Post surgery PSA level detected

Your post is wonderful. I do not think you are going to “lose” him for the prostate cancer.

The PSA is not totally produced by the prostate gland (tiny portions are produced at the urethra) therefore there will be always a value registered. After op the serum should be lower than 0.06 ng/ml. This is what doctors call “remission” and your man is experiencing such with his PSA=0.01.

You have not shared details of the pathologist report but from your narration in regards to the risky Gleason score 9 and the positive extra capsular extensions, I think that he could be involved in a salvage treatment (radiation therapy) now or wait until recurrence becomes apparent. Typically, this is declared when the PSA rises to a value of 0.2 ng/ml. In any case, many in similar circumstances lived many years without the worries of a cancer return, or the endurance of added side effects from salvage therapies. Young patients in particular are at risk of losing things taken as natural for their age. Sex becomes a hardship affair and the possibility for fathering a child has been lost.
Your man’s façade may be related to his quality as manhood. He needs your understanding, more than ever.

I would recommend him to get second opinions from a medical oncologist once he gets his next PSA results.

Best wishes and luck in the times ahead.

VGama

Swingshiftworker said:

Good luck!

Glad to hear that your husband's surgery was apparently successful but am a little confused when you say that they found some cancer outside the prostate but not in the surrounding tissue or lymph nodes.  If it's outside the prostate, it's outside somewhere, even if they cut out what they found. 

While there is always concern about the recurrence of PCa after surgery, which would be indicated by a rise in PSA, you also need to be concerned where the cancer cells that got out of the prostate will eventually land.  So, some sort of additional cancer screening also needs to be done for early prevention/detection.  Typically, if cancer escapes from the prostate, bladder and bone cancer would be the areas of greatest additional concern.  So, you may want to ask for additional screening in these areas, even if your husband's PSA does not rise significantly.

Good luck!

 

Just,

Like Swing, some of what you write is unclear to me. Perhaps if you review his surgical record it would be clearer just how they feel the cancer had escaped from the gland, but any cancer outside the gland is problematic.  Also, his Gleason numbers are indicative of aggressive disease.  As Vasco stated, PSA of less than .01 IS clinically "undetectable; it does not represent (at that level) the presence of prostate cancer while that low.  Nonetheless, I would consult with a medical oncologist and discuss the possible need for salvage therapy.  I am surprised the surgeon did not discuss this with you already.

But be aware that even metastatic prostate cancer usually moves slowly, and is usually controllable for many years, if not decades.  I would do some consultations with both medical and radiation oncologists if it were me or a loved one, but wothout panic.  His current PSA is where it should be.  But a man as young as he is, and with a Gleason that was that high, needs to be thinking very long-term.

max