PSA Rising Fast after RP

Jay2512

PSA Rising

I was first diagnosed with PC at the age of 53. My RP surgery was on 12/20/2020. A week and a half later, I was experiencing a lot of discomfort and morning erections from the catheter, so the doctor removed the catheter. The day after that (12/31/2020), my testicle grew 3x to its regular size, so my daughter drove me to the emergency room. I was in the hospital for 4 days due to an infection from RP surgery.

When I was first diagnosed my Gleason score was 3+4 with 5% pattern 4. One

9.20(9/22/2020) Radical Prostatectomy on 12/21/2020 <0.01(2/3/2021) <0.01(5/25/2021)           <0.01(8/12/2021) <0.01(11/18/2021)  <0.01(3/1/2022)  0.02(4/26/2022) <0.01(7/13/2022) 0.02(11/30/2022) 0.03(2/27/2023) 0.04(6/02/2023)

Received:  12/21/2020

Reported:  12/23/2020

Specimen(s) Received

A: ANTERIOR FAT PAD

B: PROSTATE AND SEMINAL VESICL

Final Diagnosis

A. Anterior fat pad, excisional biopsy:

- Benign fibro adipose tissue

B. Prostate, radical prostatectomy:

- Prostatic adenocarcinoma, Gleason grade 3+3=6 (prognostic grade group 1) 

Procedure: Radical prostatectomy

Prostate Size: 43 g, 4.0 x 3.9 x 3.8 cm

Histologic Type: Acinar adenocarcinoma

Histologic Grade: Gleason grade 3+4=7

Grade Group and Gleason Score: Grade group 2 (Gleason Score 3+4=7)

Percentage of Pattern 4 in Gleason Score 7 (3+4) Cancer: 5%

Intraductal Carcinoma (IDC): Not identified

Tumor Quantitation: Estimated percentage of prostate involved by tumor: 10%

Tumor size (dominant nodule): Multifocal, involving bilateral lobes, greatest nodule

dimension 10 mm at left mid

Extraprostatic Extension (EPE): Not identified

Urinary Bladder Neck Invasion: Not identified

Seminal Vesicle Invasion: Not identified

Lymph vascular Invasion: Not identified

Perineural Invasion: Present

Margin:

 1) Bladder neck margin: Uninvolved by invasive carcinoma

 2) Peripheral margins: Uninvolved by invasive carcinoma

Treatment Effect: No known presurgical therapy

Regional Lymph Nodes: No lymph nodes submitted or found

Additional Pathologic Findings: High-grade prostatic intraepithelial neoplasia (PIN)

AJCC Staging

pT2: Organ confined

pNX: Regional lymph nodes not examined

eonore

Hi Jay,

Obviously you should discuss your concerns with your medical team, but I would not be overly concerned at this point. These variations are exceedingly low as is the total PSA. When I completed salvage radiation, my doctor told me not to get alarmed at small variations like this.

Eric

Clevelandguy

Hi,

Something to keep monitoring over the next several years. Even though your Prostate was removed you still produce a small amount of PSA from your Cowpers gland. You have a long way to go before your PSA gets to .2ng which is considered reoccurrence. Good luck…….

Dave 3+4

Old Salt

I don't want to ring any alarm bells, but if your next PSA test result is up again, I would start to read up on radiation therapies. These can often eradicate any leftover cancer.

You should discuss the "perineural invasion" finding at your next appointment.

Max Former Hodgkins Stage 3

Jay,

Per long-established standards, any PSA result below .20 is clinically un-detectable. And your results are all FAR BELOW .2. As such, your results do not suggest recurrence of PCa. With newer ultrasensitive assays, the readings for nearly all men post-R.P. fluctuate significantly between tests, but as long as these remain below .2, such fluctuations are considered irrelevant by MOST doctors. I am 8 years out from R.P., and am tested at least annually, but my numeric value has NEVER been anywhere near 00.00 And my surgeon, who is the lead urinary tract oncologist at a teaching hospital, says my results constitute undetectability and are of no concern. Many centers have even recommended upping the standard for recurrence to .4, but the most commonly accepted level remains .2 This information is all widely available at all of the major university Cancer Sites. The article below addresses most of these points, and show that debate continues. The established threshold for initiating therapeutic radiation after R.P. is .5

max

https://www.prostatecancerfree.org/pca-commentary-vol-91-2-your-psa-is-undetectable-what-does-that-mean-how-does-an-undetectable-psa-affect-management/

Steve1961

I wouldnt consider that rising quickly