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First PSA following prostatectomy.

jculha
Posts: 11
Joined: Apr 2010

Hello everyone, I am returning following robotic assisted radical prostatectomy. My gleason was 3+3=6. Cancer was found in part of one biopsy of twelve. I dont know what stage it was but the doc said he could not feel any lumps on digital examination prior to the biopsy. The surgery went well and my recovery has been very good. At my first visit following surgery, for catheter removal, I was told that the cancer was entirely contained in the prostate, there were negative margins and no involvement in the lymph nodes or seminal vesicals (?). I was told, "You can consider the surgery a cure." My optimism was curtailed last Tuesday when I went in for my 3 month followup psa. The reading was 0.17. My doc said that he was concerned about the reading and a bit surprised by it. He scheduled another psa in two months. Of course, I'm going nuts now researching online and scaring the heck out of myself looking at worse case scenarios. I lost a brother to prostate cancer this last spring so this is all very real to me. Just wondering if anyone has had similar experiences or knowledge concerning this initial psa following surgery. Thanks

bdhilton
Posts: 752
Joined: Jan 2010

Sorry to hear about the rise in your post surgery PSA as I know the whole post surgery PSA testing is an anxious time for all of surgery guys and it does not seem to make sense based on your “pathology” that I assume is a Gleason 3+3, negative margins and fully contained… I am on the other side of the spectrum with a post surgery Gleason 4+3, one positive margin, right SVI…etc…but stranger things happen with this beast PCa…

My advice is that you are best to have a plan of action and believe in that plan of action…I would strongly urge you if you have not already change you diet to a low fat heart healthy diet (no more than 15%-20% fat in calories), give up dairy 100%, no red meat, 3-10 serving of green tea (I drink ice tea), one serving of soy product daily, one serving of pomegranate juice, etc…Fight this beast with all guns blazing… I believe that diet and exercise are just as critical as knocking this beat down with a medical treatment.

I would be reading studies from the following sources (to name a few) so you have an educated basis to talk to your doctor…

European Association of Urology
John Hopkins
Northwestern (Dr Catalona)
JAMA
Prostate Cancer Foundation

I know if I was to have a reading >.1 my oncologist would be pressing for radiation before it hit .2….but with negitive margins most of what I have read do not recommend radiation in the prostate bed but that is my take from what I have read....God Bless you in this journey-B

jculha
Posts: 11
Joined: Apr 2010

Thanks, that seems like good advice. Your response also reminds me of another question. Up to this point, I have treated with Urologists. My doc, I believe is an excellent urologist/surgeon but I am wondering if at this point, I should be consulting with an Oncologist as well?

bdhilton
Posts: 752
Joined: Jan 2010

As soon as I heard I had a questionable “DRE” my primary doctor became an Urologist Oncologist and I feel that he has looked out for me from day one but I do my homework so I can talk to him and this is very important for you to do as well…. He is also a well regarded surgeon (however, he sent me to Northwestern to have my surgery)...Do what makes you feel comfortable...these are extremely important next steps for you-Whatever you decide-God bless you in your journey

2ndBase's picture
2ndBase
Posts: 220
Joined: Mar 2004

This .17 is exactly what my psa was following my radiation. My original psa was 24 and Gleason 9. I have survived over 6 years and am now in hospice care. It sounds as if the cancer may have spread and believe me it is not easy to find out where it is at this point. I had several very expensive tests which showed nothing at the time. I have well outlived my diagnosis and plan to keep that trend going another year or more. I took no further treatment and have had a great quality of life. Getting the stress out of my life was the best treatment and it is why I have survived so many years. Try to stay calm and use your best judgement as for how to proceed in your dealing with this problem. All the best.

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

Sorry to hear about your detectable psa after surgery. Mine was .3 after surgery & I was told it was contained & psa would go down. It went up to .4---------5 months after surgery & with a .7 psa I opted for IMRT. I finished just before Christmas and PSA has gradually declined to .1 Next month I get the next test. The diet advice one of the brothers gave should be beneficial. I would not worry too much with that .17-----your next test should be the indicator on how you proceed. Try to get that diet right & relax.......and keep the faith.

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

As I understand it, biochemical recurrence after RP is a PSA reading greater than 0.2 ng/ml and the follow up PSA is a good idea.

You may also want to discuss statins (if you haven't already) with your doctor. The following quote comes from Duke University in a report they issued last month:

"Researchers at Duke University Medical Center in Durham, N.C., analyzed data from 1,280 men in the Shared Equal-Access Regional Cancer Hospital (SEARCH) database who underwent RP and were not on statins prior to surgery. Of these, 350 (27%) started statin treatment after RP. These subjects had a lower mean age than men who did not take statins (61.5 vs. 62.8 years), higher median BMI (27.5 vs. 27 kg/m2), and lower median pre-operative PSA levels (6.5 vs. 7.8 ng/mL). After controlling for clinical and pathological parameters, post-RP statin use was associated with a significant 39% decreased risk of biochemical recurrence defined as post-RP PSA levels greater than 0.2 ng/mL, two PSA determinations of 0.2 ng/mL or higher, or receipt of secondary treatment due to rising PSA."

I have also read that should BCR be determined, that hormone treatment significantly extends long term survival rates as does IMRT radiation, and that the combination of the two is more effective than either as a stand alone treatment.

One of the most important parameters to consider when looking at potential follow on treatments if you do determine that there is BCR is to calculate your PSA velocity. A lower PSA velocity and there are plenty of articles about post RP PSA velocity you can find using Google that can give you good insight.

I hope your next PSA reading nothing to worry about.

jculha
Posts: 11
Joined: Apr 2010

Thanks to all for your insights and encouragement. I did talk with a friend who had a similar experience with high psa on the initial test following surgery and his psa was lower two months later and is now undetectable. He said that his doc told him that some people metabolize psa slower than others and that could account for the initial high psa. I read a report that I found online of a study which was trying to determine if caucasians metabolize psa faster than african americans. The study affirmed that psa is metabolized in the liver and can be detected following radical prostatectomy surgery. For now, I am going to hang my hat on that possibility and get on with enjoying life. I did hear your good advice and I will be adjusting my diet and increasing my exercise. God bless you all. BTW, the study found that caucasians and african americans metabolize psa at approximately the same rate. Just a followup, I was able to consult with a well known urologist who conducted a study on psa metabolization. He told me that it was not possible to have non-metabolized psa in my system 3 months following radical prostatectomy. He said that it is entirely possible even with negative margins that there was a small amount of prostate tissue left behind after the surgery. That tissue will produce psa and may die out over time or may continue to grow with a negligable rise in psa over time. He did not recommend radiation if that is the case.

Klemon
Posts: 26
Joined: Jun 2010

My husband age 64, underwent robotic prostatectomy at Mayo in Rochester in July 10. After 3 yrs and 3 negative biopsies he was diagnosed 1 postive core at 3+3=6..and PSA had reached 8.2, Saturation biospy at Mayo revealed 3+3=6, 3+4=7 and 4+4=8. After negative bone and CT scans,.... He underwent the robotic surgery and also an extended pelvic lymph node dissection where all the nodes in the entire pelvis were taken, as opposed to the typical regional ones... It was 5 1/2 hours of surgery. All nodes were negative, 2 margines were "involved" at 1 mm each- (which we were told by Mayo surgeons and our urologist at home, that they are considered insignificant/negative due to size and location)... He went through it fine, felt completely normal at 2 weeks. He was downgraded to 3+4=7 post surgery which is huge.
Now we are scheduled for the 3 month post op PSA test next month. I am so worried. Even though he was downgraded to a 7, and we were told it was organ confined at T2 (involved both sides of the prostate at 3mm x 1.7 mm)...I am very worried about biochemical failure. He of course is not. How do you all survive this anxiety?

mrspjd
Posts: 688
Joined: Apr 2010

I've read a few of your posts, but the one you wrote directly above "speaks" to me--"How do you all survive this anxiety?" Sounds like you and your husband have been on a real roller coaster ride. I can empathize. My husband has T3 locally advanced non-met PCa, diagnosed Feb 2010, Gleason 3+4=7, PSA 2.4. I've previously posted the stats elsewhere, but just to give you a thumbnail--he elected not to have RP, and instead, because of his intermediate risk, high volume PCa (9/12 cores positive w/many @100% & PNI) decided to do ADT3, HDR-B (completed) & IMRT.

Getting back to the "anxiety" issue...it's one thing for the guys to address how they handle it, but for me, the wife, it's my anxiety & stress about this PCa beast that I am personally dealing with--not to diminish the anxiety from waiting for post-tx PSA results, which is just another buffet item from the long menu list of anxiety-producing PCa issues. I try not to create more stress and anxiety for him by showing mine, although he knows its there. Something that has helped me--I've recently completed an 8 week "Mindfulness Based Stress Reduction (MBSR)" meditation class based on the book (which I recommend) by Jon Kabet-Zinn called "Full Catastrophe Living" (Delacorte, NY 1994). This has helped tremendously (not gone, but emphasize "helped tremendously") with my anxiety and stress and taught me how to put those issues in perspective. As part of the class and from add'l reading ("The One Minute Meditation"), I've also learned how to breathe during meditation, and I think the breathing practice has helped as much, if not more, than the meditation. BTW, if you're old enough to remember, this is not the same "yogi" knot-sitting meditation practice popular in the 60's and 70's--its very different. I've learned through the class that all we really have is this moment, the moment we are in right now (as fleeting as it is), we do not have the past or the future, so I try to stay focused on this time/moment, the present, right now. If I spend too much time thinking about what the future MAY bring (no one knows), or the decisions that have already been made (can't go back), that just adds to the anxiety and stress levels. Although it can be hard to do since the mind often seems to drift to the "what ifs" and resists the stillness of meditation, it takes practice (and I'm still learning), I try to focus on what is now, right here, this moment, take some big slow full belly breaths and stay positive in the present moment. Walking and exercise only enhance this practice. Hope my experience and book recommendations are useful.
Best,
mrs pjd

JohnK11
Posts: 23
Joined: Nov 2009

Re : High PSA after treatment and
my experience on hormone treatment (10-month report)

I am one of the least lucky prostate cancer patient
(I've only seen a few people with comparable or worse
experience). After Robotic surgery, my PSA DID NOT go down,
and stayed at 7 (retest 2 weeks later at 9.2 --> 2+ month
doubling time).
Since the PSA was so high, and doubling time short,
I did not even consider SRT (unlikely that all the cancer
is nearby the removed prostate)
If the spread is far away (bone, far away lymph nodes, etc.) no initial treatment
will impact that. Furthermore, any diagnostics when your PSA is low (below
20-40) will unlikely find far-away cancer, since it is likely to be too small
(I think I wasted the effort in bone scan, CT scan, and MRI/prostascint scan,
since at that time, my PSA was only 7).

However, hormone treatment seems to be working.
The uro claim 5-8 years of effectiveness, but that might
be optimistic. There are treatments beyond that, but
some of the side effects are horrendous (I don't think I
want to go chemo just to extend my life by 2-4 months).
The side effects of hormone seems to be okay --hot flashes are
a bother, but I got used to it.
I still live an reasonably active life--go to work
every weekday (fortunately, office job), play singles tennis
(not as rigorously as before, but I am getting older), walk
a lot, not other serious side effects (perhaps having trouble
getting full 8 hours of sleep since I tend to get up every
2 hours to pee--still some urinary leakage).
So, as long as the hormone (intermittent) treatment
works, I am going on with my life as before. My attitude is
that I have lived a reasonably full life, been involved with
a few discoveries (bottom and top quark), so will like a full
life until I go. Cheers.

---------------------------
PC history
4/09 Pre-biopsy PSA 4.2 (this triggered the
7/09 biopsy 4+3=7 Gleason prostate cancer)
10/09 Pre-surgery PSA 6.7
10/9/09 DaVinci surgery (Gleason 4+3=7; T3c; right seminary
vesicle cancerous; has to remove that AND "way beyond the
prostate" to get negative margin)
11/30/09 6 weeks post surgery 7.0/6.4
12/13/09 8 weeks post surgery 9.2 (doubling time 2+ months)
12/16/09--took Trelstar (Lupron surrogate)
3/3/10 <.1 (testoserone 13)
3/15/10 --took 2nd Trelstar LA shot
6/10 PSA <.1
8/1/10 --took 3rd Trelstar LA shot (plan to go intermittent)

12/09 Both the Bone scan and the Prostascint/MRI scans were
negative (the uro says that most of the time, one would
not see cancerous modules in these scans until your PSA is
~40+.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

DreamV
Posts: 16
Joined: Mar 2012

Hi,
My husband had a robotic prostatectomy on Feb.3,2011. Prior he had neg DRE but a rising PSA (6,9,14). He missed a year of having his psa done which was 0.2 the year before. Neg. ultrasound of pelvis. , Neg. prostate biopsy. Had 3 T. MRI revealing small tumor in prostate, possibly one lymph node involved. Needle guided prostate bx using MRI REPORT REVEALED 2 pos cores. Gleason score of 8. Bone scan neg. Post surgical pathology report reveal post margins, one regional lymph node involvement. 1st post op PSA at 4 weeks was 26. My husband will speak to his urologist tomorrow about elevated post surgery PSA. I think he should also find a medical oncology.

Good luck with your numbers and your perspective on life is very inspirational to us.

ralph.townsend1's picture
ralph.townsend1
Posts: 350
Joined: Feb 2012

Make sure you have the right people looking at this! You only get few chance! These local Doctor's can miss thing's Go to a specialist like MD Anderson in Houston or some place. I went to a Local Oncology doctor, he specialize in cancer , not Prostate cancer!!!

Then my Urologist told me of MD Anderson cancer Center. The best in the world or close to it. I went from Dallas to Houston and everything was schedule for the same day testing, That was 4 years ago and I have maybe another 5 years or longer :-) My Gleason was 4+5 and is in the Lymph nodes. They have a specialist for prostate and they have the best med's.

But my point is get to a place that know's!!!!

DreamV
Posts: 16
Joined: Mar 2012

Thanks Ralph,
We are following up with medical oncologist specializing in prostate cancer at Sloan-Kettering Cancer Institute. Could it be testosterone flair?? He received his first dose of Trelstar right after his blood was drawn for his 1st PSA

ralph.townsend1's picture
ralph.townsend1
Posts: 350
Joined: Feb 2012

It's looks like the right place. :-)

My prayer's will be with you!

Stay in contact!!!

VascodaGama's picture
VascodaGama
Posts: 1517
Joined: Nov 2010

Dream

I wonder if there is any mistake in the results units presented to you. It is hard to believe that the PSA got so elevated after surgery, from 0.2 to 26.
Ralph is passing sound advice regarding the place where your husband is being cared. MSKCC is one of the prime hospitals treating prostate cancer and they will give you the best answers. Trelstar agonist could cause a flare in PSA if taken BEFORE drawing blood which I believe that is not the case. Such mistake would not be "expected from MSKCC professionals.
Nevertheless, why should your husband been put on hormonal drugs just after surgery? Does his protocol include a combine treatment?
Did he in fact had a prostatectomy?

I hope the folks at MSKCC will give the explanation and peace of mind.

Best to you both.
VGama

DreamV
Posts: 16
Joined: Mar 2012

Hi VasodaGama,
Yes he did have e daVinci robotic prostatectomy. How soon after surgery should hormonal therapy begin? His TNM was pT2c,N1,cM0. Lymph-vascular invasion. Thanks for all your info and he plans to repeat his PSA. Will kep all posted.

VascodaGama's picture
VascodaGama
Posts: 1517
Joined: Nov 2010

Dream

I would like to help you in understanding the status of your husband, but you need to confirm some of the info you posted and add details regarding his doctor’s treatment protocol.

What is the Gleason score ?
Have you mistaken the date of surgery?

You have indicated that his surgery was done in Feb 2011 (one year ago ?) and that at 4 weeks post-op the PSA come as 26 (ng/mL ????), and that he was given a Trelstar injection.
I understand his pathological stage pT2c,pN1,pM0 (Lymph-vascular invasion) and the series of negative scans and tests done before surgery but would like to know why did the doctor decide on the adjuvant hormonal treatment.

Was the decision due to extra capsular extension at the Lymph nodes?
Or was it part of the initial protocol?
His your husband involved in a trial?

Concomitant systemic therapies are usually done to improve the prognosis of a prime treatment (surgery in your case). In such cases, the start of the HT has no established protocol, but if HT is done as a sort of salvage treatment then it is usually started once recurrence is declared. The behaviour of PSA tests would be considered to decide on a date.

Here is a link on the matter; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472854/

I hope MSKCC will "clear" your doubts.

Please let us know about your findings.

Regards
VGama

DreamV
Posts: 16
Joined: Mar 2012

Hi Vasco,

Sorry about the date. Now to answer your questions:
1. Gleason score 4+3=7
2. Surgery : Feb. 3, 2012
3. Pre-op PSA 19. First post op PSA at 4 weeks 26.7
4. Pathological stage: pT2c, N1, cM0
5. No capsular extension but metastatic carcinoma in 1 of 2 lymph nodes, following carcinoma of prostate gland

Because of mets to lymph node Trelstat injection started.
He is not involved in any trials.
My understanding is usually after a prostatectomy PSA LEVELS DROP to < 0.1. You want to see some zeros right? But in his case it rose.

He spoke to his urologist last night about the high PSA number and was told it could be residual and not to seek out a medical oncologist as of yet because he didn't need any other medications as of yet. He wants him to have another PSA in 6 weeks. However, I talked him into having it done in 2 weeks. Now that he has had one shot maybe it will still be elevated due to testosterone flair. In the meantime he has an appoint with a medical oncologist after that second PSA. I just fear hat he has the aggressive type because prior to surgery his numbers were increasing quite rapidly.

Thanks for your input as I am at my wits end.

VascodaGama's picture
VascodaGama
Posts: 1517
Joined: Nov 2010

Dream

I am sorry to read about the prognosis. You are absolutely correct in seeking a consultation with a medical oncologist. You should get a copy of the path report to show him. Try to get someone that is specialized.

Your suspicious are also correct, in my opinion. The PSA should go down to <0.1 after removal of the prostate. PSA=26.7 at 4 weeks and the classification of pT2c do not fit at all. One should expect positive extensions not only at lymph nodes but in the tissues surrounding the prostate (T3a or b). It is difficult to believe that folks at MSKCC would pass you erroneous results but when suspicious exits, in your shoes I would seek a second opinion on the prostate specimens. Surely by doing so the newer revelation would not alter the treatment but you would have in your possession the real status which is important data for future actions.

Getting a PSA done at two weeks is a good step and probably it will show already a drop because the flare is common to occur within a maximum of 14 days post administration of the shot. In any case the agonist will influence the PSA result so that it would not serve you at this time to judge the progress of the disease. BOL, it will indicate if your husband’s cancer type is hormone dependent.

I would also recommend you to ask the doctor for how many lymph nodes were dissected (the path report include this). The percentage is important in a case like your husbands’. In my case back in 2000 with open surgery they have dissected 9 nodes, but it is common to take more when patients have high PSA levels before surgery (mine was 24.2).

The reasoning is that cancer leaves the prostate spreading firstly to lymph nodes and then moving to bone at the iliac and far places. In the iliac it forms what is called oligometastatic cancer before becoming systemic. A high number of affected nodes could imply a diagnosis of systemic at far places.
If in fact, the number is small it shows that his case may still be curable with radiotherapy.

Traditional MRI and CT are efficient in revealing cancer when the PSA is high. In your previous post you mentioned that those image studies were negative. I wonder if those tests were done at biopsy when the PSA was low (less than 10). Your husband could get now additional image studies taking the opportunity to get it done with higher resolution equipment (3-tesla) to check for any metastasis. If practical (but not yet required) I would get him to a F18 or C-11 choline PET bone scan to check for far metastasis.

I do not know his age or about any other health problem he may have but in good health I believe that he would like to pursue cure more than “control”, and such can only be achieved with salvage radiotherapy.
Only proper diagnosis can give you assurances on such possibilities.

Meanwhile, the Trelstat shot will control any advancement of the cancer (if it is dependent). Hormonal treatments are very effective as palliative in holding the cancer for long periods of time. An oncologist would then be the proper physician to care his case.

You need to consider that all treatments entail risks and side effects that will interfere with the quality of life. Diet and physical fitness are a must to help in countering the side effects. A copy of this book may help you understanding what I mention above;
“Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers; which informs on diagnosis and treatments for systemic cases. This famous oncologist specialized on PCa is himself a survivor of a challenging case on his 13 year of survival, where he battled the bandit with IMRT and ADT (hormonal treatment). He is also a leading oncologist with regards to oligometastatic cancer.

Again, I would recommend you of getting second opinions from proper specialists. I have no medical enrolment. I have a keen interest and enthusiasm in anything related to prostate cancer, which took me into researching and studying the matter since 2000 when I become a survivor and continuing patient.

Be positive. He will beat the bandit again.

Wishing you both the best.

VGama

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