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Psa .10 to .11

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Posted 1/26/2018 1:47 PM (GMT 0)
At six weeks after surgery my psa was 0.10. Yesterday, at twelve weeks, it was 0.11.
Waiting to hear from the surgeon. Disappointed but emotionally prepared for whatever comes next.
Posted 1/26/2018 2:44 PM (GMT 0)
I’m in pretty much the same spot, Progressing. Pulling for you. Let us know what the surgeon says. But I’d think if your 1/25 PSA isn’t dramatically better, you’d want to meet with an RO too at this point.
Posted 1/26/2018 3:31 PM (GMT 0)
Saipan, my 1/25 psa is 0.11, up .01. Not better, so looks like I will be joining the ART/SRT group, which I’m following on this forum. Thanks for the good wishes.
Posted 1/26/2018 4:42 PM (GMT 0)
My bad, Progressing. I got focused on the “next check” in your signature and forgot you’d already gotten the result. Hang in there. The numbers aren’t what we want — yours and mine — but we have good chances of beating this on salvage.
Posted 1/26/2018 5:24 PM (GMT 0)
At 12 weeks post surgery .11 could still be background noise. You’re going to need about another three months of healing before starting any SRT. Keep getting your PSA checked every few weeks and hope for it leveling off or dropping.

Do study SRT options just in case. Good luck. 👍
Posted 1/26/2018 11:49 PM (GMT 0)
I vote for a retest.

and there are worse things than SRT.

um, best not to do the full list...
Posted 1/27/2018 12:12 AM (GMT 0)
PSA of 0.11 at 12 weeks is definitely not background noise. I agree with Saipan that a visit to an RO now would be prudent.
Posted 1/27/2018 2:01 AM (GMT 0)
Thanks. Curious that surgeon hasn’t contacted me and I assume won’t before at least Monday, four days after the test. The pathology report said “no tumor at surgical margins” rather than “no prostate tissue at surgical margins” so it’s possible there is benign tissue on the nerve-spared side, but that’s more wishful thinking than likely.
Anyway, I will contact the RO unless surgeon gets to me first with a persuasive reason not to.
Posted 1/27/2018 2:27 AM (GMT 0)

Progressing said...
I will contact the RO unless surgeon gets to me first with a persuasive reason not to.


I can’t think of one. You’re T3a, PNI, EPE. If not yet — if the 0.11 is operator error or something — at some point in the next few years there’s a very decent chance you’ll have a consistent upward PSA trend and clear BCR. Why delay getting a top RO’s POV?
I was in a somewhat similar situation to yours at 12 weeks. Although my PSA had eventually fallen below <0.05, I was having symptoms that suggested lymph node involvement. I met with an RO, who advised immediate ART; my urologist, who advised waiting for the next PSA but told me he thought ART was a reasonable choice if I decided to do it; and spoke with my surgeon’s PA, who also advised waiting, as he and the surgeon believed the symptoms were related to a lymphocele. I chose to wait, and the symptoms soon cleared up. But I’m super happy I hooked up early with an RO. I learned a lot, established a relationship, and now that my PSA is rising, I’m a step ahead. Think it over.
Posted 1/27/2018 2:59 AM (GMT 0)
Saipan, thanks. Curious — what symptoms indicate lymph node involvement?
I had met with an RO at MSKCC to discuss radiation before opting for surgery. We hit it off well, and when he followed up to see what I was planning, he assured me he would do ART if needed. Glad to have that relationship and appreciate your advice.

Tall Allen, I know you think highly of Michael Zelefsky at MSKCC in New York. The RO I’ve been working wirh is Borys Mychalczak, head of radiation oncology at MSKCC Westchester, which is a more convenient location for me.

Does anyone have an impression of Dr. Mychalczak’s work?
Posted 1/27/2018 3:25 AM (GMT 0)

Progressing said...
Curious — what symptoms indicate lymph node involvement?


Usually, none. A met in a lymph node would have to be quite large to cause the sort of soreness and pain one typically gets from a benignly inflamed LN. Given how low my PSA was, it didn’t add up that the cause was mets. Either a lymph node was still “reactive” to the surgery, or what the radiologist thought was an enlarged LN was actually the remains of a lymphocele that had shown up on an US 6 weeks earlier. Seems like it was the latter — but we may never know for sure.
Posted 1/27/2018 3:39 AM (GMT 0)
I don't know him, but I assume he's following the MSKCC salvage radiation protocol, which is excellent. MSKCC has been a leader in salvage dose escalation (routinely delivering 72 Gy) and in expanding the pelvic LN field. And he probably uses the same linac that they use in Manhattan. I think you are wise not to travel far for treatments
Posted 1/27/2018 5:43 PM (GMT 0)

Saipan Paradise said...
......my surgeon’s PA, who also advised waiting, as he and the surgeon believed the symptoms were related to a lymphocele.....

Based on what symptoms? Isn’t lymphocyte quire rare??
Posted 1/27/2018 7:56 PM (GMT 0)
Looks like my situation all over again. While my PSA went to undetectable about eight weeks after surgery then it started to rise, first .05, then .07, then .11, then .13. Very slow doubling rate, but I decided to pull the trigger at .13. Just finished 26 sessions. Not bad. Penis burned for a while but back to normal. Little blood in rectum but back to normal. First PSA check next month. So as Tall Allen says, it’s not noise, but as my oncologist says, the cancer is too microscopic to show up on a Scan, so they just light up the area where the prostate used to be located. Good luck!
Posted 1/27/2018 9:02 PM (GMT 0)
Howard, was your full treatment 26 sessions? If so, could you let me know where? Did you have wide area pelvic radiatin?
Thanks — trying to learn as much as I can from the collected wisdom on HW.
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