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psa rise 5yrs post radical surgery

caprosfght
Posts: 2
Joined: Feb 2012

just found out after 5 yrs post radical surgery that my psa is 0.1, all post surgery psa tests were <0.1, pre surgery psa 14 age 51,post surgery gleason 7, both lobes positive, margins,nodes, bladder neck all negative, however there was perineural invasion. Uro dr says retest 3 mos to check doubling time, if changes to 0.2 would advise radiation of prostate bed.Questions why wait 3 mos to retest psa? Can the cancer spread through the nerves? will any tests show where the cancer is located? ie mri ct scan? If some prostate "normal" tissue was left behind can it regenerate to produce psa?

tarhoosier
Posts: 182
Joined: Aug 2006

Caprosfght:
Glad you are here. Sorry you feel the need to be here. Your doctor is following a conventional program. Nothing out of the ordinary. Your psa has risen, maybe, and the rise, if any, appears to be slow. A few months is a reasonable time to monitor this situation. It has never been proven that perineural invasion leads to metastasis so nothing can be confirmed with that information. At such very low psa numbers it is impossible to identify any location with current imaging technology. That would require a psa of 2.0-5.
If some prostate tissue were not removed in the surgery then it is possible for the remainder to generate psa now, and this tissue may actually be benign, rather than cancerous. Locate the pathology report from your surgery and read it closely. If there were a bit of prostate tissue cut through and left after surgery it is likely that the path report will mention it. This is something of a long shot.
Your recurrence has not been confirmed, and treatment, if necessary, may be well into the future. Patience is required. Anxiety is of little value, though it is regrettably expected. Your surgeon did as well as he could. Your psa is nearly zero. There are numerous treatments that will likely allow you to live your normal life span.

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

capros,

Tarhoosier gave you some sound advice. Waiting three months gives your medical team better data points about PSA doubling time and velocity, both of which are important in gauging the aggressiveness of recurrent cancer, if that is what is happening. Since you seem to be taking the standard PSA test instead of the ultra-sensitive, the < .1 or = .1 numbers are probably iffy. It could be just a standard deviation in the laboratory analysis so it's too early to get concerned.

When the prostate is removed it is not like unbolting a carberator. Some prostate material always remains behind but prostate material does not regenerate itself. Since your margins at surgery were negative there was no detectable prostate cancer at that time. Prostate cancer is inherently metatastic and frequently spreads. One of the most common places it spreads to early is the tissue immediately surrounding the prostate which we commonly refer to as the "prostate bed." The amount of prostate tissue left is theoretically capable of producing PSA but it would likely be at levels well below 0.1

PNI is not uncommon. PCa seems to like to lodge itself in or near the nerve bundles that surround the prostate. When the surgeon performs "nerve sparing" surgery it seems logical to me that there might be some residual cancer cells in that area but as Tarhoosier points out, there are no conclusive studies that prove this is one of the paths that prostate cancer travels to other organs. The most common methods of cancer cell migration is through the blood stream and lymph system.

It's unlikely at this early stage that any imaging tests will reveal cancer in other parts of your body. There are some circulating blood tests and other things they can do to determine if cancer is still present in your body but they're going to have a hard time locating it at the microscopic level.

Recurrence occurs in about 35% of men who have RP. Standard treatments with excellent prognosis are radiation to the prostate bed and is often combined with hormone therapy.

It seems to me that you've got a good urologist who is taking a deliberate and calculated approach. Second opinions, however, are always useful.

Scott

caprosfght
Posts: 2
Joined: Feb 2012

thanks for the info, yes there is anxiety as i witnessed my step/father in law battle for 10 yrs reocurring prostate ca , finally died from it in the bones jan 2007 just prior to my radiacl in feb that year.My lay brian/knowledge tells me that nerves are nurished by blood and if invaded by ca could spread , i might ask to get psa test sooner but don't want to upset uro dr,any thoughts

tarhoosier
Posts: 182
Joined: Aug 2006

Cap:

From my viewpoint, without the anxiety you currently feel, I say there is no rush to test. There is CERTAINLY no rush to treat, which is the whole purpose of testing psa. It will take some months, perhaps years, to identify the rate of psa growth, velocity and other factors that weigh in the next step.
I emphasize here that a recurrence has not been identified because you need serial increases in order to meet that criterion. It is hard to just hold one's breath for months. I know. Those of us who follow psa are almost always those who have never had a chronic condition that required years of close monitoring, such as asthma, diabetes, and many others. Those people know that one must exist WITH the condition and not let it become you.
If I may, I would like to address the issue of the relationship with your urologist. You hire him. He works for you. You need not worry about his feelings. If you are concerned about how he feels it is unlikely to be reciprocal. Ask for what you feel you need. I personally think that the urologist is done (unless you have continuing urologic issues). If you need the best advice about the road ahead, a medical oncologist is your choice, preferably one who has lots of experience with Prostate Cancer (PCa). If you are ready to move on from the uro, this would be a reasonable time to do so. You are looking ahead, and not back.

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

I too appreciate your anxiety, particularly given your background. But the definition of recurrence that most prostate cancer specialists use after RP is a PSA > 0.2 ng/ml and rising. Your are a long way from there. Rushing out to do another PSA test is not going to help anybody figure out your PSADT or velocity. If it goes down, you're maybe going to be relieved but I suspect you'll find something else to worry about. There's always something. If it goes up, you're still likely to be less than 0.2.

Of course nervers are nourished by blood. Everything is. And of course PCa can spread but it doesn't spread via ther nerve system although its cells might like to cuddle up to nerve bundles.

Good advice about your urologist too. Sooner or later you have to move on.

K

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