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PSA 1.4 after radical prostatectomy 3 month

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Posted 4/24/2019 12:48 AM (GMT 0)
I'm new to the forum. I just had my 3 month follow-up PSA after having radical prostatectomy surgery on 1/3/2019. The surgical pathology report results were: Organ confined , margins negative, seminal vessels invasion none and lymph nodes were negative for tumor. My gleason score before and after surgery was 3+4=7 (40% pattern 4).
My PSA should be zero. Does it take longer for the PSA to get to zero for some patients? What should I do? Is there any explanation for my situation?
Posted 4/24/2019 12:51 AM (GMT 0)
Also, my PSA prior to surgery was 7
Posted 4/24/2019 12:56 AM (GMT 0)
Welcome & sorry you are here. That is way higher post op PSA than mine. It should be zero. You should be referred to a radiation oncologist for follow up treatment. You can still be "cured". You might also want to have your tumor tissue reviewed by Dr Epstein (or your biopsy slides). I think that is an important thing to do. I went from G7 to G9 with a 2nd look. Where are you located? You might get some opinions on experts in your area.
Posted 4/24/2019 1:19 AM (GMT 0)
Art,
Unfortunately that isn’t good news. I’m assuming this was your first post-op PSA. Have you discussed the result with your Urologist yet? You likely will be referred to a Radiation Oncologist to discuss radiation to your prostate bed and lymph nodes. As gobucks said, there is still a chance for a cure with this treatment. I’m sorry that it appears surgery didn’t get it all.
Posted 4/24/2019 2:02 AM (GMT 0)
Art - I think I would recommend a second PSA test pretty quick after discussing with urologist just to confirm the value, mistakes happen. Having your pathology slides sent to Johns Hopkins for a second opinion is a good idea also, more knowledge is always good. Nothing can be done too quickly as you heal up from the surgery and need to get more info for the next steps.

We surgery survivors hope to be undetectable, < 0.10, at three months which should be easy if all the prostate cancer tissue is gone. Your PSA may be high enough where a special PET scan can be done looking for the source of the PSA since your surgery results appear to be good. Could be adjacent to the prostate removal where radiation could zap it or it could be somewhere else which is another issue.

Your urologist should be able to refer you to the appropriate oncology people as he/she has about reached the end of their work. Depending on where you live, the folks here can recommend various specialists for follow up.
Posted 4/24/2019 2:36 AM (GMT 0)
Yes, I just completed a 2nd PSA test to reconfirm the values with 2 valves of blood today. They are sending the 2nd valve to John Hopkins. Based on my pathology results, they strongly believe it could be a Lab issue. I have already schedule an consultation appointment with John Hopkins Radiation Oncologist.

I Iive in Washington DC, any recommendations and/or advice I would greatly appreciate.

Thank Yousmile
Posted 4/24/2019 2:53 AM (GMT 0)
Welcome to HW.

sadly, lab errors happen. Hopefully that's the case here. If it is confirmed you'll need that RO appointment.

It's possible there's some tissue left behind that the surgeon missed and if the PC is still confined to the prostate bed, the SRT treatments will clear that out.

Before they do SRT, you'll like want to wait another month or two for things to completely heal before going under RT.

Do keep us updated on the test results.
Andrew
Posted 4/24/2019 3:23 AM (GMT 0)

art92 said...
Yes, I just completed a 2nd PSA test to reconfirm the values with 2 valves of blood today. They are sending the 2nd valve to John Hopkins. Based on my pathology results, they strongly believe it could be a Lab issue. I have already schedule an consultation appointment with John Hopkins Radiation Oncologist.

I Iive in Washington DC, any recommendations and/or advice I would greatly appreciate.

Thank Yousmile

Welcome, and sorry to meet you under these circumstances. I am fairly shocked that you have that much PSA after a surgical pathology report that I would have killed to have. It just seems so unlikely, though not impossible.

I suppose the surgeon might have left some behind, but that seems really unlikely. Even if he did leave some behind, which would be producing some PSA, that does not automatically mean that cancer was left behind, it could be healthy tissue. But again, that much tissue left behind seems unlikely.

Yes, lab errors do happen. Machines go out of adjustment, maintenance is done wrong, or humans doing the test and reading the results screw up. That seems like the most likely possibility considering your low risk surgical pathology report. Can you get tested at another lab? EDIT: never mind, I see some blood is going to JH.
Posted 4/24/2019 3:29 AM (GMT 0)
Hi, art92--

My first thought when I read your post was it's either a lab error or the surgeon left a good deal of prostate tissue behind. More likely the former. While the fact that post-RP pathology says the G7 PCa was confined to the prostate is no guarantee the surgeon "got it all," 1.4 ng/mL at 3 months is just plain loopy. Whatever's going on, the Johns Hopkins folks will sort it out. You're in good hands.

Here's hoping lab error!
Posted 4/24/2019 9:59 AM (GMT 0)
Art92... yes definitely get another psa check with your post op stats let's hope that is an erroneous reading. You will want to wait till around 6 months after surgery to get pretty healed up to help with incontinence issues so that will give you a chance for another check and time to talk to a RO and his team and discuss your future treatments. Wishing you the best! Make sure and let us know how it is going.

Larry
Posted 4/24/2019 12:09 PM (GMT 0)
All us imagine the anxiety involved in waiting for the confirmation (hopefully non-confirmation) test result. With our own different experiences behind, we do not need much to feel empathy about your case.
Even in the worse outcome, it is possible that the cause of the elevated psa is some missed local (or, less desirable, nodal) extension that can be easily localized and then treated by radiation.
Best luck.
Posted 4/24/2019 12:29 PM (GMT 0)
Art, not much to add to the excellent comments above. Just a warm welcome to the forum, a place that everyone finds valuable, but nobody wants to be.

FWIW I vote lab error. It happened to me, at my 9 month checkup, PSA came back at 3.8. Retest was undetectable. I hope it’s the same if you.
Posted 4/24/2019 1:28 PM (GMT 0)
Art,

Not much to add to what the other guys have said -- probably a lab error and if it's not the good doctors at Johns Hopkins will get you sorted out -- so I will only ask that you keep us posted on further developments.
Posted 4/24/2019 2:44 PM (GMT 0)
Pratoman..
Read your entire story. I had surgery with Dr. Tewari on April 11....catheter out on the 18th. For anyone considering surgery, Dr. Tewari and his team are outstanding. I have no illusions that my journey has only begun. I do take some comfort that I'm in remarkably able hands with Dr. Tewari and his team at Mt. Sinai.

Biopsy results....Jan. 30.... 3 positive cores; one 3+3 and two 3+4
Pre-op PSA of 7.42
MRI...confined and contained
Post Op pathology...ECE apex around bladder neck (slight extension) all margins negative; all lymph nodes negative....T3a
Posted 4/24/2019 3:43 PM (GMT 0)
art92,

A lab error could be the explanation to the PSA reading but in the case of PC, one size does not fit all.
After RP in 2013, my PSA was 2.8. Thought that this was just some PC tissue left behind by the surgeon. For the next 2.5 years, PSA climbed to over 8 and then dropped down to 1.17 in summer, 2018. Nobody in the medical community could give me an explanation for this anomaly. Right now, my PSA is .05 after undergoing ADT and RT fall of 2018. This was after I enrolled in a clinical trial which included a ultra sensitive PET scan that identified 2 local positive lymph nodes.
Everyones situation can be different when talking about the way our bodies react to PC, therapies, drugs, procedures etc.
Learn all you can and be patient about your decisions along this journey you are on.
Dave
Posted 4/24/2019 4:27 PM (GMT 0)

slapshot said...
art92,

A lab error could be the explanation to the PSA reading but in the case of PC, one size does not fit all.
After RP in 2013, my PSA was 2.8. Thought that this was just some PC tissue left behind by the surgeon. For the next 2.5 years, PSA climbed to over 8 and then dropped down to 1.17 in summer, 2018. Nobody in the medical community could give me an explanation for this anomaly. Right now, my PSA is .05 after undergoing ADT and RT fall of 2018. This was after I enrolled in a clinical trial which included a ultra sensitive PET scan that identified 2 local positive lymph nodes.
Everyones situation can be different when talking about the way our bodies react to PC, therapies, drugs, procedures etc.
Learn all you can and be patient about your decisions along this journey you are on.
Dave

Wow, David, what a wild and crazy ride!
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