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rising psa after radical prostatectomy

Billybumps
Posts: 18
Joined: Aug 2003

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

Benji48
Posts: 117
Joined: May 2003

Hi Billy,
I was pretty much in the same situation about 3 years ago. I would certainly demand another PSA test at least at the 3month interval. Don't wait 6 !! If your PSA at the 3 month time is >0.6 & <2 you have a distinct advantage to submit to radiation treatment since that is the next available option. Try to convince your md of this. If he's not amenable, get another Dr.!
good luck,Benji

rogermoore's picture
rogermoore
Posts: 265
Joined: Mar 2002

Morning Billy,

I would have another test done through another facility, i.e. clinic or another DR. Sometimes the lower limits of the testing lab varies. i.e. one lab may test to a low limit of .04 and another might be 0.1

I would not wait 6 months.

Good luck, please keep us posted.

Roger

stuart
Posts: 88
Joined: Dec 2001

I agree with the others don't wait! We all worry when our PSA rises...My recommendation is don't go more than three months...If your doctor has a problem with that, get another doctor...If I have learned anything over the past five years, you must be your own advocate

Trombone1st
Posts: 3
Joined: Aug 2010

YYYYYYeeeeeeeeeaaaaaaaaaa STUART!!!!! More Americans need to stop thinking doctors are gods. As you said "you must be your own advocate" Another opinion should be required part of medical diagnosis.

The horror story known will not be diverged but went through several doctors who cared absolutely nothing about me but wanted high paying insurance. Taking matters in my own hands things are very well after four years with PSA indictable.

Photon
Posts: 57
Joined: Jul 2005

Hi Billy

I would seek a second opinion immediately. I had a RRP in April 2004 with a post op pathology of Gleason 7&8 in all sides and my psa was 0.3 after 3 weeks. During the next 6 months it varied between 0.27 and 0.31. My urologist and oncologist decided that they would give my conformal radiation to the prostrate bed because of that rise.
A rise of your level might be nothing serious but deserves more investigation by a second doctor. The current wisdom by Patrick Walsh the prostrate guru from John Hopkins is that if psa is allowed to rise above 1 that is not is not good for the future.
Sorry to sound pessimistic but if its caught early then the survival chances are good.
All the best
Photon

Mark58
Posts: 29
Joined: Jun 2004

I also experienced a rising PSA after my RP. I had the surgery in March 2004. By November of that year my PSA had risen to 0.16. By July of 2005 it had slowly risen to 1.03. My doctor had tracked my PSA every 3 months during that period. I think 6 months is too long of an interval. I couldn't have waited that long. You can probably talk your doctor into a 3 month interval. I would try that before seeking a second opinion. I then had 39 IMRT rad treatments to my Prostate bed. There was no pain and only minimal side effects. I had my last treatment on Sept. 20th and 3 days later went out west for a 2 week RV vacation covering almost 5000 miles. No problems at all. Nov 18th I had another PSA test. It was 0.23 which is quite a drop from 1.03. I'm optimistic and hopeful that it will continue to drop. My next 2 PSA tests will have more importance, I'm sure, but for now I'm satisfied and do not regret having the rad treatments. I'll just live life to it's fullest for the time being and wait as always for.....THE NEXT PSA TEST. I know it is next to impossible, but try to keep a positive attitude and keep fighting.
Good luck and keep in touch.
Mark

fitzner
Posts: 1
Joined: Dec 2005

Mark, I will be praying for you my wife and I. My story is just beginning though. In 2003 the VA did a blood test and I never learned about it until 2005 the psa was 8.9 so I went for another blood test and from 2003 8.9 to 2005 it went to 9.8 psa. I went for a byopsy and was told it was a smidge of prostate cancer. I am 61 and in good health otherwise so I am going to elect for the radical. Now get this while getting radiation counceling the Doctor order yet another blood test and the next night at home a VA surgeon calls me for any questions about radial option. Then he tells me that "hey you psa lab tests came in on my computer as we were talking and he says my psa is 2.0 or around there, like real low and normal. I am going to see him early in January 06 should I ask for another byopsy to find out if it is gone or what? I think he want to operate. Really confused and just don't know what to do. I am going to call my primary doctor to also enquire. Fitzner

marcel333
Posts: 1
Joined: Oct 2008

Scheduled for radiation therapy- a 39 session treatment to the prostate. Told a likely side effect will be FATIGUE.
Had also scheduled to enter a sports competition which will occur on the 28th-29th day of treatment. Am trying to decide if the level of fatigue is such that I should cancel this event. Not getting idea of level of fatigue one experiences. Would appreciate any guidelines/personal experience you had....did it prevent you from active daily life?
PS- sport is veteran fencing- which requires short periods of intense physical activity- 3 to 9minutes long(bouts) spaced by brief rests until the next bout...and so on for some 6 to 10 bouts.
Event is distant from hospital so will have to stop treatment for 1 or 2 days- another question- should I wait until after event and start treatment dec 15
marcel

Aricka's picture
Aricka
Posts: 1
Joined: Jun 2009

Here's my story for what it's worth. I had RP in December of 2000. It was caught very early and completely encapsulated. No Chemo or radiation recommended. 7 years later PSA still undetectable. In 2007 PSA 0.2. Early 2008 PSA 0.3. April 2009 PSA 0.3. Now Doctors recommend Radiation therapy. I guess I was naive about this thing and had begun to believed the waiting for the other shoe to drop was over. I'm sorry but I'm so angry. I see the look in my wife's eyes and can't stand to know I'm having to put her through this again. Especially knowing her father died of prostate cancer a year after we were married. I didn't mean to bring this thing to her. I'm so very sorry. I don't how to begin to make this up to her. Hell we're only 60 and recently retired. I just don't know what to do.

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

Sorry to hear about the slight rise in your PSA. I've been recently diagnosed and waiting for my surgery on August 12th. I would suggest openly talking to your wife about your fears and hers. The cancer is not something you brought on to yourself and I'm sure she knows that. I've been anry myself since I found out that I have Prostate Cancer. My Dad was diagnosed back in 1997 and still doing fine, but I'm 54 and not wanting to deal with all the possible side effects. Talking helps me tremendously.

Keep us updated on how you are doing.

Larry

worriedwife
Posts: 15
Joined: Oct 2010

Are you still online? I have some questions?

crescent
Posts: 4
Joined: Mar 2004

I had surgery 2 years ago and my psa went from a 12 before and after 0.1 for 2 years. Went back for PSA month ago and it was a 0.2 and all Flags have gone up with my Family Dr and the surgon that did my surgery 2 y ears ago. I had another psa done month later and it was down to a 0.1 but surgeon has refered me to a Radaition Therapist Sounds like I will be going thru some Radiation. My family Dr. explained to me that anytype of movement of psa that they get alarmed now. so they dont take any chances even if mine did go down. He said that there still might be some small cancer cells in the prostate area even if the prostate is gone. I will know more this next week what is going to happen to me.

mammie
Posts: 1
Joined: Jun 2009

i just called my daddy to wish him a happy father's day and he "just mentioned" that his psa has risen to 3. he had a rp 10 years ago. he will be 81 on Wednesday. My husband is going tomorrow for biopsies, they take 12. His psa has risen from 1.5 in 2005 to 4.9 last month. His brother had rp last summer and his father died from colon cancer. I guess the waiting game begins. thanks for listening.

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

Please keep us posted on your dads and husbands progress! I'm waiting for my robotic surgery on August 12th age 54. My dad also had PC and was treated in 1996. Still doing OK but gets checked every year.

ARNIE.D
Posts: 1
Joined: Aug 2010

I had a radical surgery in Dec of 1993 and now my psa has risen from .01 after surgery to .89. Over the last year it has jumped from .04 tp its current level. Not sure what to do. Doctor is on vacation and will not be back till end of summer. Anyone have similar experience?

BRONX52
Posts: 156
Joined: Apr 2010

SINCE YOUR PSA DOUBLED IN A SHORT PERIOD OF TIME I WOULD BE HESITANT TO WAIT AND HAVE IT CHECKED OUT. A RAPID RISE IN PSA COULD MEAN AN AGRESSIVE CANCER LURKING SOMEWHERE. I WOULDN'T WAIT TILL THE END OF SUMMER TO SEEK ADVICE. GOOD LUCK !!

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Arnie, I agree with Bronx that you ought to be looking at another doctor. I believe that most doctors now consider that a post-RP level that rises to greater than 0.2 ng/ml is indicative of a recurrence. Since it has been so long since your RP, you will want to know whether or not the cancer has recurred in the prostate bed or spread to some other area and what treatment options you have for it.

If your doctor does not have a colleague who handles his cases while on vacation, I would consider getting an opinion with another specialist. In any event, you will likely want to get two or three opinions beyond what your primary urologist says so you aren't really walking away from the existing relationship.

Since its almost the end of summer anyway, you probably don't have too long to wait for the doctor to return from wherever his is.

While I think you should move deliberately on this, I don't think you need to rush into anything.

Best of luck,

===================================

Age at Dx: 59. PSA at Dx: 4.3 PSA at Tx: 2.8 (after eliminating dairy)
1 of 12 cores positive with 15% involvement.
Gleason 3+3=6. DRE Normal. Stage T1c.
Treatment by CyberKnife radiation in June 2010. Side effects: Zero.

Skid Row Tom's picture
Skid Row Tom
Posts: 118
Joined: Apr 2010

I second what Kongo said. Everything I've heard or read, greater than .2 is supposed to be the magic number. I had a radical prostatectomy in 2006. My GP has run PSA's and has reported scores of less than .01 (undetectable). However, my urologist has also run PSA's (the most recent was three weeks ago), and my scores from his office have been consistently less than .1 (undetectable). Psychologically, I feel better with the .01 than .1, but the doctors may use a different lab or have different reporting procedures. If I'm not mistaken, Dr. Walsh at Johns Hopkins considers everything below .1 as "undetectable". You can search the Internet to verify this through his writings.

trappj5277
Posts: 1
Joined: Aug 2010

I had RP Aug 2005 gleason was 3.5+3.5. 10 samples 7 cancer PSA was 2.1 lucky Dr. said He felt some thing growning on Prostrate. PR started as robitic but ended up as conventional. Prostrate was infected. PSA was less than .01 for 2 years. Then .02 Took 40 radiation treatments. It is now two & half yrs. later so we'll see what happens now. Don't wait. Get another test or another Dr.

Paul

griff 1
Posts: 114
Joined: Jun 2010

what side effects did you have after the radation treatments. thanks griff

The Nev
Posts: 50
Joined: Sep 2009

I don't mean to hijack this thread but just took a gut punch myself this morning.I'm 55 yrs I had robotic surgery last Sept lymph nodes clear negative margins Gleason 7 3+4. All PSA since 0 then this morning PSA .75 so I guess its radiation now. I had my surgery at MD Anderson Houston Tx and have a call into them for the next step; any idea's on what tests they may run and what I can expect from here?

ezra99
Posts: 18
Joined: May 2010

Sorry to hear of rising PSA. I never got the chance to have a time of undetectable PSA so not sure how I'd feel if I was in your shoes. I too had negative margins although I was a T3B with seminal vesicle involvement. I'll let you know what I did. I met with a radiation oncologist and a medical oncologist and would encourage getting appointments with both. I talked extensively about the appropriateness of radiation with negative margins. I wanted some "magic test" to tell me that cancer cells would be in my prostate bed which is what is going to be radiated. Prostascint was discussed but I chose not to do that and it wasn't encouraged by either MD as they felt it would not give me useful information with a PSA of only .37. The biggest discussion was whether to do ADT concurrently with IMRT. Some indication that doing ADT for 2 months before, 2 months during and 2 months after radiation increases chances of staying undetectable for 5 years after. I really struggled with the decision but chose to do IMRT only. IMRT alone option for me was 35% chance of 5 year undetectable and 53% chance of 5 year undetectable with ADT andd IMRT concurrently. Two biggest reasons I choose IMRT only was I'm concerned about weight gain and impact on my diet & exercise controlled diabetes. Hate of survive prostate cancer and die from complications of diabetes. Also I was worried that I would not know if a post radiation undetectable PSA was due to radiation or ADT and that thought bothered me. I figured I can handle it if my PSA is still detectable after IMRT but not sure my "head" can handle not knowing if it is due to success of radiation or temporary undetectable due to ADT. I may have made a stupid decision not to do both ADT and IMRT but I'm okay with it and really feel like it time for me to get a decent break so I'm betting IMRT will work. Whatever the outcome is I will be okay with it because I made the informed decision. No one told me what I had to do. I haven't started IMRT yet so can't tell you if it was a good decision based on my outcome. I start within a week.

Prep for radiation is another one of those "experiences". Not that bad but I really get tired of "exposing myself" to so many different people. Keep thinking it would get better but ever time they tell me to remove "all your clothes and put on a gown" I cringe. Anyway, only uncomfortable part was they put contrast liquid into the ureathra and placed a plastic clamp on the penis to do a scan. Rest of prep was fine.

Good luck to you.

The Nev
Posts: 50
Joined: Sep 2009

Thanks for the reply Ezra, hope your IMRT comes out ok. Its a strange thing for me looking like my future was long and now looking to making it another 5 years. But one day at a time I still have to get my appt and talk to the Dr and make a decision hope I'm as content after as you are.

ezra99
Posts: 18
Joined: May 2010

Don't get concerned about the 5 year thing. I'm a couple years older then you. All my MD's kept throwing that 5 year failure rate term around. I finally stopped the medical oncologist and ask what he was saying "in plainer English". He said that he wasn't saying that I was looking at advancing metastatic disease in 5 years....just that I would had a 30-35% chance of non-detectable PSA in 5 years -so a 65-70% of detectable PSA. He said it's entirely possible that I would have a PSA low enough that I wouldn't need to start ADT for several years. He said that if my PSA approached 10 they would recommend ADT. He briefly talked to me about intermittent ADT and said he has had similar patients like me that have lived 20 or more years with out advancement. He said it's still highly likely that I would die WITH prostate cancer but not FROM prostate cancer. I am trying to do some things like avoid meat and dairy, exercise and living health lifestyle.

The Nev
Posts: 50
Joined: Sep 2009

When I had my biopsy they told me there was about a 75% chance it was not cancer, and of course it was. Then after surgery they said I had better then an 80% chance of no return in the next 5 years and one year later its back. So I know they really don't know, as I said one day at a time I'll deal with it as it comes thanks.

worriedwife
Posts: 15
Joined: Oct 2010

My husband has been cancer free for 10 years after RP. April was .02. This month his PSA is 3.7

I am confused. His urologist, not the original, said he would re-do PSA in 3 months to make sure it isn't something from another gland that just pushed his PSA up.

All of you keep saying that when your PSA is above .30 you are having radiation already. My husband is off the charts compared to you and his doctor wants to wait 3 months.

did you wait 3 months and it show up again on the PSA test before they decided on radiation?

I am scared but my husband is comfortable waiting as he believes it to be a false positive.....

Thanks for any suggestions.

dalindg's picture
dalindg
Posts: 11
Joined: Oct 2010

I feel for you - switching doctors is not my choice either. Just remember, different labs, different results. The follow up psa in 3 months should be at the same lab if at all possible. I've been having double tests for years - spring tests sent to Mayo in Minnesota and fall tests done in Nebraska. Results are very different. (detailed above.)

How old is your husband? Waiting 3 months really won't make much difference unless he is very young. My DH was 38 at diagnosis, so running against clock much more. Younger, more hormones, faster growing cancer.

Did you see comments above about reducing dairy and no sex to modify the psa test? Would be worth a try.

I'm praying for you.

worriedwife
Posts: 15
Joined: Oct 2010

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.

dalindg's picture
dalindg
Posts: 11
Joined: Oct 2010

My DH had a radical prostestomy March, 2005 at age 38, PSA 7.2, Gleason 3+3=6, Stage T2, prostate was 2cm X 1.2cm, clear margins, not spread to lymph nodes. Mayo Clinic, Minnesota.
We have had PSA tests every 6 months. The Spring tests are mailed to the lab at mayo, and results have all been <.1 "undetectible", The Fall tests are the more sensitive tests from our local Nebraska lab.
August 2006 - .00?
August 2007 - .00?
August 2008 - .012
August 2009 - .021
August 2010 - .052
Local Doctor is freaking out. Calling for Nuclear Bone Scan, CAT Scan, and repeat test in 3 months. Call to mayo in 2009 told me not to worry until .1 is breached.
I personally want to go back to Mayo and schedule the diagnostics there.
Liver enzymes also were high, so now my husband is worried that the cancer is in his liver. I think it is a side affect to the zoloft antidepressants he is on.
Any advice?

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Sorry that these test scores are causing you anxiety. More than a specific PSA reading, I believe the trend is what is most important. In your case, the PSA rise since August of 2008 has been pretty consistent and you may want to start considering options but I think the Mayo Clinic is giving you good advice about not worrying (easy to say, I know) about it till PSA goes above 0.1 ng/ml. Most definitions of recurrence are associated with a rising PSA that goes above 0.2 ng/ml.

One thing to keep in mind is that the standard deviation for the ultra-sensitive tests are often well within the the difference between your reading...in other words, it may just be a function of the lab procedure or equipment calibration.

Since you had a favorable biopsy at RP you have every reason to be optimistic and even if they should determine that there is a recurrence, the advances in just the past few years in salvage radiation therapy are very, very promising.

Please keep us up-to-date on your decison process.

Best

dalindg's picture
dalindg
Posts: 11
Joined: Oct 2010

Thank you Kongo for your reply. I hope the test variances are because of calibration, but wish one of results had gone down, instead of up.

I just got off the phone with the Mayo clinic urology department. They would like us to get the tests as suggested by our local doctor. The tests can be performed here in Nebraska, and they will accept those results. Our RP doctor (Robert Myers) is no longer at mayo, so I havn't made an appointment with them yet. Surprisingly, they could get us in tomorrow, two weeks, and three weeks from now with another urologist.

Just trying to stop crying at work right now. At least we had 5 years with no worries.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

I know how upsetting this is but if you research the background on recurrence you will see that about a third of the men who have RP experience a rising PSA within 10 years. Many times, if the PSA rise is very slow, no treatment at all is required. If the PSA doubling time is less than 2 years (which your numbers suggest)it may be an indication that the cancer is starting to grow along the margins which is very easily treated. There are several treatment options that provide excellent long term results. Typically treatment includes some form of hormone therapy or radiation treatment or a combination of both.

There could also have been a small amount of prostate material left behind at the time of surgery that could be causing the rise in PSA.

While the tests your local doctor is suggesting are prudent, given the readings you have described I would be astonished if they showed anything but I think what they want to do is rule something out. If the cancer had moved someplace else where it could be detected by those tests, I believe your husband's PSA score would be much, much higher.

As you did before when your husband was first diagnosed, you have to take this one step at a time and make sure you are getting second opinions and doing your homework.

This forum is an excellent place to get good information and many men who post here have dealt with similar circumstances and you will receive a lot of strong support.

dalindg's picture
dalindg
Posts: 11
Joined: Oct 2010

Our local hospital will be doing the CT scan 9am Monday, and the Bone Scan at 1pm. My DH says I don't need to be there since I can't go in the testing room with him. I've been with him (well... in the closest waiting room) through all the tests and procedures with the RP 5 years ago, and want to be there for him now.

For you who have been on his end, should the wife push to try to be close, or is it really something you want to deal with alone? I remember him being very tired after first set of tests, but then that was with the fresh "C" diagnosis and facing unknowns at being diagnosed at age 38. We both are dealing with this episode much calmer.

We both work full time, and can take time away from work (sick days are available, so no pay loss)...

dalindg's picture
dalindg
Posts: 11
Joined: Oct 2010

Our CT scan and Bone Scan came back with no signs of metastases. Now just waiting for 3 month psa follow up. I hope this time it doesn't continue to rise. Doubling time for his last 3 tests has been 14 months, so at least not going fast.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

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.

worriedwife
Posts: 15
Joined: Oct 2010

My husband had the RP in 2000. Over 10 years now. His PSA was always around 0.02
His last test in April was still at 0.2.

He just had his PSA done this month and it was 3.7!!!! I am really worried.
I met with his doctor who is not the original doctor. We moved in 2004.
He said not to be worried yet. He will retest his PSA in 3 months. Then he
will make a decision to do further testing if it does not go down.

When my husband had the cancer last time his PSA was 1.4, no outward signs,
and found by accident during a TURP procedure. I explained all this to the
doctor.

My husband is comfortable with the test being redone in January. He doesn't
really want to talk about it anymore. He was even hesitant when I wanted to
talk to the doctor myself. The doctor did say that, if I could not wait the
3 months, he could do a CT scan or MRI. I wish we still lived up north. His
original doctor was so much more concerned about these things.

Since it was at 0 in April, could this be just a bad PSA test. He has been cancer
free for 10 years, now this????????
My husband is only 64. He was 54 when he had the RP.

dalindg's picture
dalindg
Posts: 11
Joined: Oct 2010

I had replied to your post above, and now see this one. Over 60.... waiting 3 months really won't hurt.

I personally just faced this same decision, and we chose to immediately have the ct and a nuclear bone scan, but since my DH is only 42 our hormones would make things move much faster.

This has to be scary since your husband's psa is higher now than with his initial diagnosis. We were up to a 7.2 and our doctor at Mayo clinic in Rochester Minnesota still waited a full month for RP surgery after biopsy (swelling/nerve sparing concerns.) Even with psa that high and only 38 years old, concerns of spreading within months was not a problem, with our gleason numbers.

I hope this makes you feel better. I totally feel for you. We just had the CT and Nuclear bone scan yesterday and are facing a 48 hour wait for results. We will also be repeating PSA in 3 months too.

Not a fun journey, but at least you are not alone!
Prayers from Nebraska-
Darci

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Worriedwife:

Was the doctor who recommended waiting three months your family doctor or a urologist. Most urologists define recurrence in men who have had a RP as >0.2 and rising. Apparently, your husband was at that point last April. The latest PSA of 3.7 is highly significant and without any other information available, I would strongly suspect that this is an indication of recurrence.

More than a third of men who have RP see a recurrence within 10 years and there are several treatments available that have been shown to be highly effective in treating a return of PCa, including hormone treatment, radiation, or a combination of the two. From what I have read, the earlier your husband receives treatment when there is evidence of recurrence the more likely that he will have a positive outcome with very high long term survival rates.

Frankly, I don't understand the strategy of waiting another three months. What is he waiting for, some evidence of definite metastasis?

A CT scan or MRI is unlikely to show anything definite unless the cancer has spread to bones or other organs and created a tumor big enough to be detected by this equipment. Given the rise in PSAs you described, I doubt that this is what has occurred, although if it makes you feel better, I don't see any harm in it.

If this was your family doctor who is making this recommendation, I would make arrangement to consult with a urologist immediately. If it was your urologist who made this recommendation, I would seek a second opinion.

Best of luck to you and your husband.

worriedwife
Posts: 15
Joined: Oct 2010

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.

worriedwife
Posts: 15
Joined: Oct 2010

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

bobgr
Posts: 2
Joined: Nov 2010

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

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

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.

bobgr
Posts: 2
Joined: Nov 2010

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.

hopeful and opt...
Posts: 1290
Joined: Apr 2009

suggest that you contact your pharmacist and doctor, and google on the internet for possible side effects of zoloft antidepressants, and any other meds, both prescribed and over the counter...

dalindg's picture
dalindg
Posts: 11
Joined: Oct 2010

I love your name! I checked webmd, and "abnormal liver function tests" is a side effect of zoloft. I will have to point that out to our doctor when we go in to have the other test results.

hopeful and opt...
Posts: 1290
Joined: Apr 2009

to deal with the Mayo Clinic, a center of excellence..find the best doc there...i'm not knowledgeable enough to know what specialty, maybe a medical oncologist who specializes in prostate cancer...........your local doc, my opinion...a doc should know the side effects of what is prescribed.

About going with your husband to get the tests, I think that it would be positive..but you need to respect his wishes...but I would definately go for the results with him.

It's going to work out

Wanttoknow
Posts: 7
Joined: Oct 2010

Billybumps:

Same story with me. I was seen every three months post surgery and when my PSA comtinued to rise from .14 , my oncologist recommended radiation therapy which I did undergo. Since then it continues to rise (now at 1.67)and the recommendation is Hormone Therapy. Still haven't decided to go this route because of the side effects. I am on a homeopathic diet right now. Every case is different. Trust your doctor but also research all you can. A PSA at this level is still just a number and we are treating just a number at this stage. My bone scan and MRI recently were both negative.

J

buzzz
Posts: 26
Joined: Aug 2010

This is horrible to read, all these recurrances after surgery, I though with surgery they took the gland so the threat was very low, and that they wouldn't do surgery if cancer was outside the gland. Now I read this thread, does anyone think that maybe it's because of the biopsy, that it spread one tiny speck of cancer? What else could cause so many relapses?

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

I don't think that the biopsy causes the relapse. For many it comes down to two factors:

The Gleason score post surgery when they examine the complete speciman and if you have what is referred to as a positive margin post surgery.

The higher Gleasons 7, 8, 9 and 10 have more risk then a Gleason 6.

When the surgeon removes the prostate there is a very fine line between 'how much to cut'.
If you cut to little you may leave cancer behind and if you cut two much then you get into other problems. Or on examining the surgical speciman cancer is found at the very edge or 'positive margin'.

I'm Gleason 7 and a positive margin. Tomorrow morning I get my 14.5 month PSA result. I'm being monitored about every 4 months on blood work and will post in the morning.

Larry

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