Cancer Survivors Network - PSA levels of 3 and 7 after surgery. - Comments

Re : Prostascint/MRI scan is negative, but PSA still high

JohnK11 — Wed, 23 Dec 2009 14:24:10 -0500

Both the Bone scan and the Prostascint/MRI scans are negative (the uro says that most of the time, one would not see cancerous modules in these scans until your PSA is 40+.
Note that Prostascint/MRI scan can not detect liver problems (though Prostate cancer cells almost always attack lymph nodes and bone preferentially) since the liver will be hot
due to dead red-blood cells collected there regardless.

However, my PSA is now 9.2 (it was 7/6.4 1 month ago, which was 6 weeks post DaVinci--so my doubling time is 2+ months, pretty bad); so, I just got a hormone injection (Trelstar) and hopefully my reaction (which is not due for another 2 weeks or so) will be mild and my PSA will drop to 0. Wish me luck.

JohnK11 - How did your

pinot — Tue, 22 Dec 2009 13:39:44 -0500

JohnK11 - How did your MRI/Prostascint scan go? I suggested that my Dad ask his doctor about the procedure. He has an appointment today, so I am hoping that maybe they can arrange to have it done.

I will say some prayers for you as well ... good luck to you.

Bill, Thank you again. Sorry

pinot — Tue, 22 Dec 2009 13:37:47 -0500

Bill,

Thank you again. Sorry that it's taking me so long to reply to your questions - I have a new baby and she takes up a lot of my time.

Yes, I believe that the external foci was the same as an extra capsular extension.

The last MRI report refers to an enlarged left commom iliac lymph node, and then also an enlarged external iliac node on the left. They give different measurements for each.

My Dad has another appointment with his oncologist today - I told him to ask about the CellSearch technology and some of the other things that you mentioned. We'll have to see what his doctor has to say. I just want him to beat this!

I am sorry to hear about

William Parkinson — Sun, 06 Dec 2009 14:36:13 -0500

I am sorry to hear about this new PSA test, even though it is much lower than the other two. And thank you for your kind words about my surgery. In may case, I had no ECE, seminal vesicle invasion, nodal involvement, or positive surgical margins, so I stand a good chance at cure, but as you can tell, nothing is certain when it comes to cancer (I was forced not to participate in the test for circulating tumor cells based on the chance of infection, since prior to surgery they use needle aspiration of the bone marrow for that test). Anyway, I just posted a reply on a case of biochemical recurrence. I mention CellSearchTM there. It would prove useful if your father had this test done, for at least it would lend some indication if he is in real trouble. Read what I posted there (I wrote about other ways to control the cancer, at least a little bit, for the time being). Although I have no answer for why the PSA is bouncing around like this (consistent with radiotherapy but not surgery), the good news is that so long as his PSA is under 2.0 ng/ml radiation can usually help in controlling the progression of the disease. You mentioned an "external foci" on your father's pathology report; did your father mean an extra capsular extension? For now, not knowing more, I would be tempted to have at least 81 Gy of directed radiation to the prostate bed with an additional 45 Gy to the rest of the pelvic field. Also, I gave some suggestions in the other post I just mentioned. If you can provide more details on his pathology report that would be helpful. There are usually only three possibilites for continued PSA: occult micrometastasis (occult just means hidden), where the cancer spreads before it is detected systemically, positive surgical margins, and circulating tumor cells. If I know more, I might be able to direct you to some possible areas to interest in solving what happened here.
Cheers
Bill

Finding source of PSA after prostate removal

JohnK11 — Sat, 05 Dec 2009 14:02:41 -0500

I also have high though so-far non-fluctuating PSA (7/6.4) 6 weeks after Robotic prostate removal surgery (4+3=7, T3b, right seminal vesicle cancerous, prior-to-surgery CT Pelvic and chest scans clean). My pre-surgery PSA was only 6.7. Will try to do another one next week, about 1 month after the 7/6.4 reading.

So, I just did a bone scan (negative--though it will only find the most advance cancer and thus will missed many of the less obvious or smaller cancer elements)
and will do a fused-MRI/prostascint) scan next Friday. The prostascint (to be injected
96 hours prior to MRI) is supposed to attached itself to soft cancerous cells, and thus show up on the MRI scan, though there are apparently not universal agreement on how useful it is.

If the MRI/Prostascint finds a (hopefully just one) cancerous area, then radiation treatment is called for (even though my urinary incontinence is still really bad).
If nothing shows up, it's Lupron (hormone--i.e., chemical castration). Which is supposed to keep cancer at bay for 5-8 years (though, with my apparent really fast PSA doubling time, I'm scared).

May I suggest that your father look into fused MRI/Prostascint (if you have not already done so)--I have to go to a hospital 15 miles away, since it is available only in few hospitals (my 280-physician medical group does not do it, even though it has at least
7 diagnostic imaging labs).

Good Luck (though I might need more of the good luck myself).

Thank you for your

pinot — Fri, 04 Dec 2009 21:11:00 -0500

Thank you for your well-thought-out reply. I hope that your own surgery went well and that you're on the road to recovery. Hopefully you can join the "zero club" and have better luck than my Dad!

Here's the update:
After receiving post-surgery PSAs of 3 and 7 (taken within an hour of each other, sent to separate labs) my Dad was referred to an oncologist.

His oncologist did his residency at Sloan-Kettering, and he supposedly still has a mentor there. After reading your post, Bill, I felt pretty good about this. Of course, the first thing the oncologist did was order another PSA.

This one came back as 1.3.

So, the oncologist ordered another 2-hour-long MRI. Supposedly they did one pass without dye and one pass with dye, from the neck downwards. The MRI came back showing no evidence of cancer.

So, the urologist is baffled, as well. He took no action, but instead scheduled my Dad for another PSA test at the end of December.

Anyone else have any ideas of what could be causing his PSA to go all over the place?

As far as the pathology report goes, his Gleason score was 4+3. The tumor took up 30% of his prostate. Seminal vesicles were okay. They said something about having an "external foci" but my Dad said this was different than having positive margins. Lymph nodes were ok. Perineural invasion was present ... his prostrate weighed about 45 grams ... I think that's all that I remember for now.

*sigh*

Sorry to hear of this news

William Parkinson — Sun, 22 Nov 2009 17:05:29 -0500

I will have to be brief, since I am just a few days out from my own surgery. First, perineural invasion is quite serious. This is the most documented route by which prostate cancer can spread outside the prostate gland. I am quite worried, in that both readings were so high. One lab may have mishandled his blood specimen, but it is very unlikely that both labs made an error. So, for now, I will assume that your father has a very significant
PSA level after his radical prostatectomy. Also, it should be noted that some men harbor circulating prostate cancer cells which can reside in bone marrow, so it is quite possible that the cancer has spread outside his prostate gland, one way or another. First, I would ask for another PSA test and I would seek it from another urologist. I would go to the best hospital in your area and do it there, with the resident urologist there. So, find out first what that reading comes out as. Secondly, I would consult with the very best urological oncologist (prostate cancer urologist obviously) there you can find. If you need help you can call Memorial Sloan-Kettering in NYC and ask for any recommendations. If you let me know where you live, I can find out for you. If it turns out that the cancer has spread you need to find out if it is regional (within the pelvic field) or if it is systemtic (outside the region and growing in other areas). Scans can be deceptive when it comes to prostate cancer. This is not a sarcoma ( a cancer of hard tissue like bone or cartiledge) after all. There are many treatment options. He can have the entire pelvic field irradiated to a dose of roughly 45 Gy and the prostate bed much, much higher (as much as 85 Gy). There is also androgen deprivation (stopping the production of androgens like testosterone), all of which together can have a significant impact even in the face of systemic disease. If you can, pls let us know what his pathology report said; e.g., Gleason score, extra capsular extentions and the like. There are many men here who can tell you what has likely happened. Best wishes to both you and your father.
Cheers
Bill

PSA changes

gkoper — Sun, 22 Nov 2009 16:55:11 -0500

I have heard of PSA fluctuations, but none so dramatic.
I was told by my uroligist that c-scans are better at finding PCa related cancer cells then MRI. Keep us posted on how it goes...we are pulling for you & Dad.

The PSA levels of 3 and 7

pinot — Sun, 22 Nov 2009 13:07:45 -0500

The PSA levels of 3 and 7 were actually taken on the same day one hour apart.

The blood was drawn at the doctor's office and sent to 2 different labs. After the reading of 3 came back, the urologist wanted a "second opinion" from another lab, so he had my Dad's blood drawn again and sent to a lab off-site.

My Dad had his blood drawn on Friday and this time the PSA level was 1.3. Has anyone else had wild fluctuations like this?

My Dad goes in for another MRI Monday in an attempt to see what is going on.

Psa rising

gkoper — Fri, 20 Nov 2009 07:19:03 -0500

A PSA of 3. , then 7. a few days later is hard to believe.

I am 65 & had Davinci in March. My PSA was 0.3, 6 weeks later. 4 months later it was 0.7.

I am now half way through (37 total) IMRT radiation treatment.

My guess is the oncoligist will recommend the above & possibly hormone therapy.

Your Dad is lucky to have a supportive daughter like you.

Good luck.

PSA levels of 3 and 7 after surgery.

pinot — Thu, 19 Nov 2009 18:27:28 -0500

My Dad had prostate surgery in mid-September. Prior to his surgery, he had a bone scan which came up as clean. His pathology report came back so-so - it said that there was pueraneural (sp?) invasion. The urologist said that this was probably minor.

8 weeks after the surgery he went in for his PSA check. It came back as 3! The urologist was baffled, and it took another sample that same day and sent it to a different lab. The second lab sent back a PSA of 7!

How can the PSA level vary so much between labs? What would cause such a high PSA level with a mostly ok pathology report and a clean bone scan?