Cancer Survivors Network - rising psa after radical prostatectomy - Comments

another gland

worriedwife — Mon, 22 Nov 2010 21:22:04 -0500

Thank you for letting me know and I think in my stressful visit, he might have mentioned
the thyroid gland.

What kind of side effects have you had with the radiation and/or hormone therapy?

I am so glad there are people here to talk to and vent. I truly appreciate any and all input.

higher psa

worriedwife — Mon, 22 Nov 2010 21:19:18 -0500

Yes, the turp was a result of what was believed to be BPH. He was having trouble urinating.

The cancer was found when biopsies were done during the turp and his PSA was 1.4.

The surgeon did a nerve sparing prostatectomy. It was the new urologist, since we moved, that said that there is tissue left even during the RP.

I guess I will know in about 2 weeks what the numbers mean. It was the VA report I was going by and he was staying at .002 to .003 for the past couple of years, the latest in April of this year.

In October is when the urologist ran the test that came back at 3.7 and the VA is doing another next week with a follow up with the doc the following week. This way I can compare and ask a few more questions.

He did not cancel the January appt with the urologist for his follow up PSA test. I am guessing if all 3 come back this high, there will be decisions to make. He had this new urologist for 6 years, but, during this stressful visit he seemed to have no bedside manner and I guess that is where I got a bit upset.

I will keep posting on his next results and am grateful for everyone's input and support.

Thanks to everyone here. Together we can all conquor this!

Worried Wife

Kongo — Mon, 22 Nov 2010 09:30:58 -0500

I understand the frustration you have with your urologist and in my opinion he should have taken more time to explain his thoughts. I also understand your anxiety from dealing with these new issues as your husband recovers from his brain surgery.

In your original post you mentioned that your husband’s original PSA was 1.4 and that some prostate cancer was discovered during a TURP procedure. I am assuming that the TURP was performed to alleviate some urinary discomfort from an enlarged prostate. Prostate cancer frequently begins to show itself at the same time as BPH (benign prostate hyperplasia). As you may know, very often incidental prostate cancer is found in men beyond the age of 50 without any other indications. Frequently this incidental cancer is indolent, very slow growing, and never poses a threat to the patient. Without knowing the details of the post RP biopsy this is just speculation but it’s certainly possible that the PSA you are seeing now is a result of a small amount of cancer left behind from the original surgery that has taken ten years to reach a stage where it is making enough PSA to show up. Remember that most forms of prostate cancer are very, very slow growing and these cancer cells only divide about every year and a half.

Prostate cancer spreads through the blood stream and the lymphatic system so it is possible that in the years since the original RP that prostate cancer has taken hold in a nearby lymph node or seminal vesicle (you will want to check the records from the prior surgery to see if they were removed or not). Outside the prostate, cancer grows faster than it does inside the prostate and PSA will tend to increase more quickly. Some scientists believe that the prostate produces protective tissue that acts to isolate the cancer but that outside the prostate this does not happen.

Given that your husband’s prostate was removed, it is difficult to imagine that this is a new prostate cancer distinct from the earlier form. Although since there was undoubtedly some prostate tissue left behind after his RP, I suppose it is possible but I have never heard of that happening. Most likely, it is a continuation of the previous cancer and recurrences after ten years or more while uncommon are not unheard of.

It’s entirely possible that if you do discover that prostate cancer has returned that it is a very slow growing, indolent type of cancer that does not pose a health threat. I would be prepared to calculate the PSA velocity which is a valuable tool in determining the severity of any recurring cancer. I also urge you to seek out second opinions, particularly if you’re second guessing whether or not your existing medical team is meeting your needs.

Another gland

2ndBase — Mon, 22 Nov 2010 07:54:15 -0500

When I was first diagnosed 7 years ago this week I was told by my urologist that another gland also puts out small amounts of a tertosterone type chemical that makes the cancer grow faster. It may have been the throid but its been a long time and my memory is not that good. Anyway, he put me on some pill to discourage this from happening. I too am not a fan of hormone therapy and speak from experience. Side effects are not worth the time in my opinion.

Not sure I understand

worriedwife — Sun, 21 Nov 2010 23:15:56 -0500

I agree that if things are not explained properly, I will seek another opinion. I replied above to correct myself in that my husbands PSA was at 0.002 not0.02 in April and then jumped to 3.7 6 months later.

I was not happy with his explanation and he seemed surprised that I met with him after he spoke with my husband and told him he would retest in 3 months. My husband had a brain injury last year and is almost back to his normal self with some residual minor issues. He had a great neuro surgeon. But, due to this issue, I have to get first hand information to understand what is going on. I also was not happy that he seemed so aloof about it all.

I am thinking of calling his original surgeon if it turns out it is cancer again. This urologist talked to us like it was no big deal. He said since it is 10 years out he doubts recurrence, rather it would be more likely a new cancer????? Yes, that made me feel good. Then as we were leaving he said if it is recurrence, they would just shoot radiation into that area and it would be all better. Then he said he was not a fan of hormone therapy.

Thank you for all your words of wisdom.

Likely recurrence

worriedwife — Sun, 21 Nov 2010 23:04:17 -0500

Kongo,

I just re-checked his April numbers and I misquoted them.

He was still at 0.002 not 0.02

The last test 6 months out was 3.7

He is having his blood test done at the VA in December so I can see the differences in the two lab tests. He still has his 3 month follow up with the urologist in January.

I guess that is why I got so scared. It went from 0.002 to 3.7 in just 6 months.

I really appreciate the information you have provided. If it is positive I will, as last time, ask for the best doctors to help him.

Thanks again

Thank you so much for your

bobgr — Wed, 17 Nov 2010 22:55:13 -0500

Thank you so much for your reply. I went to the hospital today to get another blood test, even thought I just had one at my local GP's office, this one is at the hospital where had my RP. I fully expect it to be the same reading of .18 or thereabouts. My appointment with the surgeon in next Thursday, I will let you know how I get on and the recommendations. Thank you again for your help.

Welcome

Kongo — Tue, 16 Nov 2010 17:06:08 -0500

Bob,

Welcome to the forum and I'm so sorry that after several years you now find yourself dealing with all the issues again.

Most urologists today classify a biochemical recurrence (BCR) following a RP as 0.2 ng/ml and rising. You seem to be right there even though your latest score is technically less than 0.2. There are some nomograms available on the web where you can plug the date and the PSA value and it automatically calculates the doubling time. The quicker the doubling time the more worrisome the indications.

At the time of your RP there was undoubtedly a small amount of prostate tissue remaining from where the surgeon cut it away. Even though the margins may have seemed clear at the time, there could have been a very small amount of cancer left behind at the microscopic level. Since this is a slow growing cancer it took several years for it to generate enough PSA to be detectable. The other possibility is that the cancer had spread beyond the prostate before it was removed and these prostate cancer colonies at remote sites have now grown large enough to generate a detectable level of PSA. About a third of the men who have had their prostate removed eventually see a recurrence of PSA within 15 years. It seems that you have caught this pretty early on.

Prostate cancer is an inherently metastatic disease which means it will move to other parts of the body via the bloodstream or through the lymphatic system. However it got to where it is today, you now have to deal with it…or not. Older men with a slow growing recurrence may choose not to seek additional treatment. Given your relatively young age with a long life span in front of you I think you would want to seek some treatment.

Typically treatments for recurring prostate cancer include radiation, hormone therapy, or a combination of the two. If they can for sure localize the new tumors there may be some other options but my feeling given your relatively low PSA score is that a bone scan, MRI, and other tests are not likely to pinpoint exactly where the cancer is that is generating the PSA. I don’t think those tests really hurt; I just don’t think they’re going to give your medical team any useful information.

As you probably suspect, additional treatments carry a potential risk of side effects so when your doctors go over your options, make sure you understand the downside risk associated with them. Having said that, most studies show that early treatment of recurring cancer is extremely effective and has a long term prognosis.

There really isn’t any other reason for your rising PSA readings other than a biochemical recurrence. Of course there could have been some trauma to the remaining prostate tissue which caused the PSA to go up but it would most likely be a spike up and then down. Yours has been on an upward trend for a couple of years now. The other scenario is that the last two or three readings were errors…maybe the doctor changed labs or they’re using a different procedure or something. I would ask about it but it seems to me that’s a rather remote possibility.

I think you’re smart to start researching your options now and this is a great place to get advice from men who have experienced exactly what you’re going through now.

Best of luck and keep us informed.

Three rising PSA tests

bobgr — Tue, 16 Nov 2010 16:08:23 -0500

Having distanced myself from cancer for the last 10 years I find myself back on the internet and have come across this site which is very helpful, thank you for all the posts.

I had a RP 9 years ago at age 47. My annual PSA tests remained undetectable until 2008 when it registered .05, then 2009 it jumped to .09 and just last week it has come back as .18. My local GP had now recommended a bone scan and ultrasound. (He first recommended leaving it for 3 months and then getting another PSA test, it was only when I mentioned concern about levels between .1 and .2 that he changed his recommendation, not very reassuring!)

I just contacted my surgeon who has booked me an appointment next week for "seeing for biochemical failure", which I assume means seeing for recurrence of cancer. Do you think that radiation and or hormone therapy is likely, is there any way other than a recurrence, for the PSA to rise like this?

Thank you for your help

Something I heard from a radiation oncologist

hopeful and optimistic — Fri, 12 Nov 2010 10:23:56 -0500

........basically he believes that it is a good idea to hold off hormone therapy; after other salvage treatment(radiation) because of the potential ill effects....(I did not ask for source information)...just mentioning here for possible discussion.

Not sure I understand

Kongo — Fri, 12 Nov 2010 08:49:10 -0500

Worried Wife:

I'm about confused about what your doctor relayed to you when he explained potential rises in your husband's PSA reading. I certainly agree with his discussion about prostate tissue left behind after an RP. That is always the case after surgery. What I do not understand is his discussion about another gland being "out of whack." I don't know what that means unless he is suggesting that prostate cancer has spread to another place, such as a lymph node or seminal vesicle, liver, lung, or bone but technically those aren't "glands." PSA comes from prostate cells. When a man has a prostate, non cancerous PSA elevations can be caused by a urinary tract infection, BPH, a biopsy, or other inflammation. Short term PSA elevations can come from ejaculation, a DRE examination, a hard stool, or even bicycle riding. Since your husband had his prostate removed more than 10 years ago, there really isn't another potential cause of the PSA elevation except for a return of prostate cancer where these cells (regardless of where they now are in the body) are generating PSA. The only possibility I can imagine that could be an alternate explanation is an error in the PSA reading due to equipment calibration, human error, or some accidental contamination of the blood sample. I would be fascinated to know what other glands he is talking about when he suggested to you that "... other glands could cause the sudden rise..."

I am certainly not trying to scare you or give you gloomy news but I think you and your husband deserve accurate and precise information about what is happening and why and what options you have to deal with it. Doctors should take pains to explain to you what is going on in exact terminology and make sure you understand it. Terms like "out of whack" only make sense if you understand the chemistry and biology of what is going on at the microscopic level. I do hope that your next reading comes back at the very low levels you have experienced for so long but you should also be prepared for what you should do if it comes back and shows another increase.

I was also surprised to see than in antother post on this thread that you indicated that your urologist doesn't believe in hormone therapy and would probably do radiation instead. Radiation is a common treatment for recurring prostate cancer but so is hormone therapy or a combination of both hormone therapy and radiation. Most studies show that there is a much higher long term prognosis with a combination of hormone therapy and radiation than with either treatment used alone.

As with any diagnosis of this serious nature, I would seek a second opinion on your doctor's recommendations.

Best of luck to both of you.

I had same questions

worriedwife — Fri, 12 Nov 2010 00:44:51 -0500

After this past test being 3.7, I had the same question. The urologist explained that when the prostate is removed, there are small parts that remain. There are usually no problems if all the cancer is removed, but, if a very small amount of cancer remains, over the course of years, the PSA can rise and thus the recurrence. My husband had been at 0.02 for 10 years. I still am a bit befuddled. He also said other glands could cause the sudden rise and that is why they wait the 3 months to be sure it just wasn't from another gland out of whack. Either way, my husband and I would do it again. He has been cancer free for 10 years and that is alot of stress relieved. We will work it out again if that is what the results show this year. I was really scared a few weeks ago but just chatting on this site has actually eased a bit of my fears. Keep the faith.

Urologist

worriedwife — Fri, 12 Nov 2010 00:38:21 -0500

It was his current urologist who he has been seeing the past 6 years. He has been having his PSA checked once a year. The test in April was with the VA doctor and last years PSA with the urologist both were under the 0.02 range.
Then this year with the urologist it came out 3.7 just out of the blue. He made an appt with the VA to double check in December and then depending on what that shows, he still has his 3 month follow up with the urologist. My concern is that his urologist does not seemed concerned at all. His original doctor was a Johnny on the spot doctor. When I asked why waiting, he said it could be a false read from another gland or recurrence, or a totally new cancer. Yes, that made me feel better. I asked what would happen if in 3 months his PSA was at 3.7 or above again. He said they do the ct or mri scan. He does not believe in the hormone therapy and said they would probably just do some radiation and that should bring his numbers down. It just did not seem like a real thought out process.

Thanks for helping with this and for so many to be so supportive of each other.

Thank you

worriedwife — Fri, 12 Nov 2010 00:36:26 -0500

He has his follow up with his urologist who he has had for the past 6 years in January.
He will also be following up with his VA doctor that also runs the test once a year.
That test is in December so I will be able to see how it differs from the urologist.
I was just so scared when it jumped from the 0.02 margin to 3.7 in just 6 months.
Thank you for your words of kindness and I pray for all those suffering from this disease.

Great News

Kongo — Tue, 09 Nov 2010 16:16:47 -0500

Darci, Glad to year all the recent tests came back negative. There are some interesting discussion threads in this forum recently about diet and its potential effect on PSA. Many of us have seen our PSA scores decline significantly when dairy is eliminated from our diet. You may want to poke around through past threads and see what folks have to say about it.

Best wishes for continued good news.

rising psa after radical prostatectomy

Billybumps — Fri, 25 Nov 2005 16:50:51 -0500

I had RP in June 2003. My post surgery pathology was: Gleason 7 (4+3), margins clear, cancer on both sides of prostate. All of my PSA readings since then have been less than .04. The last blood test with that result was in June 2005. My most recent PSA taken on 11/9/05 was .6. I saw my doctor the day before yesterday and he didn't think it was something to be concerned about. He told me to come back in 6 months and he would do another blood test at that time. I am worried. To me, going from less than .04 to .6 is a significant increase. Do you think I am worrying for nothing? Should I seek a second opinion? Is it normal to wait another 6 months after there has been some increase in the PSA? I appreciate any information you can provide to me . Thank you. Bill