What sense to make of these post-prostatectomy test results?

andrewNYC

    My six-week post-prostatectomy PSA was 0.47.  Three weeks later this was 0.39.  Can anyone help me understand what is most likely going on?

The background results are as follows:

    5.5 pre-op PSA (age 65)

    7 or 7.5 Gleason with seminal vesicle involvement.

    Clean margins and clear lymph nodes according to the post-op pathology report.

    No cancer showed up on the MRI I had seven weeks after the surgery.

   My understanding is that the 0.47 and 0.39 PSA readings six and nine weeks after the prostate's removal indicate the presence of prostate cancer, but the post-op PSA decline may suggest the opposite. Or is this a red herring?

     Any information about what these results indicate, and the likely results of a PT scan with tracer dye, would be a huge help in number of important ways.

     Thanks in advance for any information or opinions.

   

 

 

 

 

 

    Before my prostatectomy my PSA was 5.5 and my Gleason score was 7 or 7.5 with seminal vesicle involvement.

Yank31

You have to wait a bit...

Andrew

Four years ago my post-op PSA was 0.2. My surgeon told me that there was no cause for worry unless the PSA started to go up rapidly. Occasionally, after surgery a small amount of non-cancerous prostaste tissue can be missed during surgery, a so-called "remnant". This tissue can still produce PSA, but as long as the readings remains steady, there is no cause for immediate concern.

You are also using the double-digit assay for your PSA results. With such a low PSA after surgery, you can expect your scores to bounce around a bit. Some doctors will test PSA earlier than others after surgery. I have heard some wait as long as three months before testing after surgery.

Take some time to research your options about what to do if your PSA starts going up, especially if it starts doubling within three or four months. Find an oncologist with vast experience in treating rising PSA after surgery. You have options to deal with this. Start researching now.

It is still early and you have plenty of time. I am sure others will have more suggestions here shortly.

Good luck.

 

Clevelandguy

Wait

Hi,

I would hope it's a good sign that your PSA continues to drop.  I would wait for a few more tests looking for a trend(hopefully downward).  Hope for the best...........................

Dave 3+4

contento

Andrew, Im not sure we had

Andrew, Im not sure we had others on this forum that had a relatively high psa post RP then continued to drop below the recognized treatment trigger of .2 ng/ml.

So it would be good if we could hear from the others. If your psa continues to stay above that threshold I think you'll want to know where the cancer is so that potentially it could be treated with adjunct radiation w/wo HT. Also Andrew even if the scans can't locate the cancer your doctors may still suggest to you to have radiation treatment to the pelvic area as sometimes the cancer is just too small to see.  A gleason 7 is considered somewhat aggressive so you do need to keep close watch of your psa. Im hoping for your that this is just a blip but Im really not so sure. --- Good Luck- contento

Clevelandguy

Question?

 7 or 7.5 Gleason with seminal vesicle involvement.

    Clean margins and clear lymph nodes according to the post-op pathology report.

Can you have clear margins with seminal vesicle involvement?

Dave 3+4

Grinder

Same

My PSA was 18 before surgery, and my first post op PSA was similar to yours, but by the six month test, it was negligible. It was my understanding that residual antigen remains in the blood stream for a period of time even after the prostate is removed and no longer produces prostate antigen. The key, and I am guessing your doctor would suggest this, is the six month testing that will tell you if the residual antigen has cleared out by a negligible reading of .01 or so. If it has increased from .4 that is a dangerous sign that "bandit" prostate cells are continuing to produce antigen somewhere. But that is, hopefully, unlikely. More likely you will continue to see the decrease in PSA at your six month test. The six month test is the key.

andrewNYC

    Many thanks to the four

    Many thanks to the four of you who were good enough to reply to my questions. The apparent consensus here, that I will need to see if subsequent readings show a rise in my PSA, is consistent with everything I have found online, and with what my surgeon's two assistants have said.

    But the surgeon, who is celebrated internationally, spoken of with awe by his peers, and has done 6,000 prostatectomies, tells me that my 0.47 and 0.39 post-op PSA readings can only be explained by the continued presence of cancer.  Based on these, he says he is virtually 100% certain my PSA will rise.  He would probably say that Yank31's great outcome (reply #1) is not entirely relevant to mine since his original post-op PSA was right at the 2.0 threshhold.

    How possible or plausible is it that he is correct?

    In response to "Cleveland guy" (response #4), the "seminal vesicle involvement" was a finding on my pre-surgery biopsy report, and the "clear margins" was on the post-op pathology report.  I'm of course not a doctor, let alone an oncologist, but my understanding is that the seminal vesicles are considered part of the prostate and were removed with it.  My guess is that if prostate cancer is in these, but not spread beyond them, the margins will be clear.  I'm sure, though, that many others here are more knoweldgeable about this than I am.

    Thanks again for the responses.

 

Max Former Hodgkins Stage 3

andrewNYC said:

    Many thanks to the four

    Many thanks to the four of you who were good enough to reply to my questions. The apparent consensus here, that I will need to see if subsequent readings show a rise in my PSA, is consistent with everything I have found online, and with what my surgeon's two assistants have said.

    But the surgeon, who is celebrated internationally, spoken of with awe by his peers, and has done 6,000 prostatectomies, tells me that my 0.47 and 0.39 post-op PSA readings can only be explained by the continued presence of cancer.  Based on these, he says he is virtually 100% certain my PSA will rise.  He would probably say that Yank31's great outcome (reply #1) is not entirely relevant to mine since his original post-op PSA was right at the 2.0 threshhold.

    How possible or plausible is it that he is correct?

    In response to "Cleveland guy" (response #4), the "seminal vesicle involvement" was a finding on my pre-surgery biopsy report, and the "clear margins" was on the post-op pathology report.  I'm of course not a doctor, let alone an oncologist, but my understanding is that the seminal vesicles are considered part of the prostate and were removed with it.  My guess is that if prostate cancer is in these, but not spread beyond them, the margins will be clear.  I'm sure, though, that many others here are more knoweldgeable about this than I am.

    Thanks again for the responses.

 

Overall

Andrew,

The difference between your first and second PSA draws is actually very slight, almost small enough to be attributed to testing anomalies.

In general, the clinical read of your case corrosponds to what your surgeon said: A residium of PCa is round and about somewhere.

Based on what I have read, Cleveland Guy is correct as regards PCa in the seminal vesicles. I think this would constitute only Stage 3 disease (i.e., would NOT prove metastasis), but I'd need to look that up.

Your first sentence from November 5 is correct: This must be followed closely, but ist seems your doctors are indeed doing so.

I would think that you warrant a full regimen of IGRT radiation treatements to the bed of the gland. Ask your doctor.  RT post RP, even for significant Stage 3 disease can remain curative.  I would hammer the doctors with this line of questioning.  Probably, you have much cause for hope toward cure still at this juncture of investigation.  You have healed long enough to satisfy the typical wait post-RP to begin RT.  Like you, I am no doctor, but sooner is commonly better than later.  RT is probably justified now if only as a cautionary treatment (your docs and the Insurance providers will have to argue this out).

What does your post-surgical pathology report list as the STAGE ? 

(Note: NOT the biopsy, but rather the post-surgical assessment.  This will sometimes be linked to the Surgical Report, but usually is a seperate document.   Ask for a paper copy, even if you have it via the internet, unless of course you can print it from the internet.)

 

max

AZ Guy

Me Too

My first post op PSA (nine weeks out) came in at .40. Disappointment. I did have Positive Margins and Gleason 3+4=7. Went to the Mayo Clinic today and we are planning on radiation+Lupron (6 months). I will get a confirmation PSA and Pelvic MRI before getting started. It's kind of hard to put a positive spin on .40 PSA after having positive margins. Time for SRT+HT. I'm 49 years old and eager to do whatever I can to fight this.

VascodaGama

AUA standards for recurrence is PSA above 0.40 ng/ml

Andrew,

You got good responses above. In my opinion the decline in PSA of 0.08 points signifies nothing. The tiny value could be instrument's reading noise. Your surgeon may be correct in beliving that your PSA will rise in the future. Surgeons have their own thresholds to confirm surgery success/failure after OP. My surgeon threshold was a PSA=0.06 ng/ml (Gleason 6; PSA=22.4; clean margins but positive extracapsular extensions) at one month post OP. Unfortunately mine was 0.12 and the second reading was 0.18. Later I reached 0.24 which declared me with biochemical failure. At six month recurrence was declared with a PSA = 0.42. This is the value recommended by AUA for one to think in starting a salvage therapy.

Apart from such high levels in PSA post surgery, your initial findings that included seminal vesicles invasion in a Gleason 7 setting (intermediate risk for metastases), turn you into a status prone to recurrence. This is typical occurrences in similar cases which may have guided your surgeon to his statement.

In your shoes I would wait for the next PSA result while engaging in additional tests to try locating any metastasis. For instance, a PET 68Ga PSMA could help you in deciding the protocol of salvage radiotherapy. I also recommend you to investigate on its side effects and consequences. You should involve addition therapies only after fully recovery from RP.

Best wishes,

VGama