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Undetectable!

novaguy
Posts: 76
Joined: Jul 2009

I just got back from my uro's office, and my first PSA is undetectable! He said to have another test in 3 months but he doesn't need to see me for 6 months. He asked how many pads I'm using and I told him zero, I was continent from day one. He then asked about my ED and I told him I'm only 60% even with pills. He was happy that I was that much. I told him I'd gotten a pump but it doesn't do that much, after I let the pressure out I lose whatever erection I had. He recommended using an Actis band with the pump, so I will check that. Main thing, though, was the PSA. I was really worried about this first one.

dopplerjockey's picture
dopplerjockey
Posts: 39
Joined: Jul 2009

Welcome to the Zero club, we love to hear about those that have undetectable PSA's following therapy or surgery. And, I would jump for joy if I had 60% funtion with the ED issue. Congrats !! Keep that PSA level at undetectable.

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

Glad to hear your good news! I'm in the 0 club also for now. HOpe to stay with my positive margin at pathology but time will tell.

Larry

wxman
Posts: 19
Joined: Jun 2009

Hey Larry,

I had my check up about a week and a half ago. My psa levels did not drop to zero. I had a .8 and a .6 retest here in Atlanta. Went to Nashville and retested again at .5. The doctor said it was one of three things... 1. it's possibly still cancer, but probably not. 2. part of the prostate is still left. 3. "we don't know". The results were very unexpected by them. I will get a psa again in 6 months. If the levels stay the same for a while we can assume the answer it # 2 or 3. It was quite demoralizing getting that answer.

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

I can imagine that it would be demoralizing to you. My PSA came back at 0.
I can understand Number 1 and 3 from the comments but am confused by comment #2.

Part of the prostate is still left?
Were These comments from the Doctor in Atlanta?

Seems like surgery would take out all of the prostate.
Keep thinking positive and please keep in touch.

Larry (lewvino@yahoo.com)

wxman
Posts: 19
Joined: Jun 2009

No, this was the report in Nashville. There was some scar tissue. I suppose that it could have been a small part of the prostate left. The doctor is optimistic that the cancer is gone, but I sure would have liked to see my numbers near zero like most others are reporting.

William Parkinson
Posts: 60
Joined: Oct 2009

It seems to me, that waiting for 6 months to run another PSA test would be unwise. First I would ask your doctor if you had any positive margins on the prostate specimen (i.e., cancer was not totally removed by the surgery at the margin of the inked specimen). The usual presumption is that if you do not have any positive margins and your PSA does not drop to near zero levels, then the cancer is elsewhere, like in the lymph nodes. Thus, if the PSA drops to nearly zero levels and then goes up slowly then the thought is that it is a local occurrence (although on rare occasion some benign retained prostatic tissue may be to blame, see J. Kellogg Parson and Alan W. Partin, "Clinical management or rising prostatic-specific antigen after radical retropubic prostatectomy" in "Treatment Methods for Early and Advanced Prostate Cancer,( eds., Kirby, Roger S. & Mark Feneley, 2008): 107). The pathologist will know that answer and it should be in the doctor's file on you. Also, bear in mind that one gram of normal prostate tissue will produce 0.3 ng/ml of PSA, but one gram of PCa tissue will produce 3.0 ng/ml (Andrew J. Stephenson and Peter T. Scardino, "Clinical Evaluation of the Patient with Prostate Cancer," in Atlas of the Prostate, 3rd ed. eds. Peter T. Scardino and Kevin M. Slawin: 126). So, if the entire prostate is removed, there should be nearly a zero reading, while even a little cancer left after surgery can produce PSA levels like what you are seeing. The good news is that evidence suggests that when radiotherapy is given when the PSA is still around 0.5ng/ml the person has an excellent chance at cure. If you want to see the nomograms on this, go to the website for Memorial Sloan-Kettering and click on the tab for prostate cancer. There you can enter your own details and the nomogram will make a prediction about your prognosis. You can even enter the radiaton dose in greys. Enter something close to 80 greys; that is close to standard 3d-EBRT dosage. You can also add if you went on supplemental androgen deprivation at the same time. In any event, the earlier you determine if the cancer is still there, whether in a favorable local occurrence (i.e., positive margins) or the more unfavorable distant spread, the better your odds will be. I wish you the very best and please let us know how you are doing when they find out what the cause of the PSA issue is.
Cheers
Bill

NM
Posts: 214
Joined: Jul 2009

Hi and welcome to the zero club. Good thing to hear novaguy. My first psa was .05. My doctor said that anything less than .2 is ok. Any thoughs on this number.

Nick

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

Are you asking for thoughts on .05 or the .2? I've been told with my positive margin if I get .1 in my blood work I should start radiation right away. So that would be inline with the .2 number.

Larry

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