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PSA 0.1 but detectable.... :(

Hollynn22
Posts: 15
Joined: Aug 2009

My boyfriend had prostatectomy in July 30, 09. His path report shows with a posible margin. His first PSA check in Aug. 28, 09 was 0 undetectable. His second PSA test was in Nov. 20, 09 with 0.1 but detectable. His doctor refers for radiation but he thinks that he would wait until next PSA check in Feb. 2010 if his number still going up then he will make his decision. My questions are:
* Is that possible some cancer cells still left behind after his surgery or it could be a false alarm?
* 0.1 detectable. Should he go for radiation right now or it is the right thing just wait until his next PSA test?
* 0.1 is low number but detectable is something we should concern about? Should we wait for next few more PSA tests?

I really appreciate any advises or inputs.

Hollynn

gkoper's picture
gkoper
Posts: 174
Joined: Apr 2009

A friend had his prostate removed and held a .1 psa for about a year. then it went to .2 (doubled) ...his uroligist suggested IMRT radiation. He did his 7 weeks of radiation & his psa is again .1

My psa was .3 after surgery, going to .7 in 4 months. I am now in IMRT therapy. No side effects.

I am not a doctor.......but if I were your friend....I would wait till my next psa result.(watchful waiting).

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

Hollyn,
So sorry to hear about your boyfriend. This cancer is a very strange one to deal with.
What was his gleason score post surgery? It would most likely be a 6, 7 or 8.

My Gleason score was a 7 post surgery which is borderline aggressive. I have a positive margin post surgery and my 1st psa came back as 0. I will be tested again in Feb. My Doctor recommended starting radiation if I ever get to .1 on the PSA. I believe the reasoning is that gives a very good opportunity to kill it off completetly before it can increase.
To answer your questions - Yes it is possible to have some cancer cell's left behind after surgery especially with the positive margin.

Waiting has to be a decision your boyfriend makes with his doctor. For me being a Gleason 7 and a positive margin if/when I hit a .1 on psa I will start radiation I am not going to wait.
Best wishes to you and your boyfriend.

Larry

Hollynn22
Posts: 15
Joined: Aug 2009

Larry, my boyfriend gleason score was 7 post surgery. His path report shows the cancer already there by the edge. Your path report and bf's path report pretty much the same. My bf will be 55 in this Dec. Let us know your PSA test in next Feb.

We will wait until his next PSA check in Feb. 2010. We are seeking opinion from other doctors for treatment that he may have soon.

Thanks all again for your advises and support.

Hollynn

William Parkinson
Posts: 60
Joined: Oct 2009

Hi Hollynn. The twe cutoff points to remember are 0.2 ng/ml and 2.0 ng/ml. The best response to radiation occurs when the PSA number is at or below 0.2 ng/ml, according to numerous studies. At the fairly high number of 2.0 ng/ml, radiation is rarely useful except as palliative care for bone metastasis. And since your bf had positive margins, it does look like it has started to grow. According to Catalona, a very famous surgeon who does prostatectomies at Northwestern U., roughly 50% of men with positive margins will need to add other therapies, at some point in time, to control their cancer (usually radiation). If it were me, I would wait and see if it goes to 0.2ng/ml. The reason for this is as follows: the prognosis is really just as good at 0.2ng/nl as at 0.1ng/ml before additional treatment, plus it gives your boyfriend more time to heal from his surgery before he undergoes radiation, which might reduce complications from the radiation. Plus, the time it takes his PSA to double, called the PSADT (PSA double time) can yield a great deal of useful information about the nature of his cancer for the doctor and can, therefore, influence treatment choices. In any event, your bf should pose these questions to his doctor and as always it never hurts to seek another opinion from another doctor. I hope this helps and I wish you well and your bf a complete cure of his cancer.
Cheers
Bill

Hollynn22
Posts: 15
Joined: Aug 2009

Larry, my boyfriend gleason score was 7 post surgery. His path report shows the cancer already there by the edge. Your path report and bf's path report pretty much the same. My bf will be 55 in this Dec. Let us know your PSA test in next Feb.

We will wait until his next PSA check in Feb. 2010. We are seeking opinion from other doctors for treatment that he may have soon.

Thanks all again for your advises and support.

Hollynn

steven.sims@cbexchange.com's picture
steven.sims@cbe...
Posts: 2
Joined: Nov 2009

He was my surgeon 5 1/2 years ago when I was diagnosed at 47 years old. Ive been 0 PSA since a month ago. Now at .1 Had no margins or seminal vesicle invasion but did break thru to outer edge of capsule. Already has radiation after surgery. Nervous but trying to be optimistic. Gleason was 7 4+3

STeven

masdada
Posts: 1
Joined: Jan 2010

Hi there
I was a bit confused by this post . Are you saying radiation is generally not successful if the PSA is over 0.2. Or, are you saying that AFTER SURGERY then radiation is only advisable at PSA under 0.2?

We (well really, my dad) started radiation at PSA of 197. Then it dropped to below 1 and stayed there for 18 months. It was never as low as 0.2 though. I think it ranged from 0.5-0.9 which at the time sounded FANTASTIC. It has now started to rise in the last 6 months and has reached 9. We are horrified.

BTW, I was on this site in 2007 but I guess I didn't post for a long time and my profile was deleted so I had to reregister.

shubbysr's picture
shubbysr
Posts: 87
Joined: Jun 2009

I am at 6 months since surgery. I have had 2 PSA levels drawn. Reported as <0.01 and <0.04. I talk with my doctor next week for interpretation. I know the levels are expected to be zero or very close. I was told that there can be some cancer cells that linger but, the trend is to watch the levels and decide.
It is good to keep asking the questions.

shubbysr

jlk6874
Posts: 10
Joined: Dec 2009

My husband had radical surgery-found out after surgery that it as broken thru the capsule. His surgery was 3/11/04 and he started 37 radition treatments on May 20,2004. He tolerated the radiation VERY WELL-mostly just tired.

His PSA stayed undetectable until Dec of this year, it is now a .2. We are a little stressed out, trying to remain calm.

We are very glad he didn't wait to have the radiation, it gave us a much better peace of mind in the years since cancer entered our lives.

I will keep you in my thoughts and hope things go well. Please feel free to ask ANY questions. Take care of him and yourself.

Hollynn22
Posts: 15
Joined: Aug 2009

Hi Jlk6874,

Since this cancer came to our life, it really eats me from inside out. I was vegetarian for a month during my praying for him and lost 10 pounds. I'm very upset since i don't know how to help him but praying...that's all i can do right now. Everything else i will put in God hands.
I wish you and your husband the best on the road to cure his cancer.

Hollynn

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

Hollynn, Try and stay positive! It is human nature to worry but you have to take care of yourself also. I'm sure we could all stand to loose 10 pounds but do take care of yourself!

Besides praying, listen and talk to your boyfriend, be open and talk to each other about your fears and concerns.

Larry in TN age 55
Gleason 7
1 positive margin post surgery
PSA 0 at 6 weeks waiting for 6 month checkup in Mid Feb.

Hollynn22
Posts: 15
Joined: Aug 2009

Thanks Lary for your advises. I have been trying to keep myself calm and do not show my emotions to my boyfriend. May i ask what is the percentage of cancer involved in your prostate and what is your stage? My boyfriend's is 15% and stage T2C. How is your leaking? My bf's leak is gone after 2 months of his surgery. He is pad free now.

Wish you luck on your next PSA test,
Hollynn

jlk6874
Posts: 10
Joined: Dec 2009

Hi Holly,
I also lost weight(about 12-15 pounds) when my husband was diagnosed-he actually gained a couple of pounds. I threw myself into a journey of knowing everything I possibly could about his cancer-I needed to know and he relied on me for info. We are both very glad he did not wait to have the radiation-as I said before, we were able to relax a bit more knowing he was being pro-active. He was 54 when diagnosed and it is a very tough time. We did call the ACS help line and they put my husband in touch with someone who had undergone the same procedures-very helpful.
It is very hard to know what to do--I found talking and writing to be very good therapy. I would write my feelings-good and bad-happy and sad, and just keep my own diary.
I wish you both serenity and great results.
Janet

Hollynn22
Posts: 15
Joined: Aug 2009

Janet,

When your husband had radiation treatment, did he stay in hospital or just a outpatient treatment? If he did inpatient so how long he stayed? Is that internal radiation or external radiation? as I know that they have two kinds. Did your husband make it 8 hours at work at all back then? I would like to know more about radiation treatment, how they have it done and how it impact your life.

Thanks for your advises and inputs.
Hollynn

jlk6874
Posts: 10
Joined: Dec 2009

Hi Holly,
My husband had external radiation-only took about 10 minutes and he either came home or went to work,depending on the time of the appt. We were lucky that the treatment center is 5 minutes from home. He went back to work part time at 1rst-mostly because of the surgery-not the radiation! They will give you a complete schedule for treatments when you first go
for the prep.
My husband gets tired now-seems to take a few years before the radiaton had much of an affect on his stamina(could be age even-not sure radiation had any adverse effect). It is a hard thing to go thru- I may not have physically felt his pain-but mentally we were in this together.
His psa never really got very high-it was how quickly it was changing-did not find how that it got outside until the biopsy after surgery. The intire left side was malignant and the right side was clean.
We do try to remember how lucky we are that they found it quickly-the impact on our lives has strangly been positive, we take time to smell the roses and make sure our children and grandchildren know we love them ALL the time.
We are now keeping our hopes up that his psa rising is just a quirk from the lab-we can deal with what we know-its the not knowing that is harder.

Take care -have to go to work now!
Janet
(we are from Peabody Ma.--he goes to Lahey Clinic for treatment)

WHW's picture
WHW
Posts: 189
Joined: Jul 2009

Hollynn,

I have been following your posts for a few days now and feel that I can add to the discussion.

My journey is well documented here. Most of my posts contain the name Sonny in the subject line.

I was diagnosed in July 2009. At the time my wife was just admitted to the hospital (she herself is fighting cancer) and wound up staying in ICU for 7 weeks. So my days were spent with her and my nights were reserved for research into the world of PCa and my options.

I decided that surgery was the best for me as it would provide for the minimum amount of recovery and downtime. I would then be able to spend more time as my wife's caregiver.

I had da Vinci surgery on September 17, 2009. My surgeon is one of the most recognized PCa da Vinci surgeons in the US. He preformed as was advertised and my recovery was almost a non-event. I was fully continent from the day the catheter was removed and back on the ball field as a college official 5 weeks after surgery.

Subsequent PSA tests indicated that there were still cancer cells present. So at 74 days following surgery I began IG/IMRT radiation treatment. Last Friday I completed #25, I have 10 more to go. The radiation therapy has been almost as non-eventful as my surgery. I have had almost no side effects other than a little increase in frequency for the need to urinate. My treatments are daily at the same time and are about 1 1/4 hours with the travel time added in. The treatment itself takes only about 15 minutes. If I were still working I would have no trouble in keeping my daily schedule. Being retired my day is still full of activities, physical exercise and exertion.

There have been many studies and research papers released in the last year indicating the improving success rate of having radiation therapy as a follow up to surgery. In fact there have been a few reported that show a higher degree of long term chemical free recurrence when using radiation even before PSA shows any increases.

I hope that this helps a little. If you have any questions just ask away. There are many here that have been on this same journey and will continue to chime in where there experiences can be of assistance.

Good luck to you and your husband in your journey,

Sonny

61 years old
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative
da Vinci 9/17/09
Post Surgery Pathology:
Gleason: Changed to (4+3) = 7
Stage: T3a
Tumor Volume 12.5%
NERVES SPARED-positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT began Nov 30,2009 (74 days post surgery)

lion1
Posts: 239
Joined: May 2007

ALL,

FOR THE LAST 3 1/2 YEARS my PSA has been <.1. I had no positive margins---Isn't that where you want to be??? And go no higher??

Lion1

Putter's picture
Putter
Posts: 2
Joined: Jan 2010

I only discovered this network this evening. You seem to be recovering very well, and
I hope your wife is recovering as well or better.

Your story is similar to mine. Every year I have a physical and a PSA test. Every year we haul our 5th wheel to Tampa, play golf, & wait for the snow to melt.

I am 71, and thought I was in good health.

Last April my PSA was 7.3, which doubled from the previous year of 3.something. Altho I felt great, my urologist indicated that my chances of having prostate cancer were real. A white paper from Johns Hopkins indicated that if your PSA doubles w/in a year, then most likely my life expectancy is 5 to 7 years. My biopsy taken in August 09 indicated cancer present in both sides 10% on the left and 40% on the right. A gleason score of 3 + 3 = 6, which was later upgraded to 3 = 4 = 7 Stage T2c B2). I figured an agressive attack on this cancer might prolong my 5 to 7 year prognosis.

I elected to have the di Vinci robotic nerve sparing procedure @ the Vattikuti Urology Institute - Henry Ford Hospital. I was very pleased with the procedure, the skill of the surgeon, and care provided by the hospital. Incontinence has been almost a non issue, but I still wear a pad every day in case I might experience a small leak as a result of some unforseen exertion. I am working on the sexual rehab w/some success, especially w/the shots. I have read that at my age, forget it, however I am optimistic. Like golf, think positive.

This afternoon I learned the results of my first post surgery PSA blood test (about 80 days after surgery). It is 0.5. At first I thought that was great, however I started reading posts on this site, and it appears that anything above 0 isn't good, and I guess when the reading gets to 1, then more procedures are needed; i.e., radiation treatment. I have not had the opportunity to speak w/my doctor yet.

I guess my next step will to have another PSA test to verify no lab error.
Then a bone scan to see if any residual cancer can be located.
Wait 3 months to see what the PSA does.
If it goes up, I believe I will start the radiation treatments.

I have read that the radiation treatments can be bad news in the continence/bowel and sexual departments - so I am not looking forward to this procedure. However, just this evening I have read several posts (like yours) that indicate minimal problems. Hope this is the case. Good luck in your recovery process...

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