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FIrst PSA after surgery

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Posted 6/25/2015 6:30 PM (GMT 0)
Great news first, my husbands latest PSA was <0.1, other news, the original biopsy at small local hospital was not accurate GL 3+4, the surgical biopsy was GL 4+3. Can't believe the local urologist put off his biopsy after repeated rise in PSA over the last 3 years. Glad we went to the big city hospital for follow up and surgery. Recovering witout any bladder leak, hasn't has pain or swelling since 2 weeks after surgery, only needs to work on penile function. Injections?, he's not crazy about that one, mechanical, or increase in sildenafil? Any opinions?
Posted 6/25/2015 8:08 PM (GMT 0)
Great news is right on the PSA. Pretty common to get upgraded, but if it was negative margins, organ confined, not a big deal.
I wouldn't be going to injections right away, at least from what I've read here on others experiences. Ask about a higher dose of Sildenafil, or maybe Viagra? And the pump.
I'm not an expert on this subject but since nobody else has chimed in yet, thought I'd give my 2 cents. I'm sure others will follow with more experience dealing with this issue
Posted 6/25/2015 10:06 PM (GMT 0)
La Salle,

I wouldn't jump to injections too soon but it is very important keep the blood flowing down there with oral meds, VED, or injections. Otherwise he will experience permanent and significant shrinkage.

Having a post surgery PSA of <.1 is very encouraging and is great news!

Given the G4/3 I would get the ultra-sensitive PSA test every 3 months for at least the first year. The PSA will likely remain at <.01 but if it starts rising you will catch it and can consider adjuvant (ART) or salvage (SRT) radiation therapy. There are many papers that stress the advantage of starting ART at .05 or less and SRT at .1 or less.

(Note: One issue with the ultra-sensitive test is stressing over small changes of .01 or .02 which are probably just measurement variation. If you get a small up tick, clam down and wait 3 months till the next measurement.)

Let's hope for the best that it never makes it to .1, but you do not want to miss the opportunity for a second shot at a cure because a optimistic doctor feels a standard .1 measurement floor PSA every 6 months is "generally sufficient".

With a G4/5=9 and positive everything my post surgery 3 month PSA was <.01, and then .01, .05, and .10 at the 1 year mark when I started SRT.

Best wishes!
Posted 6/25/2015 10:15 PM (GMT 0)
Good news about the PSA; that's what matters at this point. A Gleason downgrade with the surgical pathology isn't uncommon. It happened to me.

As for function, it's probably a little early to think about injections. If he had good function before surgery he'll probably recover it. He should be on daily Viagra or Cialis as a rehab regimen. That's probably the best thing he can do to ensure that he regains function. I suggest you check with the uro on that.

Best,

Jonathan
Posted 6/25/2015 10:17 PM (GMT 0)
That is the concern, since the margins were not clear. The lymphnodes were clear though. He is taking Viagra and we are scheduled to see the director of the rehab soon to see what mode he would like to try.
We will be stressed at 3 month intervals for the next five years as they monitor the bloodwork.
The PSA done was the standard that notes anything less than .1 is registered at <.1, not the actual number. I will ask for the ultra sensitive PSA in 3 months. At that time we also will see the surgeon for the second time since surgery. Thanks so much.
Posted 6/26/2015 12:20 AM (GMT 0)
Congrats on the first of hopefully many <0.1, undetectable tests. I am on a every 3 months PSA testing regime also, coming up on 3 years next month. I would got nuts if I took the ultra-sensitive test.

If this is his 3 month post op PSA test, he needs to start ED rehab now, not later. My "rock star" surgeon had me taking Viagra (Sildenafil) 72 hours after the catheter was removed and using a VED pump 4 weeks later everyday to get blood flowing in those surgery shocked nerves. Insurance paid for the pump 100%.

I was told to take 50 mg of Viagra Monday and Wednesday and then 100 mg on Friday, play night. My doc prescribed 100 mg pills so
I could cut one in half to make the 50 mg. Remember he needs to take it on an empty stomach. Maybe a little before dinner, works for me.

Way to early to even consider injections. It will take time for recovery. He has has some serious plumbing surgery.

So far so good. Good luck!

Bill from Florida cool
Posted 6/26/2015 12:54 AM (GMT 0)
Your journey is just beginning...It will be a year before having sex is a point of concern...In the meantime, the more physical activity the better...Don't become a PSA slave...
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