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PSA test and recurrence question

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Posted 11/9/2023 9:26 PM (GMT 0)
I had robotic assisted prostatectomy on 9/22/23.
I have a follow up PSA test this month and I'm curious about the test.
If it's called a Prostate Specific Antigen test, but the prostate is gone, what is it testing?
I know, dumb question, right? I'm almost chuckling to myself as I type this.

But in all seriousness, I'm crossing my fingers for a very favorable test result.

For those of you that have PSA levels rising later on down the line after surgical removal, what does that mean? Where are the PSA antigens coming from?

FINAL PATHOLOGIC DIAGNOSIS
A. PROSTATE, ANTERIOR FAT, RESECTION: NEGATIVE FOR MALIGNANCY

B. LYMPH NODE, RIGHT NODE OF CLOQUET, NODE DISSECTION: NO METASTATIC CARCINOMA IDENTIFIED IN 1 OUT OF 1 LYMPH NODE (0/1)

C. LYMPH NODE, RIGHT PELVIC, NODE DISSECTION: NO METASTATIC CARCINOMA IDENTIFIED IN 3 OUT OF 3 LYMPH NODES (0/3)

D. PROSTATE, RADICAL PROSTATECTOMY:
1. HISTOLOGIC TYPE: ADENOCARCINOMA
2. HISTOLOGIC GRADE (GLEASON PATTERN): 7
3. TUMOR LATERALITY: BILATERAL
4. MAXIMUM TUMOR DIMENSION: AT LEAST 1.5 CM (AS MEASURED ON SLIDE)
5. MARGIN STATUS: NEGATIVE
6. EXTRAPROSTATIC EXTENSION: NOT IDENTIFIED
7. SEMINAL VESICLE INVASION: NOT IDENTIFIED
8. PERINEURAL SPACE INVASION: PRESENT
9. PATHOLOGIC STAGE (AJCC): pT2N0



SYNOPTIC REPORTING SUMMARY
Procedure:
Radical prostatectomy
Histologic Type:
Acinar adenocarcinoma
Grade:
Grade group 2 (Gleason Score 3 + 4 = 7)
Minor Tertiary Pattern 5 (less than 5%):
Not applicable
Percentage of Pattern 4:
21 - 30%
Intraductal Carcinoma (IDC):
Not identified
Cribriform Glands:
Not identified
Treatment Effect:
No known presurgical therapy
Estimated Percentage of Prostate Involved by Tumor:
21 - 30%
Extraprostatic Extension (EPE):
Not identified
Urinary Bladder Neck Invasion:
Not identified
Seminal Vesicle Invasion:
Not identified
Lymphovascular Invasion:
Not Identified
Perineural Invasion:
Present
Margin Status:
All margins negative for invasive carcinoma
Regional Lymph Node Status:
All regional lymph nodes negative for tumor
Number of Lymph Nodes Examined:
4
Primary Tumor (pT):
pT2: Organ confined
pN Category:
pN0: No positive regional nodes
Additional Findings:
None identified
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Posted 11/9/2023 9:34 PM (GMT 0)
Hi John, glad you are on the other side of surgery. PSA is made by prostate cells, both benign and malignant. Aftr your prostate is removed, if they got all the cancer, your PSA should be “undetectable”. On a test result it would be reported as “<.x”. With X being the lowest level of detection that the lab can attain. It’s different for each lab.For example Labcorp tests down to .02, so an undetectable result would be reported as <.02. I test at MSKCC, where they test down to .05, so I look for <.05. In any case, what you want to see is the < sign.
If the reading comes back as say .07, without the < sign, then you may be experiencing some cancer cells left behind. But even when that happens, it could be lab error, so before jumping to Onc,unions, you’ll want a retest.

Good,luck keep us posted. With your clean pathology, you should hopefully be fine.
Posted 11/9/2023 11:15 PM (GMT 0)
John. My PSA was tested a little over 2 months post prostatectomy. It was .04. I freaked out. They tested it again about a month later. Undetectable. One assay still shows a consistent .02. Been that way for 6 years or more. The other assays show completely undetectable. Go figure. If it consistently rises over time, then it could become a concern. The best we can do it get it checked periodically and monitor. It appears you got a favorable pathology report for someone coming out of surgery. Nice. Best of luck to you.
Posted 11/10/2023 12:36 AM (GMT 0)
John - Women can actually have a PSA in small amounts. One problem is that we can detect PSA at very low levels now so it is much easier to have a really small value with no prostate or cancer.

Prostate cancer can generate PSA when it grows (not dormant) so if there are rogue cancer cells hiding out somewhere, they can reproduce and start to generate PSA again which can be detected with periodic testing. Most other cancers call these “cancer markers” which can indicate if cancer is growing again after treatment. Their accuracy is terrible compared to PSA so in a perverted way, we are lucky to have such sensitive indicator of PCA activity.

However, it is hard to get past the fact that you are “cured” yet they want to keep checking your PSA. Cancer is a tough adversary and can go dormant for extend periods of time so one can never be too confident. The testing anxiety will always be there but gets easier as time goes by and the frequency is reduced.
Posted 11/10/2023 2:41 AM (GMT 0)
JohnU,

Your surgeon/urologist/regular dr should be checking your psa every 3 months or so for the first year or two….then if all clear….every 6 months for a couple of years, then every 12 months for years and years.

Hopefully they got it all, but these psa tests are an excellent, and cheap, way to make sure. If they didnt get it all, knowing sooner rather than later gives you a chance to wipe out the last bit with other therapies.

Your pathology looks great!
Posted 11/10/2023 10:10 AM (GMT 0)
John,

Congratulations on getting to where you are, don't be surprised if the recuperation from the surgery takes a while. Honestly, I didn't really feel past it for probably 6 months.

As others have said, if they left any cancer behind, you'll still have measurable PSA, and if the cancer that got away starts growing, the PSA will start rising. What you're looking for is a PSA with a "<" in front of the number. For the first year or 2, you'll have it every 3 months, then every 6 months, and after 5 years, assuming no changes, you'll go to annual for the rest of your life.
I'm 8 1/2 years out, and just had my annual, it's just part of your regular medical care along with checking your cholesterol and sugar.
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