PSA after surgery interesting

Steve1961

From John Hopkins 

Study Explores AccuPSA Test

During one study, Dr. Partin and his colleagues examined blood samples from 31 patients whose PSA level had been undetectable for at least five years after radical prostatectomy. All these patients had PSA levels less than 0.1 ng/ml after surgery. However, one third of them later had biochemical recurrence, while the others continued to have an undetectable PSA level for many years after surgery. The study participants were similar in age and race and had negative surgical margins after surgery. Interestingly, patients whose PSA levels went up had a greater presurgical PSA, clinical and pathological stage and Gleason grade than the men whose levels remained very low.

When the investigators tested the samples with AccuPSA, they found that at three months after surgery, all patients who ultimately had a rise in PSA had an AccuPSA level of 0.003 ng/ml or greater. By standard measures, this number would be considered undetectable. Among patients whose PSA levels never went back up, 75 percent had AccuPSA levels less than 0.003 ng/ml.

Initial Findings Reveal New PSA Threshold

In addition to this pilot study, larger tests are needed to confirm the results. These initial findings suggest that you could have an AccuPSA test three months after surgery. If your PSA level is less than 0.003 ng/ml, you could be confident that all your cancer has been removed. On the other hand, if your PSA level is greater than 0.003 ng/ml, you might choose to be monitored more closely for PSA recurrence in the immediate years following your surgery.

 

 

thats pretty darn low ..never heard anyone on this board having PSA that low after surgery ,then again only 0.01% of men with PC post on this board .so who knows probsbly thousands of men out there less tha 0.003 

Clevelandguy

More info

The New England Journal of Medicine had this for thought:

Nearly 600 patients who underwent radical prostatectomy were followed an average of 10 years; patients had PSA testing (using an ultrasensitive assay) every 3 to 6 months during the first 3 postprostatectomy years and annually thereafter. Among 187 patients with undetectable PSA (<0.01 ng/mL) at 3 years, only 2 patients had later biochemical recurrence (defined as PSA elevation to >0.2 ng/mL). Among 162 patients with undetectable PSA at 5 years, none had later biochemical recurrence.

COMMENT

This study suggests that if the PSA level, measured by an ultrasensitive assay, remains undetectable 3 to 5 years after radical prostatectomy, probability of biochemical recurrence is extremely low, and PSA monitoring could reasonably be stopped. The authors also remind us that biochemical recurrence is a surrogate marker: It doesn't necessarily predict clinically evident progression of prostate cancer during the patient's lifetime.

 

Dave 3+4

Steve1961

Well that's good news ..I

Well that's good news ..I guess I am still bitter with myself for not doing surgery ..all this data I see and read is always about surgery which I didn't do ..next month will be 18 long stressful months for me .if my PSA isn't below 1 ..from what I read the treatment will have failed ..I know they will say another six months I hope it will be down but after all the series of events that  happened to me .i just don't know 

hewhositsoncushions

Basically saying any psa at

Basically saying any psa at all after surgery means recurrence. I had a couple of 0.5 readings and then bcr.

Post SRT 0.5 -> 0.9 so again bcr soon likely.

Wonder what anecdotally other people here experience with higher numbers < 0.1.

 

 

Josephg

hewhositsoncushions said:

Basically saying any psa at

Basically saying any psa at all after surgery means recurrence. I had a couple of 0.5 readings and then bcr.

Post SRT 0.5 -> 0.9 so again bcr soon likely.

Wonder what anecdotally other people here experience with higher numbers < 0.1.

 

 

Other People's Experiences

Helio.  My PSA was .05 3 months after surgery, and it rose to .11 at the 15 month mark.  I then underwent the salvage combination of hormone and radiation therapy.  My PSA was then undetectible (<.02) for 30 months, and then it started to rise again.

Georges Calvez

PSA levels of 0.1 and below

Hi there,

PSA is not prostate specific so levels up to around 0.1 can be normal for women or men who have had prostatectomies or if treated for bladder cancer, complete removal of the bladder, prostate and all the other associated gubbins.
Men who have been treated with radiation should be looking for a constant low PSA.
PSA levels do move up and down, doctors and patients seem to forget this all the time, you really need three results over a period of three to nine months to show a trend unless the line is rising at an extraordinary rate.
Stop panicking!!!

Best wishes,

Georges

Steve1961

hewhositsoncushions said:

Basically saying any psa at

Basically saying any psa at all after surgery means recurrence. I had a couple of 0.5 readings and then bcr.

Post SRT 0.5 -> 0.9 so again bcr soon likely.

Wonder what anecdotally other people here experience with higher numbers < 0.1.

 

 

Sorry

This is sooo nerve racking how does one not think about it always ..that's my problem 

Georges Calvez

Steve1961 said:

Sorry

This is sooo nerve racking how does one not think about it always ..that's my problem 

Permutations

Hi Steve,

Not thinking about it is a problem that most of us face with some of us being in a worse position than others.
I spend a lot of time running through the various permutations in my case.
Every so often a doctor gives me a prediction but it is just a guess, maybe more or less educated than someone else's guess but a guess none the less.
My case could see a range of outcomes from the very good where I could recover a great deal and live for another two decades or more to the very bad where things could take a rapid turn for the worse and I could move to mCRPC that would get me in about a five to ten year window.
I have managed to find about ten case studies with similar starting points to me, some of them are cured, others are holding out against the slow advance and others are looking at the wrong side of the daisies!
Really there is no way of saying what will happen.
I am off to see Dr Pooh the general practioner tomorrow afternoon to talk about general things!

Wish me luck as you wave me goodbye,

Georges

Langley

Hi , I just had my first 3 month sensitive PSA test after RP and it was .31( the clouds covered the sun). The surgeon was somewhat shocked since the margins were clear and no nymph node problem. I did have a very aggressive amount of Gleason 9 with seminal vesicle invasion on the pathology. I am having another PSA test next week , about 2 weeks after the previous one, and meeting with a radiation oncologist the next day. So probably RT and HT to follow. Has anyone else had a PSA like mine so soon after RP?

Steve1961

are you sure its not 0.03 instead of 0.003 i dont think they can test that low

Langley

Unfortunately it’s 0.31

Langley

I read that >0.2 is officially BCR. I would like to get a PSMA PET to better direct the radiation plan but the health insurance says you have to be >0.5 to have one.

Old Salt

This is from a reliable source (ASCO)

• At present, we recommend seeking a PSMA PET scan for most patients at PSA 0.5 to 0.9 ng/mL; for patients eligible to receive metastasis-directed therapy (MDT), we recommend considering PSMA PET at PSA 0.2 to 0.5 ng/mL, with special consideration if PSA doubling time (PSADT) < 3 months.

https://dailynews.ascopubs.org/do/consider-psma-pet-scan-after-radical-prostatectomy-and-salvage-radiation-prostate#:~:text=We%20do%20not%20recommend%20obtaining,mL%2C%20given%20low%20detection%20rates.

Langley

Thankyou Old Salt,

I will look into what eligibility for MDT means. Ironically, maybe it takes the greater sensitivity of PSMA PET to show metasization at this point. My pre RP PSMA did not show anything outside the prostate site. However, pathology did show seminal invasion and extracapular extension although clear margins. When I spoke with the surgeon after the test result I asked him if it were possible for a metastasis to have formed in the 3 months between surgery and this PSA test and he said it was possible. I asked him if PSA growth at this stage was straight line and he said it was . So if the second test next week (2 weeks after the first)’ shows another increase then one could extrapolate the rate of increase and this might figure into the MDT algorithm?

centralPA

I think 2 weeks isn’t long enough to compute the growth rate, particularly a doubling rate (exponential growth). My gut feeling.

Langley

Yep it is a short interval …..I guess its purpose is confirmation of the first one

On_A_Journey

https://csn.cancer.org/discussion/comment/1715186#Comment_1715186

Yep, me!

PSA was 10.6 before surgery in June 2015. Gleason 3+4 at surgery, negative margins etc. My first PSA test after surgery was 0.53 at the 8-week mark and a follow-up test showed my PSA at 0.75 three months after that. I underwent 33 sessions of salvage radiation after that, but not with hormone thereapy. MY PSA nadir was 0.04 in May 2018 but it has been slowly climbing ever since. It is currently 0.54 but has flatlined over the past year. I have had some PSMA PET scans along the way but they didn't reveal anything. I'm currently on active surveillance and not receiving any form interventionalist treatment.

So yeah, you're not the lonely bear there!

Langley

https://csn.cancer.org/discussion/comment/1715199#Comment_1715199

Hi On_A_Journey,

Thankyou for sharing. I had the follow up PSA test 2 days ago and it was 0.42 ( up from 0.31 two weeks ago). It was a bit of a knock then I remembered the "very aggressive " pathology descriptor ,which I am starting to get used to. Anyway, I met with the radiation oncologist yesterday and have a plan. Another PSA test in 2 weeks , with a high probability of greater than 0.5, and a PSMA scan pre-scheduled for shortly after that. MRI/CT to map out the area for radiation together with the PSMA results. Shortly thereafter start 7 weeks of radiation. Also, immediately after the PSA result start HT , probably for 18 months. If the PSMA shows non-local metastasis ( the pre surgery PSMA four months ago did not show anything other than the stuff around the prostate) or PSA not at 0.5 then plan will be modified. I am happy with this….it feels good to have a plan.

Cheers Langley

Old Salt

That's an excellent plan (who am I to judge?); best wishes with its execution!