High PSA after prostatectomy? Please read.

Jobriski

Re-posting for my Dad:


I recently(3/21/12) had a prostatectomy via the daVinci method and all went well.
My recovery was good, all post op biopsies were good with cancer contained in prostate and lymph nodes were clear.

Last week I returned for the 3 mo checkup. PSA was taken prior to visit and the results were unbelievable to the doctor. The PSA was 6.5, 7.7(retaken) and 7.7(retaken).

My doctor, who has performed thousands of prostate surgeries, has no explanation other than to say that prostate cancer does not perform in this manner. He has ordered additional CT scans of bones and pelvic area which are negative and are identical to those taken pre-op. There is nothing unusual in these tests.

I have met with an oncolgist who is recommending Hormone Therapy.

I am reluctant to begin this therapy based upon information which is not conclusive or understood and without precedence since the cure could have more side effects than the cancer(if it is cancer) and additionally based upon the fact that the PSA test results could be false readings. My blood is being checked for antibodies which could interfer with the PSA test.

Has anybody encountered very high post-op PSA readings and what was the treatment?

VascodaGama

Prostatic tissue may have been left behind
Job

Welcome to the board.

In my lay opinion high PSA levels post prostatectomy occur in cases where some prostatic tissue (cancerous or benign) was left behind by negligence or because it may have been part of the protocol (it happens in never spare surgeries or portions of seminal vesicles close to the bladder). Otherwise, the PSA relates to existing metastases unseen by conventional equipment.

You have not share info on your PSA chronology before surgery, or on the type of image studies done. In any case you should be aware that common MRI, CT and Bone scans do not usually detect metastases in cases of a PSA lower than 10. It is also difficult to get positive “pictures” from small spread of colonies known as Micrometastases. Traditional equipment has low resolution that only is able of “catching” sizes bigger than 1.5 mm.

I also never heard of antibodies that can interfere with the PSA test. Surely laboratory errors occur (exchange of samples from other patients or error in the reported units) but yours have been rechecked.
You could do it again in another reliable laboratory, just for peace of mind.
On the other end, high PSA levels after prostatectomy are possible in cases of patients with very high pre op PSA.

I would recommend you to get an image study in higher resolution equipment such as Tesla 3 MRI with the latest contrast agents and with a rectal endoscopic coil. The results will clarify suspicious and the image will serve you in the decision of a salvage therapy.
Combined scanners are more reliable. The PET/CT with C-11 Choline proves to be successful in detecting cancer in localized tissue. MRI-Spect and MRI-DCE are also other ways.
The combi Na F18 PET/CT bone scan is quite reliable to detect metastatic cancer in far places.
Discuss the matter with your doctor in your next visit.

Search the net for salvage radiotherapy with or without hormonal treatment.

Wishing you the best.

VGama

Jobriski

VascodaGama said:

Prostatic tissue may have been left behind
Job

Welcome to the board.

In my lay opinion high PSA levels post prostatectomy occur in cases where some prostatic tissue (cancerous or benign) was left behind by negligence or because it may have been part of the protocol (it happens in never spare surgeries or portions of seminal vesicles close to the bladder). Otherwise, the PSA relates to existing metastases unseen by conventional equipment.

You have not share info on your PSA chronology before surgery, or on the type of image studies done. In any case you should be aware that common MRI, CT and Bone scans do not usually detect metastases in cases of a PSA lower than 10. It is also difficult to get positive “pictures” from small spread of colonies known as Micrometastases. Traditional equipment has low resolution that only is able of “catching” sizes bigger than 1.5 mm.

I also never heard of antibodies that can interfere with the PSA test. Surely laboratory errors occur (exchange of samples from other patients or error in the reported units) but yours have been rechecked.
You could do it again in another reliable laboratory, just for peace of mind.
On the other end, high PSA levels after prostatectomy are possible in cases of patients with very high pre op PSA.

I would recommend you to get an image study in higher resolution equipment such as Tesla 3 MRI with the latest contrast agents and with a rectal endoscopic coil. The results will clarify suspicious and the image will serve you in the decision of a salvage therapy.
Combined scanners are more reliable. The PET/CT with C-11 Choline proves to be successful in detecting cancer in localized tissue. MRI-Spect and MRI-DCE are also other ways.
The combi Na F18 PET/CT bone scan is quite reliable to detect metastatic cancer in far places.
Discuss the matter with your doctor in your next visit.

Search the net for salvage radiotherapy with or without hormonal treatment.

Wishing you the best.

VGama

Thank you.

Thank you.

starr15

Keep us posted on your
Keep us posted on your situation.

Kongo

Wow
Jobriski,

Welcome to the forum and I'm sorry that your father is facing these puzzling issues while recovering from surgery. I can understand why the surgeon is so flummoxed. PSA should be at the absolute lowest point it will ever be shortly after surgery. While you did not mention what the pre-surgical Gleason, staging, and PSA readings were I have never heard of a reading this high and one that also seems to be accelerating in that it went from 6.5 to 7.7.

In my lay opinion, this level of PSA is way too high to be attributed to any residual prostate tissue that may have been left behind. Like Vasco, I also have never heard of antibodies or other blood attributes that could cause this level of PSA reading. It's a mystery for sure!

Many things can cause an elevated PSA and hopefully your father's medical team is working to eliminate the possibility of a UTI or other bacterial infection. Some medications can cause a PSA rise and if your father is still taking a drug like Advil, for example, to deal with post surgical pain that might cause a small level of PSA.

One thing I've learned about prostate cancer is that every patient is unique and it's dangerous to make generalizations but in the absence of any other logical explanation the most likely cause of such a high PSA level is that your father's cancer was not contained within the prostate gland and that it is growing somewhere else. I hope that is not the case.

Best of luck to you and your family,

K

starr15

Kongo said:

Wow
Jobriski,

Welcome to the forum and I'm sorry that your father is facing these puzzling issues while recovering from surgery. I can understand why the surgeon is so flummoxed. PSA should be at the absolute lowest point it will ever be shortly after surgery. While you did not mention what the pre-surgical Gleason, staging, and PSA readings were I have never heard of a reading this high and one that also seems to be accelerating in that it went from 6.5 to 7.7.

In my lay opinion, this level of PSA is way too high to be attributed to any residual prostate tissue that may have been left behind. Like Vasco, I also have never heard of antibodies or other blood attributes that could cause this level of PSA reading. It's a mystery for sure!

Many things can cause an elevated PSA and hopefully your father's medical team is working to eliminate the possibility of a UTI or other bacterial infection. Some medications can cause a PSA rise and if your father is still taking a drug like Advil, for example, to deal with post surgical pain that might cause a small level of PSA.

One thing I've learned about prostate cancer is that every patient is unique and it's dangerous to make generalizations but in the absence of any other logical explanation the most likely cause of such a high PSA level is that your father's cancer was not contained within the prostate gland and that it is growing somewhere else. I hope that is not the case.

Best of luck to you and your family,

K

Apparently this occurs
http://www.ncbi.nlm.nih.gov/pubmed/19264827

http://jco.ascopubs.org/content/30/5/e62.extract



http://www.clinchem.org/content/51/1/208.full

Kongo

starr15 said:

Apparently this occurs
http://www.ncbi.nlm.nih.gov/pubmed/19264827

http://jco.ascopubs.org/content/30/5/e62.extract



http://www.clinchem.org/content/51/1/208.full

Good Catch
starr15,

Good catch on the antibodies interference with PSA testing. I learned something new today and hopefully something like this is at the root of the indications Jobriski is seeing after his surgery and that he doesn't get roped into unnecessary follow-on treatment.

k

VascodaGama

Kongo said:

Good Catch
starr15,

Good catch on the antibodies interference with PSA testing. I learned something new today and hopefully something like this is at the root of the indications Jobriski is seeing after his surgery and that he doesn't get roped into unnecessary follow-on treatment.

k

Food for Thoughts
Starr

You have given us “food for thoughts”. I want to thank you for ringing the bells on the matter of false positive PSAs cases, due to immune response.
This is new to me and my curiosity made me to call my doctor. He brushed away my question with “I do not know”. However he commented on errors from laboratories due to a variety of factors. Rechecking is part of the protocol of the analyst when a not so common result is obtained.
Even so, the recheck is done with the same blood sample, and most probably with the same type of assay used in that particular laboratory for the same purposes.

In one of the links you provided, they comment about assay’s manufacturers struggle (?) to constantly improve the precision of the results precisely looking for any heterophilic antibody interference. The fact makes part of FDA’s approval of assays too. But what I do not understand is if the immune response is in the patient’s blood sample or in the assay.

Job’s father could be one of such cases, were the laboratory has performed a recheck but in an assay not proof to heterophilic antibodies. Am I correct?
It is worth knowing more details on the matter. We all trust the PSA as our marker of disease progression and want to continue to believe in our laboratory results.

Thanks very much for the post.

VGama

starr15

VascodaGama said:

Food for Thoughts
Starr

You have given us “food for thoughts”. I want to thank you for ringing the bells on the matter of false positive PSAs cases, due to immune response.
This is new to me and my curiosity made me to call my doctor. He brushed away my question with “I do not know”. However he commented on errors from laboratories due to a variety of factors. Rechecking is part of the protocol of the analyst when a not so common result is obtained.
Even so, the recheck is done with the same blood sample, and most probably with the same type of assay used in that particular laboratory for the same purposes.

In one of the links you provided, they comment about assay’s manufacturers struggle (?) to constantly improve the precision of the results precisely looking for any heterophilic antibody interference. The fact makes part of FDA’s approval of assays too. But what I do not understand is if the immune response is in the patient’s blood sample or in the assay.

Job’s father could be one of such cases, were the laboratory has performed a recheck but in an assay not proof to heterophilic antibodies. Am I correct?
It is worth knowing more details on the matter. We all trust the PSA as our marker of disease progression and want to continue to believe in our laboratory results.

Thanks very much for the post.

VGama

Thanks. I must admit I do
Thanks. I must admit I do not know much about this, other than what i posted. Looks like antibodies in patients serum can cause false-positive PSA test findings after radical prostatectomy. Dont know how common this is, but likely not common.

hopeful and optimistic

starr15 said:

Thanks. I must admit I do
Thanks. I must admit I do not know much about this, other than what i posted. Looks like antibodies in patients serum can cause false-positive PSA test findings after radical prostatectomy. Dont know how common this is, but likely not common.

great post

Please excuse this basic question that highlights my ignorance. What did you do to find this information.....how would one duplicate the process of finding this information.
Thanks

starr15

hopeful and optimistic said:

great post

Please excuse this basic question that highlights my ignorance. What did you do to find this information.....how would one duplicate the process of finding this information.
Thanks

Back when i was researching
Back when i was researching information on the PSA test and the different lab methods, I ran across the false positive articles. I remembered it when i saw this post.

One can search "anitbodies false positive PSA"

avird

VascodaGama said:

Prostatic tissue may have been left behind
Job

Welcome to the board.

In my lay opinion high PSA levels post prostatectomy occur in cases where some prostatic tissue (cancerous or benign) was left behind by negligence or because it may have been part of the protocol (it happens in never spare surgeries or portions of seminal vesicles close to the bladder). Otherwise, the PSA relates to existing metastases unseen by conventional equipment.

You have not share info on your PSA chronology before surgery, or on the type of image studies done. In any case you should be aware that common MRI, CT and Bone scans do not usually detect metastases in cases of a PSA lower than 10. It is also difficult to get positive “pictures” from small spread of colonies known as Micrometastases. Traditional equipment has low resolution that only is able of “catching” sizes bigger than 1.5 mm.

I also never heard of antibodies that can interfere with the PSA test. Surely laboratory errors occur (exchange of samples from other patients or error in the reported units) but yours have been rechecked.
You could do it again in another reliable laboratory, just for peace of mind.
On the other end, high PSA levels after prostatectomy are possible in cases of patients with very high pre op PSA.

I would recommend you to get an image study in higher resolution equipment such as Tesla 3 MRI with the latest contrast agents and with a rectal endoscopic coil. The results will clarify suspicious and the image will serve you in the decision of a salvage therapy.
Combined scanners are more reliable. The PET/CT with C-11 Choline proves to be successful in detecting cancer in localized tissue. MRI-Spect and MRI-DCE are also other ways.
The combi Na F18 PET/CT bone scan is quite reliable to detect metastatic cancer in far places.
Discuss the matter with your doctor in your next visit.

Search the net for salvage radiotherapy with or without hormonal treatment.

Wishing you the best.

VGama

Hello Job,
Sorry to hear
Hello Job,

Sorry to hear this about your dad.

I had the same isuue. I call it the Da Vinchi curse.
Apparently, many surgeries with the Da Vinchi end up with left over of prostate tissue. Had I known it before, I would have never chosen this type of surgery. I actually found out that there is a clinical trial of a new probe to solve this issue with Da Vinchi.

Long story short:
My case was the same, 3 months after the surgery I had 2.7 PSA. My doctor was clueless (I actually believe he just pretended to be).
I went to a another doctor who performed ultrasound imaging, and he found out that the first doctor left behind about half of the gland. This is more common than you would think.

Unfortunately for me, almost all the cancer was left behind.
After many consultations, I will probably go for 6 months of hormone therapy, combined with 2 months of radiation and Brachy therapy for desert.

I wonder if this is considered mal practice...probably not. But we may have a case against the Da Vinchi company. I hate these guys so heartedly.

Bottom line:
Compare the pre surgery biopsy to the pathology report (request them from your doctor. Keep copies of all the reports and tests including the surgery report. I is important). See if all the reported focii are matching. If not, you have cancer left over.
Go to a reputable institue taht deals with prostate cancer. BAsed on the volume left they should propose a treatment plan.
Don't be fooled by artifact claims. If it walks, quacks, has duck feet, then it is a duck.

I live in the Sab Francisco bay area. I can give you a couple of resources if you are in the area.
Don't panic, you have time. but act. fast.

Wishing your dad (and myself) the best of luck.

Avi