another good reason to use less of the ultra sensitive testing, unless there is a real reason or trend to do so. All I see it doing, is causing men to have anxiety about testing, when in reality, they are in little if any danger of BCR. Just my take.

David
Posted 2/25/2014 4:13 AM (GMT 0)

An38 said...
It is interesting that they keep stating that a "PSA level of 0.02 is a detectable level, raising concerns that the patient was not free of cancer." These are specialists in their field saying this in a respected peer reviewed magazine.

Yet if we have someone with a level of 0.02 post RP coming here and expressing concern our collective reaction is that they have an undetectable reading as it is under 0.1, nothing to worry about till their levels reach 0.1 and beyond and then typically the following article written in the year 2000 when ultrasensitive testing was in its infancy gets pulled out. www.phoenix5.org/Basics/psaPostSurgery.html

I think that the correct reaction is that your reading is detectable, however that by itself does not mean anything as there can be a variety of reasons that it is so, including tissue left behind by the surgeon. It is a trend upwards to 0.2 which typically results in the pulling of the trigger for further treatment.

Just an observation.

This makes my first post op PSA of 0.06 very comforting. tongue BTW, I've seen another article that says anything above 0.02 is cause for concern. I truly wonder if it isn't bad editing and they don't mean 0.2. An easy but frightening mistake to make for those of us above 0.01. i'll go with John Hopkins and Mayo Clinic on this one and not worry about anything over 0.10, even though I will a little, at times. skull
Posted 2/25/2014 7:07 AM (GMT 0)
If you read the article and check the references, one of them had to do with the relationship between seminal vesicle sparing and continence recovery (cited article www.ncbi.nlm.nih.gov/pubmed/10840084. Seminal vesicle sparing helped with speedy incontinence recovery!

Seminal vesicle sparing is no longer an option in RRP and although this article is dealing with orgasmic problems, perhaps its greatest contribution is not so much the PSA = .02 (controversy) but its focus that ALL seminal vesicles removal during RRP minimises retention of cancer.
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