PSA Detectable 6 Months After RP Surgery

jkkc61

Hi all,

Posting on my father’s behalf.

My father had a prostatectomy in January. His PSA has been undetectable since then except for recently (6 months post RP) when it rose to 0.28. The doctor has ordered a PSMA PET/CT scan to determine the cause and where. Spoke somewhat about possible follow-up radiation therapy.

Has anyone experienced a rise in PSA this rapidly post surgery?

Would this represent possibly not getting it all or..?

Thanks for any and all insight!

Father’s notes:

PSA 16.4 (9/2/2022)

DRE (11/9/2022)

Biopsy Prostate Transperineal (12/22/2022)

Prostatectomy Laparoscopic (1/4/2023)

• Gleason score 3 + 4 = 7 (25% pattern 4), prognostic group 2
• Cribriform pattern present
• The carcinoma comprises 10% of prostatic glandular volume
• Lymphovascular invasion not identified
• Perineural invasion present
• Extraprostatic extension not identified
• Bilateral seminal vesicles uninvolved by carcinoma
• Bladder neck uninvolved by carcinoma
• Surgical resection margins positive for carcinoma (limited, left posterior)
• Pathologic stage: pT2, N0
• Lymph nodes, bilateral pelvic, dissection - No evidence of malignancy in six lymph nodes (0/6)
• Additional pathologic findings: High-grade prostatic intraepithelial neoplasia (PIN)

PSA <0.10 (1/27/2023)

PSA <0.10 (4/7/2023)

PSA 0.28 (6/29/2023)

On_A_Journey

"Has anyone experienced a rise in PSA this rapidly post surgery?"

Yes, me! Actually, my PSA never went to anywhere near zero. My first PSA blood test which was two months post-surgery came back at 0.53, and three months later it was 0.75. I began salvage radiation therapy soon after. Two years later, my PSA fell to its lowest level (0.04) and four years after that, it had crept up again to be officially known as a recurrence. Another 18 months later, my reading is around 0.50 at the moment. It is said that around 30% of men who have a prostatectomy will get a recurrence at some stage.

"Would this represent possibly not getting it all or..?"

The honest answer is yes. Please don't let that worry you guys though. Any leftover cancerous cells so soon after surgery are extremely likely to be confined to the prostate 'bed' and easily treated with radiation which, using myself as an example, will result in years and years of remission.

By the way I am well, totally symptom free, and not receiving any treatment, despite knowing that I have some cancerous cells inside me somewhere. I have also had PET scans but they haven't detected anything yet. I suspect that your father's scan will also come back as all clear due to his low PSA reading; the chances of the scan detecting anything are much greater with a PSA above 0.80 or so, but no harm in getting a scan now. If the scan does detect cancerous cells, it will provide a very accurate picture for the radio-oncologist to do something about it; to know where to focus radiation.

Assuming a negative PET scan result though, his next PSA test in three months time will be critical in determining what happens after that. PSA readings will bobble around a bit but it is a combination of the actual PSA reading and how quickly it is rising that determines how agressive the bandit is. What he has in his favor is that the surgical report puts him on the low side of intermediate risk to start with.

Easy said, but please don't worry.

Good luck with it all.

jkkc61

https://csn.cancer.org/discussion/comment/1706809#Comment_1706809

Thank you for the reply.

It’s great to hear you are doing so well, and can provide reassurance to folks like us! We really appreciate it.

We agree the pathology report was pretty decent. The only thing that was worrisome to us was the perinueral invasion. Considering most surrounding tissues were negative (lymph nodes, bladder neck, etc.), we’re being optimistic and assuming the PSA uptake is from the surgical margin area being persistent/reoccurring, which was positive for PCa, and not PCa spread elsewhere.

I read a study the other night that analyzed roughly 2,000 men who only had RP. They could not have any other salvage treatment. As you said, only a certain percentage had biochemical recurrence. Of those that did, only an even smaller percentage developed spread elsewhere but it took a median of 8yrs for that spread to be detectable and then another median of 5yrs from that point to call them home. Depending upon age of diagnosis, that may be plenty of time for some people, and, considering they had NO salvage treatments, that’s impressive. In other words, those that do have salvage treatment probably have much longer than the median 8yrs + 5yrs this study indicated.

For those curious, that study is located here:

https://jamanetwork.com/journals/jama/articlepdf/189741/joc81655.pdf

Thank you again for the reply. Any insight on the PNI would be greatly appreciated.

Best of health to you.