Gleason 9 - DaVinci surgery, just got first PSA

First time on forum, just wanted to meet up with others in the same boat, share my initial outcome from surgery and see what you folks think.

Diagnosed June, 2015, 2 of 12 cores showed cancer, 5% and 10%, Gleason 9 (4+5), had surgery in August, Seminal vesicles impacted, and one lymph node of 24 had a VERY small number of TINY, TINY (doc's words) micro cells.

Initial PSA was 10.9. Got my first PSA today post-surgery, came back at <.019 - which to me (as a Gleason 9) makes me very encouraged, and tells me it was caught early.

Am I on track with that thinking?

Thanks,

Ken

Ken, I think you ARE on track with your thinking.


Dr Paul Shellhammer, a very wise urologist/surgeon who is currently himself dealing with an advanced case of PC once described that there are "two kinds of cancer, and we hope there is a third." He was paraphrasing an earlier famous saying of Dr Willet Whitmore, father of modern PC oncology, and he went on to describe the three:

1. There is the kind that can be cured, but need not be cured. (aka, PC overtreatment)
2. There is the kind that needs to be cured and cannot be cured.
3. We all hope there is the kind that needs to be cured and can be cured. This, it appears, is your spot, Ken!

Hi Ken,

There is a lot of "positive thinking" on these sites--and all that is fine and good-- but the fact is that every case is different and your path will be your very own.

I was in the same boat. GS on post surgery pathology was 4+5=9. Not what anyone wants and it puts us in a situation of being extra vigilant. My surgery was in April 2008. Very small tumor load, no extra capsular events. Basically a rattlesnake still in its shell! My wife is a physician and probably saved my life. I was 70 and was told by two physicians that with a high Gleason and given my age, surgery was not the first choice because the cancer had probably gotten out. My wife disagreed and said "the only place for a tumor is OUT" I was in surgery 31 days after the biopsy...the fastest it could get done.

My post op PSA was <0.01. Good as it gets. I have it checked quarterly. It stayed undetectible for 3 years. I was convinced I had dodged a bullet.

But after three years it started creeping up very slowly and is now 0.1. When it reaches 0.15 I am up for discussing radiation. The normal level for declaring "recurrence" is 0.2 (some centers use 0.4) but recent studies suggest that if post op PSA reaches 0.03 the chance of eventual recurrence is high. Keep in mind that high grade (4 and 5) cancer is known to at times produce LOWER PSA readings hence vigilance is crucial.

The bottom line is that guys in our Gleason range need to really stay on top of things. Never assume, even after years, that "it's gone" Commit yourself to quarterly PSA tests from the same lab!! And plot it on a spread sheet. My wife assures me that she will be drawing my blood every 90 days until there's no blood left.

Best of luck

Steve

Hi Ken-

I'm glad they got most of it, and I can see you are trying to put a very positive spin on it, which I applaud. I don't think you have to do anything right now. But please watch this VERY closely, and if your PSA reaches 0.03, you want to be prepared to act quickly. The fact is that your stage pT3b and the positive LN are considered to be adverse pathology and your GS 9 can get away very quickly. Hopefully, your immune system can finish off whatever, if anything, was left inside.

- Allen

Ken
Great news. However Gleason nines are virtually never permanently cured. I was optimistic too even with a psa of .1 post op. But I'm on my third round of treatment after failed RP and srt. Although prostate bed is clean, lymph nodes are now involved so I'm getting them zapped. As TA and others said, be vigilant and be ready to treat recurrance aggressively. When I was diagnosed as pt3b my surgeon told me I'd be fighting PCa for the rest of my life and he was right.
Bob

Hi Ken.

Congrats..

Just stay on top of it...

Thanks, all, for the feedback - believe me, I am staying on top of this with the doc, and am following any and all advice and courses of therapy he recommends. Because of the very tiny impact on only one lymph node out of 24 (as my doc put it), he wanted me to go for the first PSA after only 2 months post surgery, not 3. At the risk of sounding too optimistic, I, too was wondering whether the PSA might still be going down because I had the PSA a month earlier than protocol. I see the surgeon with these for followup tomorrow, so we will see what he says about it.

Ken,
The half life of PSA in the serum is only about 2-3 days, so any detectable amounts of residual PSA you might have had were gone by the time you had the PSA test. But your PSA was undetectable -- "<0.019" means the test they used couldn't detect any PSA.

- Allen

Got my consult Friday with the surgeon about the PSA result, declared cancer free! As some have mentioned, I have to be vigilant, get PSA every three months for a while, but what a great feeling to know that, as of now, it's gone. Thanks for all the input and support!

Ken, you are officially a member of what we call the zero club. This is cause for celebration, enjoy the rest of your weekend, and if you're so inclined, have the adult beverage of your choice on us!

Great result and reason to relax and celebrate, but do seriously consider the prior posts of Steven H, Tall Allen and Break60.
I concur that one shouldn't ever declare a G9 cancer-free, even after treatment, as your surgeon did.