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PSA rise after RP

zandric51
Posts: 1
Joined: Mar 2012

I had radical prostatectomy in septeber 2011. My PSA in that time was 10.9, I had clear bone scan (Scintigraphy).

After surgery Pathology report was: G3, Margins clear, Geason score 7 (4+3)GD 60%+40%, Pt2+(PNI) pN0 20%, L1V1 Without transcapsular spread.

My first PSA measurement (cca 6 weeks after surgery) was 0.06, 4 Months later it was 0.24, 2 weeks after that reading it was 0.3
MRI does not show any spread

My doctor is proposing wait (till PSA > 0.5) with notion that cancer cells were spreaded with high probability that it is distant spread (knowing nature of surgery - most radical that can be imagined).

He is proposing new Scintigraphy with notion that this, most probably, wouldn't show anything yet (and, most likely, will in the future). I am postponing that hoping for some other form of diagnostic (PET?) and having in mind that those procedures cannot be repeated very often.

I am trying to seek second (third/fourth) opinion in pusuit of proper diagnostic method that can/will detect "beast" especialy if it is still local (so radiation treatment can be applied).

Any advise based on your experience will be more than wellcome.

Zoran

VascodaGama's picture
VascodaGama
Posts: 1508
Joined: Nov 2010

Zoran

Unfortunately you are very correct in your descriptions. It seems that you are experiencing biochemical recurrence. Though, the last PSA of 0.3 could as well be lower if the result is from a common assay (0.X ng/ml). Sensitive assays have LDL in the two decimal places (0.XX ng/ml), similar to your other tests.

Your pathological stage is given as pT2 but, if you may see it as important, you could request a second opinion on the slides to certify its correctness. My view is that you got L1V1 which refers to lymphatic and/or blood vessel invasion. In fact this finding may be the reason for the recurrence, and if found correct you would become a .pT3a.
Nevertheless, the important diagnostic is the grade 4 in your Gs7 which classifies your case as high risky for recurrence and metastases.

I can see by your descriptions that you are an educated patient. I agree that you should pursue the best to certify any far metastasis. The newer contrast agents in PET scan imaging with C11 choline or the 18F PET/CT are expensive but a good “tool” to get proper diagnosis.
Another “tool” is the Feraheme USPIO (Ultrasmall Superparamagnetic Iron Oxide) contrast agent done with a high resolution (3 Tesla) lymph node MRI scan. If those are positive you could follow a focal treatment with radiation.
Here are some papers of past image studies to compare in case you decide something simpler;
http://jnm.snmjournals.org/content/47/2/287.full.pdf

I hope you recover completely from the radical and get fit for the continuing journey.

Welcome to the board.

VGama

Davebrown
Posts: 2
Joined: Mar 2012

I had rp sep. 2011. The path report from the operation jumped me to stage 3 and Gleason 3 plus 4 due to extra prostatic extension and positive margin one one edge. Psa trend has been .07 one month post op and .06 at the 3 month mark and earlier this week my psa was.09. No radiation is being recommended at this time given my overall path report and psa reads. I am concerned. My next appt. and psa check is in June. At that time surely if the psa rises I would imagine at least radiation may be recommended. Your thoughts on this? Also, my continence is fortunately normal but ED is an issue. I am considering injections . . . Any thoughts on that direction? I am finding comfort in knowing there surely are other men in my situation.
Dave Brown

Davebrown
Posts: 2
Joined: Mar 2012

I had rp sep. 2011. The path report from the operation jumped me to stage 3 and Gleason 3 plus 4 due to extra prostatic extension and positive margin one one edge. Psa trend has been .07 one month post op and .06 at the 3 month mark and earlier this week my psa was.09. No radiation is being recommended at this time given my overall path report and psa reads. I am concerned. My next appt. and psa check is in June. At that time surely if the psa rises I would imagine at least radiation may be recommended. Your thoughts on this? Also, my continence is fortunately normal but ED is an issue. I am considering injections . . . Any thoughts on that direction? I am finding comfort in knowing there surely are other men in my situation.
Dave Brown

VascodaGama's picture
VascodaGama
Posts: 1508
Joined: Nov 2010

Dave

Welcome to the board.
Yes, you are right; there are many guys in similar situation as yours. However, we all got “tools” to fight the bandit and knock it down. Nevertheless one should know all the aspects of their status and be positive in confronting the matter. All should be done timely and coordinately, with no rush before being certain on the decision. Researching is necessary and so it is second opinions from specialist on everything.

You have not indicated your age or other aspects regarding your health, fitness or results from tests and image studies, or cancer volume, or your pathological stage (N? M?). These are important to guys here to opinion better on your case. Surely we are not doctors and can only provide you with lay suggestions.

At first impression on your info, the PSA is still at remission levels and that signifies success and deserves celebration. Recurrence is common at rising levels when the PSA reaches above 0.20 ng/ml. Intervention with a salvage treatment is usually taken at PSA=0.4. (you are still very far from those numbers)
In any case, some doctors may recommend earlier intervention if the stats indicate seminal or lymph nodes invasion. Extra prostatic extensions (ExCE) are already indicative that you are at high risk for recurrence/spread, but there are cases of positive ExCE with years of remission. A good friend survivor veteran in this forum Lewvino (Larry) is an example. He had robotic surgery in 2009 with similar status as that of you (Gs7, positive ExCE). In saying such I do not mean that your case is equal but similar, and one could think on the possibility of having continuing remission for many years.
Here is a link;
http://csn.cancer.org/node/191388#comment-1125900

My suggestion is that you should wait for confirmed recurrence. Meanwhile you could educate yourself on the ways of diagnosing (as my above post) and about possible salvage treatments, their consequences, risks and effects in the quality of life. Side effects tend to become more evident because they superimpose from previous treatments.

You can find many threads on ED in this forum. The link above contains the opinions from other survivors.

Wishing you a continuous successful journey.

VGama

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