High 6 wk post-surgery PSA: 3.27

catsforkids

First time to post and VERY concerned. My father had a RRP Nov. 5, 2010 and now his 6 week post-op PSA is 3.27. It is devastating to us all. Just wondered if anyone had this high of a PSA and where in his body could this PSA factory still be?

Background: 76 year old, PSA of 5.8 pre-surgery with a Gleason of 9. Biopsies showed 75% glandular involvement and the surgical pathology report indicated the same with unclear margins at the vas deferens and to within 1mm of the urethra. Prostate was 100gms. His pre-op CT and bone scans were negative as were all the nodes taken. His cancer had been graded as a T3b.

We are baffled by this and were not expecting this bad news while he is trying so hard to learn to urinate again. Any insights, comments or suggestions would be so appreciated.

lewvino

I'm sorry to read about your
I'm sorry to read about your father and wishing you and your family the best.
A pre-surgery Gleason 9 as you know is not good news. The rising PSA most likely means that the cancer is still somewhere. There will most likely be tests in the near future to try and determine where and then plan of attack.

Please keep in touch on how he does.

Larry age 56
Gleason 7 -
16 months post davinci

catsforkids

lewvino said:

I'm sorry to read about your
I'm sorry to read about your father and wishing you and your family the best.
A pre-surgery Gleason 9 as you know is not good news. The rising PSA most likely means that the cancer is still somewhere. There will most likely be tests in the near future to try and determine where and then plan of attack.

Please keep in touch on how he does.

Larry age 56
Gleason 7 -
16 months post davinci

Thank you Larry
Thank you for your response. I am a nurse, so I did not expect a "0" but the 3.27 was far beyond what I ever imagined and with a "clean" CT and bone scan I just don't see where all that antigen is coming from.

Will definitely keep in touch.

Thank you,
Linda

catsforkids

catsforkids said:

Thank you Larry
Thank you for your response. I am a nurse, so I did not expect a "0" but the 3.27 was far beyond what I ever imagined and with a "clean" CT and bone scan I just don't see where all that antigen is coming from.

Will definitely keep in touch.

Thank you,
Linda

It did not surprise the doc
The 3.27 PSA 6 weeks after surgery did not surprise the doc yesterday when we went. He said with what my dad walked in with (large tumor, Gleason 9) it wasn't surprising but it shocked us. Dad's only option at this point is Lupron so he got the shot then & there.

lewvino

catsforkids said:

It did not surprise the doc
The 3.27 PSA 6 weeks after surgery did not surprise the doc yesterday when we went. He said with what my dad walked in with (large tumor, Gleason 9) it wasn't surprising but it shocked us. Dad's only option at this point is Lupron so he got the shot then & there.

I hope the lupron will help
I hope the lupron will help your dad with out to many of the 'side effects'.

Larry

VascodaGama

lewvino said:

I hope the lupron will help
I hope the lupron will help your dad with out to many of the 'side effects'.

Larry

Hi Linda, Metastasis may be Localized
Hi Linda

It is not unusual to see guys with PSA on the 5th mark in high Gleason at diagnosis. High patterns of cancer cells (G5&4) produce less PSA. The voluminous tumour and seminal vesicles involvement may justify the still high level in the PSA after surgery. However, negative lymph nodes is a good sign to that metastasis may be localized which by the statistics it means that your father could subject to salvage treatments such as RT.

The pathologist’s report classifies your father as a high risk patient (Gs9, Extra capsular extension, PSA>0.1), and HT is recommended for this group of patients after failure of a major treatment. The Lupron injection will pull down that PSA while you make a decision on the next step. You probably know that all treatments have side effects and some are not suitable to the health conditions of certain patients, including their age. You can check about that by googling “treatment side effects in prostate cancer”.
Hope this information gives you peace of mind.

I wish the best to your father and the family.

Merry Christmas
VGama

tarhoosier

catsforkids said:

It did not surprise the doc
The 3.27 PSA 6 weeks after surgery did not surprise the doc yesterday when we went. He said with what my dad walked in with (large tumor, Gleason 9) it wasn't surprising but it shocked us. Dad's only option at this point is Lupron so he got the shot then & there.

Surprise?
As the doctor's comment reveals, this man should never have been scheduled for surgery for this condition. He was very high risk from his clinical staging and at age 76 the risks and side effects of surgery were nowhere sufficient to balance this decision. The doctor reveals his bias by his comment.
The high tumor volume and the G9 indicate that latent disease is in his body, likely transmitted through lymph and blood. The pathology may mention lympho-vascular involvement. I predict it is positive for this finding, if mentioned. Scans will not demonstrate tumor masses at this level of psa. The surgery was a debulking process which may have positive effects on down the line, though one will never know. I strongly suggest this man be seen by an oncologist, especially one with experience in prostate cancer. The surgeon and urologist are (is) done.
I was a high risk candidate with G9, psa 15, cT1c. I saw two top urologists and the first diagnosed me from the get-go with systemic disease and referred me to a radiologist. He also referred me to a top national urologist who believed surgery could be beneficial though not likely a cure. At age 58, BMI 23, and without co-morbid conditions the top national guy made this recommendation. Without those conditions I doubt he would have done so.a Eight weeks post surgery I was 2.7 psa and have been intermittent ADT for 4-5 years. I ws also fully continent from the moment the catheter was removed. Great surgeon, that.
In the case of your father there is every reason to believe he can be with us for 10-15 years, perhaps more with new drugs in the pipeline and he may well have beaten his cancer by that time.

Robert1941

tarhoosier said:

Surprise?
As the doctor's comment reveals, this man should never have been scheduled for surgery for this condition. He was very high risk from his clinical staging and at age 76 the risks and side effects of surgery were nowhere sufficient to balance this decision. The doctor reveals his bias by his comment.
The high tumor volume and the G9 indicate that latent disease is in his body, likely transmitted through lymph and blood. The pathology may mention lympho-vascular involvement. I predict it is positive for this finding, if mentioned. Scans will not demonstrate tumor masses at this level of psa. The surgery was a debulking process which may have positive effects on down the line, though one will never know. I strongly suggest this man be seen by an oncologist, especially one with experience in prostate cancer. The surgeon and urologist are (is) done.
I was a high risk candidate with G9, psa 15, cT1c. I saw two top urologists and the first diagnosed me from the get-go with systemic disease and referred me to a radiologist. He also referred me to a top national urologist who believed surgery could be beneficial though not likely a cure. At age 58, BMI 23, and without co-morbid conditions the top national guy made this recommendation. Without those conditions I doubt he would have done so.a Eight weeks post surgery I was 2.7 psa and have been intermittent ADT for 4-5 years. I ws also fully continent from the moment the catheter was removed. Great surgeon, that.
In the case of your father there is every reason to believe he can be with us for 10-15 years, perhaps more with new drugs in the pipeline and he may well have beaten his cancer by that time.

Surgery?
Thought surgery was a no no for men over 70. Specially with a big prostate.

catsforkids

Robert1941 said:

Surgery?
Thought surgery was a no no for men over 70. Specially with a big prostate.

My father's decision
At the insistence of the surgeon, my father saw a radiation oncologist before he decided to have the surgery. All the odds were laid out plainly to him by both physicians. The surgeon was by no means pushing my father in the direction of surgery and made it clear he would equal in age the oldest patient he had done a RRP on. It was my dad's decision to proceed with the surgery. The thought of a prostate full of cancer troubled him deeply. Emotionally, he needed it out and physically he would rather dribble a little than not be able to go because of the pressure on the urethra from the large prostate.

And thanks for the encouragement...hope to have dad around for 10-15 years :-)