Looks like its back

Old-timer said:

Not to worry, Levino
Seems that my story is much like yours, except that I am much farther down the road than you are. I am a 21 year survivor of prostate cancer. The early years were much like yours. I'll give highlights and a few details.

1991, PSA 4.0, biopsy showed cancer, Gleason score 3+4 (7). Radical prostectomy. September
1991. After surgery to 2001, PSA 0. 2002, PSA .1. Early 2003, PSA .2. At 3-month intervals in 2003-2004 it climbed to 1.16. In early 2005, I underwent external beam radiation (35 sessions). The radiation did not do the job because the cancer had traveled outside the pelvic area. The PSA continued to rise until it reached 20.4 (in June 2008). I then went on hormone therapy. PSA dropped to less than .01 (undetectable) and has remained there for four and one-half years. At my recent appointment, my urologist said he no longer needs to see me. I am 86 years old and continue to be relatively active. This is a true story.

Side effects? You betcha! But I am living a great life. Yes, I could have done without the cancer. But what the heck! In some respects, I feel that the cancer enriched my life. It caused me to wake up and smell the roses!

I predict that you will be alright.

In any event, I wish you success.

Jerry

psa .2
HI I am over in the UK , 62 years young and all about the same as you, gleason 7, cancer stage T3A, just busting out! had radical open job done may 2011, no nerve spairing all taken away . had psa taken after 3 months 0.1 then again 3 mths 0.1 the surgeon then said would i go to another hospital for the psa which i did it came in at 0.05 which he was happy with , back to original hospital and 0.1 it can be down to the machines they use and the operator so dont worry (i know its easy to say) but i have been there, going back in november this year for another go! take it easy until your next test, they gave me 8 years to live before so any advance is a bonus, my brother has got it at 70yrs old and is on hormone theraphy they say old age will get him before p/cancer its very slow growing my neighbour has psa of 14 and just gets on with life he doesnt wont to get involved with surgery or other treatments that may change his way of life you takes your chances etc! you will be ok! have faith brother thinking of you best wishes.

garrho said:

Rising PSA's
Hi Jerry....I had surgery 11 yrs. ago and now my PSA's have returned and rising (last was 1.12-having doubled in 15 mos..Now I must make a decision-radiation or hormone therapy...One urologist says its all in the pelvic area & radiation would work..the second urologist says no-and i should do HT...Any opinions. what were your side effects with each? THANKS Gary

Your doctor’s opinion is reasonably rightful
Larry

Sorry for the PSA result.

You are an experienced survivor and I believe that you are aware that recurrence is not declared by a single test but from a series of continuous increases. Probably the PSA started its climbing along the past 12 months but you got only one result and you surely will not lose anything by waiting for a confirmed rise and recurrence.

I think that your doctor’s opinion is reasonably rightful in suggesting you to wait, even if the last result may already indicate recurrence.
You may be anxious and want to start a salvage treatment the soonest, however, the chances to hit the cancer with a dose of radiation are not dependent in low levels of PSA. The success is expected if the radiation manages to destroy the DNA of the cancer cells where they may exist.
Similarly to cases of RT alone (CK or IMRT) as prime treatment, the success is not dependent on the PSA level but on the perfect hit. The PSA could be 2, 3, 4 or 5 and one still get cured with RT.

It may be time for you to consider reviewing the results from surgery, particularly the pathological report. The positive margins commented in your post do not confirm existing extra capsular extensions, if they are apparent in both places of dissection of the prostate, namely at the rectum and bladder sphincter. These are typical spots of apparent margins because after cutting the outer skin may slightly retreat which is seen under the microscope and therefore reported by the pathologist.

Your path report at the time of biopsy is more worrisome because it indicated perineural invasion. Typically in such cases, spread of cancer may have occurred, even before surgery, through the path of the nerves controlling erection. That could lead to metastases far from the prostate bed.

In any case, your three years in remission shows that your cancer is slow growing. You can try to get it with salvage radiation attempting to cure or you may delay the RT treatment with hormonal therapy.

I suggest you wait for recurrence and to such an extent, in getting more than one second opinion on your diagnosis before committing. The side effects will superimpose on the ones you got and such is also important to consider.

I wish you find an answer to your quest and get peace of mind.

The best of lucks in your continuing journey.

VGama

Old-timer said:

Answers to your questions, garrho
Sorry I did not respond sooner.

First, I will talk about side effects. My uro who did the prostectomy said he did nerve sparing suergery. After surgery, he said he was not able to save one of two nerves because the tumor had engulfed one of them. This left me with good feeling but only a semi erection. Incontinence, not good the first few weeks, then a pad a day until radiation. After radiation, ED remained about the same. Incontinence gradually became severe during and after radiation. Scar tissue in the urethra appears to be the cause of this.

On hormone therapy, ED is total and incomtinence is about the same as it was after radiation and before HT.

You may find this difficult to undestand, but I am more or less OK with both of these conditions. I continue to enjoy hugging and playfully engaging in sex with my bride of 63 years. In fact, I enjoy the hugging more than I sometimes did before HT. I can now hug as long as the two of us want. By the way, orgasam still lives. I might add that I still enjoy looking at and teasing the ladies, whenever it seems appropriate. Really though, I am not a dirty old man. But I continue to enjoy living.

Concerning the incontinence, I seriously considered the AUS 800. I decided against going that route priamrily for two reasons: (my age) and (I live in a continuing care retirement center and it is reasonably conmvenient for me to "diaper myself," so to speak. I alternate using Depends-type undies, pads, and Cunningham's clamp. Thankfully, I do not leak at night while in bed, so I use no protection then. Wehn I get up in the morning, I squeeze my penis to prevent leaking as I walk to the bathroom.

What advice do I have for you? I do not choose to give advice. The only step I took that turned out to be sour was the radiation. But it seemed that I needed to do that, because there was a 67 percent chance that it would have worked. I was in the 33 percent group. But I am not bitter about it.

I wish you success.

Jerry

Lewvino
Life is either a trial or a blazing path of fun. We can not change our personalities unless we really work at it. I can not answer for anyone else, but I feel that everyday I try to change my thinking. Hard to change your outlook, but I work on it. Life is a gift. I am sure that I am not a posture child for clean living, but I work onmit everyday. Do the best you can. Enjoy life. I am sure you do, but there are at least 100 things or friends we could do more with that would give us joy. Worry about what you might miss if you do not do,it while you can.

Mike

Old-timer said:

Not to worry, Levino
Seems that my story is much like yours, except that I am much farther down the road than you are. I am a 21 year survivor of prostate cancer. The early years were much like yours. I'll give highlights and a few details.

1991, PSA 4.0, biopsy showed cancer, Gleason score 3+4 (7). Radical prostectomy. September
1991. After surgery to 2001, PSA 0. 2002, PSA .1. Early 2003, PSA .2. At 3-month intervals in 2003-2004 it climbed to 1.16. In early 2005, I underwent external beam radiation (35 sessions). The radiation did not do the job because the cancer had traveled outside the pelvic area. The PSA continued to rise until it reached 20.4 (in June 2008). I then went on hormone therapy. PSA dropped to less than .01 (undetectable) and has remained there for four and one-half years. At my recent appointment, my urologist said he no longer needs to see me. I am 86 years old and continue to be relatively active. This is a true story.

Side effects? You betcha! But I am living a great life. Yes, I could have done without the cancer. But what the heck! In some respects, I feel that the cancer enriched my life. It caused me to wake up and smell the roses!

I predict that you will be alright.

In any event, I wish you success.

Jerry

Rising PSA's
hi jerry..thanks for sharing your story...I have a recurrance, with rising psa's, 12 years after surgery..one urologist is recommending radiation , my second opinion urologist recommends hormone therapy...any opinions and would greatly appreciate what side effects (level of severity) you experienced with each...thanks again...gary

Hi Lew,
At almost 3 yrs at
Hi Lew,

At almost 3 yrs at .001 my PSA this past month was .1.

It does get one's attention, for sure. And its such a small number, too.

garrho said:

Rising PSA's
hi jerry..thanks for sharing your story...I have a recurrance, with rising psa's, 12 years after surgery..one urologist is recommending radiation , my second opinion urologist recommends hormone therapy...any opinions and would greatly appreciate what side effects (level of severity) you experienced with each...thanks again...gary

First, I will talk about side effects. My uro who did the prostectomy said he did nerve sparing suergery. After surgery, he said he was not able to save one of two nerves because the tumor had engulfed one of them. This left me with good feeling but only a semi erection. Incontinence, not good the first few weeks, then a pad a day until radiation. After radiation, ED remained about the same. Incontinence gradually became severe during and after radiation. Scar tissue in the urethra appears to be the cause of this.

On hormone therapy, ED is total and incomtinence is about the same as it was after radiation and before HT.

You may find this difficult to undestand, but I am more or less OK with both of these conditions. I continue to enjoy hugging and playfully engaging in sex with my bride of 63 years. In fact, I enjoy the hugging more than I sometimes did before HT. I can now hug as long as the two of us want. By the way, orgasam still lives. I might add that I still enjoy looking at and teasing the ladies, whenever it seems appropriate. Really though, I am not a dirty old man. But I continue to enjoy living.

Concerning the incontinence, I seriously considered the AUS 800. I decided against going that route priamrily for two reasons: (my age) and (I live in a continuing care retirement center and it is reasonably conmvenient for me to "diaper myself," so to speak. I alternate using Depends-type undies, pads, and Cunningham's clamp. Thankfully, I do not leak at night while in bed, so I use no protection then. Wehn I get up in the morning, I squeeze my penis to prevent leaking as I walk to the bathroom.

What advice do I have for you? I do not choose to give advice. The only step I took that turned out to be sour was the radiation. But it seemed that I needed to do that, because there was a 67 percent chance that it would have worked. I was in the 33 percent group. But I am not bitter about it.

Hope this is helpful to you.

Jerry

Timon said:

Looks like it's back
I am new to this so excuse my ignorance, please. In December 2010 my PSA was 5.55 so I was referred to a urologist for biopsy. I had 10/12 positive cores all with Gleason Score of 8 (4+4). Bone scans and MRI were negative so I opted for Da Vinci surgery in March 2011 at age 62. Post-surgical pathology report showed no evidence of cancer in the lymph nodes or bladder neck. The prostate weighed 28 grams and Gleason was downgraded to 7 (4+3). Report said invasive tumor involves 50% of prostate, is multifocal, bilateral and present from apex to base. Margins involved by invasive carcinoma, multifocal, right and posterior lobe. Tumor also comes multifocally within 0.5 mm of the margin. Pathologist noted lymph vascular invasion and perineural invasion and staged the beast at pT3a (extraprostatic extension), however he also concluded, "...entire base of the area of seminal vesicles is submitted without definite involvement of a scant amount of seminal vesicle tissue present."

After 8 hours I was returned to my room and, inexplicably, the catheter came out sometime during the night and they were unable to reinsert it properly. A day or so later it was reinserted with the aid of a cystoscope and I was discharged after 4 days in hospital. I remained catheterized for about 4 weeks and have remained severely incontinent ever since despite thousands of Kegles and even physical therapy.

My first post-op PSA was July 2011 and it was 0.00. The second was in March 2012 and it was 0.12. (Urologist said that was insignificant.) I went back in October for another check up and he suggested that if the incontinence was not cleared up, we could consider the "sling" or the AUS; he did a PSA and a few days later I was informed that the result was 0.22. His plan is to "observe for now" and retest in April 2013.

Seems like I'm a bit more concerned about this than he is. I can handle the continued incontinence if I have the sure knowledge that the Cancer is gone. But now, I'm not even sure of that! Is this 0.22 PSA something to get worked up about? Thanks for any advice!

Timon

Something is producing the PSA serum. After surgery the level should keep constant at lower than 0.06 ng/ml. The two increases may be due to recurrence if lab error is ruled out.

I would suggest you to get another PSA test (in three months) sooner than what your doctor's suggestion, and then decide from there. While waiting you could do some researches into salvage treatments. Check about the side effects that will superimpose to the existing ones.

Try getting details about the effects of radiation on the AUS implantation.

Get second opinions on your present status.

Wishing you peace of mind.

VG

Stay positive!
Got into this site after many months and sorry to see this direction of progression. I have been following the technology and skills improvement since my surgery 2 years ago...and there has been vast improvement in dealing with things like these. So its all positive. Fight a good fight!