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First PSA after Robotic Prostate SURGERY

manav_4
Posts: 4
Joined: Feb 2013

Hi,

My Father was dignosed with Prostate cancer Gleanson Score 7 with pernuial Invasion stage T3a.Father was operated on 26th Dec 2012 with Prostate weight around 70g.Doctors told me clearly in starting since cancer has spread near bladder we have to give radiation.My father had his First PSA after one month of operation and it came around 1.09 (in starting that is before operation his PSA was 28.6) which my doctor told me its very high and they have again called me in the month of March to review the situation. My questions are

1) is it danger stage

2) should i go for new PSA test

3) should i opt for radio therepy after second PSA test or should i take it in next month

Please advice

Regards/Manav

 

VascodaGama's picture
VascodaGama
Posts: 1511
Joined: Nov 2010

Manav

Welcome to the board.

From the fewer info you share here, I would recommend your father to get proper diagnosis regarding the spread of cancer, before engaging on a salvage treatment (radiotherapy or others). 

The PSA of 1. 09 indicates treatment failure if there were no mistakes at the lab, but such will be clarified in the next PSA test. Remission levels after RP are usually at much lower levels of <0.06 ng/ml.

I wonder what made the doctor comment on spead closer to bladder. Is there any positive image study result?

What does the path report indicate regarding their anylises on the prostate specimen? 

T3a is the clinical stage atributed to your dad before surgery. T3 patients usually are not recommended to surgery because the practice does not assure cure. Some doctors recommend RP to T3 patients with the intent of debulking.

pT3a is the designation atribuited to cases of extra capsular extension after pathologist's anylises of the dissected prostate (after RP). 

The important now is to define a proper field of attack if the case is proper for radiation. Such should be done with predefined targets that should include the whole spread at localized areas as well as at far places. Your dad must look for any cancer that may be at lymph nodes or bone, or still far at other places.

I would recommend him to get a PET/CT F18 or C11 (contrast agents) image study to look for spread in bone and tissue.

In answering your questions;

1) The cancer stage of a patient does not indicate "danger" but how far the spread has been found. I got a classification of pT3a 12 years ago. I did not managed to get rid of the cancer but I do not think it as "danger". You are negative or positive or at high risk for spread.

2) You should get a PSA test beforee making any further decision. Your dad has more than enough time to decide on what to do before commiting. He should research about the side effects of his next salvage therapy because they will superimpose to the ones he already got from surgery. Radiotherapy is also not recommended to be administered before or while the body is healing from surgery. It can arm more than doing good.

3) The PSA test will provide you with certainty but image studies should try to locate the cancer. The age or any other health concern of your father must be considered.

I would recommend you to get second opinions from specialists before engaging in anything.

 

Hope for the best and try not to be so anxious.

 

VGama

 

manav_4
Posts: 4
Joined: Feb 2013

Dear Sir,

Many thanx to your reply, yes Dad has bone scan,MRI and histogram..from which doctor made it clear that it has spread and they have to first gor for robotic and after that where there is capsular breach that can only be cured from radiation..sir if cancer has breached do he have time to take seconda PSA and they go for radiation

 

Regards/Manav

 

Samsungtech1
Posts: 350
Joined: Jan 2011

Manav,

They have to wait at least six weeks to start radiation.  This should be enough time for another PSA test.  Every Dr. Has their own vocabulary.  Yours either uses poor choices, or is trying to scare you into treatment.  We wait almost 18 months to begin radio surgery for nodules in lungs.  I had broad spectrum radiation for the bladder.  Usually if it has spread to bladder neck they use this form of radiarion rather than radiosurgery.

Vasco has given you good advice.  It is only as scary as we make it.  

 

Mike

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

Vasco is right on, and Radiation is not a cure all. In fact, if it escapes the prostates the chances of radiation working is not good. It not the only choice and a second opinion from a specialist should be required.

VascodaGama's picture
VascodaGama
Posts: 1511
Joined: Nov 2010

Manav

Your dad can and should have a PSA test, done before the radiation. The PSA is done from a blood sample. He needs this test to certify failure of surgery.

The radiation treatment can follow the test and it is not obligatory to have it done so soon.

Your dad will not loose anything by delaying the treatment three to six months. Cancer spread does not occur overnight and it is not a cause of the surgery. It seems that the doctor knew about the spread before the surgery. The problem is how to identify the location of the spread and to be sure that it does not exist at far places.

I recommend your dad to get a second opinion from a radiologist that specializes in prostate cancer treatment.

What is his age?

Best

VG

manav_4
Posts: 4
Joined: Feb 2013

Dear All,

Thanks for all your valued suggestion.My father age is 65 years.He has all the necessary test which has confirmed the leak of cancer before surgery.As per doctor is suggested the way that first we will take the prostate out and then will go for radiation to kill the spread cell.

 

Regards/Manav

 

VascodaGama's picture
VascodaGama
Posts: 1511
Joined: Nov 2010

Manav

 

From your last post I take your dad’s treatment protocol as the combi of prostatectomy plus adjuvant radiotherapy.  This may have been the choice of your dad and his doctor.

The benefits of this modality were much of a discussion since the results from past trials were published in 2007. Namely; the EORTC trial 22911 (European) and the SWOG trial 8794 (Southwest Oncology Group).

You can read about the conclusive findings in these links;

http://jco.ascopubs.org/content/25/35/5671.full

http://www.medscape.org/viewarticle/744220_3

 

Many comments were used to compare the benefits between adjuvant radiotherapy against later salvage radiotherapy, post prostatectomy. Their conclusion indicates benefits on longer times of biochemical free rates (supporting the adjuvant) but they have no conclusive evidence of better benefits with regards to prostate-cancer-specific mortality.

The PSA test is used in defining the progress of the cancer but your dad’s established protocol may not be dependent on the test results post prostatectomy. This would be the reason for earlier radio administration.

 

However, in your dad’s present prognosis with a post operative PSA of >1.0, the results from above trials do not fare so well in the adjuvant modality. On the other hand, a high PSA after surgery may already indicate failure of surgery (which has been confirmed pre op by the positive scans) so that your dad should contemplate salvage radiotherapy at an earlier stage. Though, much consideration should be done on the field of attack. In case of future failure, radiation cannot be done on tissues that have received the total tolerance limit of absorbed Grays.

In any case I would suggest him to discuss with his doctor with regards to the benefits of having a continuing treatment (the combi) the soonest (before achieving total body healing) against waiting three months and then starting SRT.

The evident PSA level you posted is higher than the recommended <0.5 as a limit to assume higher marks in the benefits pointed out by the adjuvant modality. It is also said that positive margins are not the only way to define the earlier benefits. Many guys have done well with path positive results with continuous low PSA levels years after surgery.

I also think that your dad should consider the risk factors for metastasis progression against the risks of permanent side effects that an earlier radiation can cause on the area of reattached sphincter (bladder neck). Proper healing are related to better outcomes on incontinence issues.

 

Wait for a PSA and get second opinions on the problem if interested. At the end the important is that your dad is confident with his choices and trusts his care givers.

I wish him the best of lucks in his journey and peace of mind to you.

 

VGama

manav_4
Posts: 4
Joined: Feb 2013

Dear Sir,

I really thank you for replying my queries and devoting so much of time...sir can you please let me know the following

1) what rate does this cancer spread and whether he is in danger stage

2) i have been called by my doctor next month to have his second PSA and then deciding when to go for radiation...is it fine.

Regards/Manav

 

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