Possible recurrence

"why would it go down so much in 6 months?"

It didn't. It's been very stable at 0.2 since 2015.

So, how does this happen (TA)? A guy remains undetectable for 13 years. With a G6 no less. Then suddenly jumps to .2 or thereabouts. And stays there for the last 3 years. This PSA thing is very confusing and gets more so with every post like this.

To the original poster.... my Dr said the same thing , I m at .06. But he said unless imaging at .2 shows something, he would rather I wait till .4 or .5 before acting. My eyeballs bugged out if my head. But I guess he’s not alone.

Good luck man, may you be at .2 ish, forever

Not directed at you American 73....necessarily...

Tall Allen, that blogpost clarified a few things for me and gave me a few questions for when I go for my pathology on Tuesday so thanks .... again.

It's handled a little bit differently at biopsy. If there is ANY higher grade cancer in the core, even if it's less than 5% of the cancer in the core, it is given as the second number in the Gleason score. For example, if 96% of the cancer is Gleason grade 4 and 4% is grade 5, the pathologist records it as GS 4+5. Epstein also tells you the percents of the higher grade, but not all pathologists do that.

The higher grade ones may or may not ever exceed in number the lower grade ones. But the real danger is the higher grade ones can more readily undergo changes that allow them to metastasize.

A tertiary is when a third score is >5% of the core. So you could be 60% 4, 30% 3, and 10% 5; would give you a Gleason score of 7 with a tertiary 5. In this example the tertiary 5 ups the risk factor considerably. Of course you could have a tertiary pattern that the biopsy misses.

Ken, it is not rare to have long term recurrences. One of my clients had a recurrence after 16 years of being undetectable following surgery. In his case, the docs put him on intermittent HT.

But, nothing says there is a recurrence with AA73 at this time. Remember that stable PSA of .20 is fine for a surgical patient. If it starts moving up from here, action may be warranted as the doctor said. If it starts moving up when AA73 is 95, he probably won't worry.

Here is a bit more detail from diagnosticpathology.biomedicalcentral.com


"Primary, secondary and tertiary grades

After analyzing the tissue samples, the pathologist then assigns a grade to the observed patterns of the tumor specimen.

Primary grade - assigned to the dominant pattern of the tumor (has to be greater than 50% of the total pattern seen).

Secondary grade - assigned to the next-most frequent pattern (has to be less than 50%, but at least 5%, of the pattern of the total cancer observed).

Tertiary grade - increasingly, pathologists provide details of the "tertiary" component. This is where there is a small component of a third (generally more aggressive) pattern."

So the second score has to be >5% and a tertiary is reported when a third higher score is present. I have read other reports that require the tertiary to be >5%, but this report indicates it could be <5% of the core sample. However, if the sample was 4+5+3, the 3 would normally not be reported as a tertiary since it was lower than the other cores.