PSA post RP

rogermoore said:

Hello Billy,

A reading of <0.04 is a good reading. I am a three year survivor of a RP and my readings continue to be less than 0.10. My most recent was 0.05 down from 0.08 the previous test.

The doctor explained that the lowest reading depends on the lowest figure the test lab is capable of giving. Anything below .09 should be considered very good. As for a positive assurance that the cancer has been eliminated. I have not been told by any doctor that they are absolutely positive the cancer has been eliminated. As survivors we will always have to live with that possibility.

Roger</p>

Hi:

I'm a new member. I hope I'm posting at the right place. 

I'm Spanish so I apologyse for my English.

I'm worried. My husband had Da Vinci radical prostatectomyone one year ago. 3-4- 7 Gleason. Clear margins, several nodes removed, clear. The tumor was confined to the prosate.

His PSA  two months after surgery was 0.04. Six months later, it came up to 0.05 and just yesterday, one year post surgery, according to a new blood test, his PSA has risen to 0.08. I'm really concerned about this subject and would appreciate it if some of you could give me some information or opinion about it. He's seeing the uro in twenty days time.

Thanks for letting me join you

Old Salt said:

Just wait for the urologist's opinion

I suspect that this will be hard, but wait for the uro's vision on this development. I do agree that the rise in you husband's PSA is worrisome and I suspect that the urologist will recommend a course of radiation. But I am not an MD, just another guy with prostate cancer.

THANKS for your answer.

On my husband's las visit to uro, six months ago, he said no worries if PSA was under 0.2 but as you say, it's really concerning the fact that PSA has risen from 0.04 to 0.08.

More opinions would be really appreciated, I'm in panic now.

Thanks again, Old Salt

VascodaGama said:

Lola; ... he said no worries if PSA was under 0.2 ...

Lola,

Welcome to the board. I am sorry for you being a member here and I hope you get the answers you are looking for from the survivors in this board.

The increase of the PSA represents what doctor term as "biochemical failure". If this increase further then your husband is confronting recurrence. The guidelines of urological association around the world uses a PSA=0.2 ng/ml as the threshold to declare recurrence, and recommends starting a salvage treatment before or when the PSA reaches 0.4 ng/ml.. This is what the urologist is following and probably the reason for his comment; " ... no worries if PSA was under 0.2 ...".

You may be worried for the last PSA but 0.08 ng/ml is still very low and is not judged as recurrence by the majority of doctors. We may think that the increase is due to cancer activity but no one can tell it to be true. Even the previous low values of 0.04 and 0.05 could be an error and not the real nadir. One should think that tiny variations of PSA can be a cause of equipment "noise" and the low PSA could even have origins from a tiny piece of benign tissue left behind. These are not common cases but they exist and can easily occur in robotic laparoscopy type of surgeries. Dissecting the gland with robot arms may not be easy if the surgeon has not enough training/experience, in particular, when delicate precision is required in cutting at the sphincter area. Early salvage treatments also do not guaranty better outcomes in terms of survival. This is why the guidelines set thresholds to judge recurrence and recommend therapies.

As commented by Old Salt, radiation is the common salvage treatment post surgery. This is the sequential that can give a total blow to existing cancerous cells. However, one needs to know where the bandit is hiding to try avoiding further recurrences in the future. You need to check what has been found in the diagnosis process before surgery and add exams to check in detail. The pathologist's report (post op) you summarize above pertains to the dissected gland alone and surely is not the true fact, if recurrence is ever declared.

I recommend you to do some researches on the matter and prepare a List of Questions for the next meeting with the doctor. Without proper exams to define targets for the rays the salvage therapy will be done on guessing and one can miss it again.

You may receive more replies if you start your own thread. Can you provide details on the initial diagnosis, PSA histology, image studies results, age of your husband, etc,

Best wishes and luck in his journey.

VGama

Note; we are neighbors. I live at the Algarve.

Moito obrigada, Vasco... sorry, we are neigbours and I can understand Portuguese but not writing it. My beloved Portugal!

Since I'm new here and, in addition to it,  kind of dummie, I don't know how to start a new thread, so I'm copying here the  previous and post information about my oh's desease.

Your post has been really helpful and clarifying. I really appreciate your care.

Forgive me if I'm being kind of intruder or attention demanding person, but I'm sure you know about anxiety and fear.

Here goes my husband's information:

VascodaGama said:

iberian impetuosity

Lola,

You are welcome. Thanks for sharing the details.

I wonder if your husband had any particular symptom that took him to do the MRI back in Feb 2017. Was there any urination issue? What is his age? Does he have any other health issue?

I think that for the moment you should wait for more periodical PSA tests (every three months) to verify if the increase leads to recurrence. Surely the mpMRI of 2017 did suggest extracapsular extensions that could have been left behind but it is too early to take such a result as the cause of the issue. The baddy in the data you provide above is the Gleason grade 4 that was confirmed by two pathologists (biopsy before surgery and the dissected gland specimen). The CT and bone scan are exams commonly linked to false negatives so that they shouldn't be used to judge cancer's location if recurrence becomes declared.

I do not know where you live but there are several facilities in Spain providing PET 68Ga PSMA or PET F18 choline exams which I would recommend you to do if recurrence becomes apparent. You can include this item in your list of questions to the doctor for discussion when you see him.

I hope that by now your husband has recuperated fully from the surgery.

Best wishes,

VGama

First of all, Vasco, thanks.

I'm afraaid despite my long boring drag I've not described the scenario clearly.

To begin with, I liive in Galicia, NW of Spain as you may know, but my husband Da Vinci and further tests took place in Madrid, at a relevant hospital.

Fo years my hub had had high PSA level, but no symthoms excepting for two eventual infections that were succesfully treated with antibiotics.

Due to his continuous high, (still not extremely high) PSA, he underwent two biopsies within ten years time. None was positive but his PSA continued to be high. It's then that we decided to go to Madrid for a Multiparametrical MRI with an with a new TESLAS device. The reading of the results was awful as he had PIRADs 5, extremeley likely to hace PC. Consequently a new biopsy was taken, knowing the place the tumor was placed(always in Madrid from then on). The result was that he had PC in one lobe and a small probability to have gone out of the prostate. (4+3) 7 Gleason. Then Da Vinci came At the post operation biopsy(we call it  Gleason was downgraded to (3+4) 7, a slight difference in agressivity? It was confined in the prostate and. According to the medical protocol he had bone scan and some other tests. All of them were ok.

After four weeks, PSA 0-04. Six months after surgery, 0.05 and recentrly, one year post surgery, right now, 0.08, and this increasing is what is driving me crazy and concerned. Why so? Everything was ok. He is also having a CAT befores visiting the uro  June 27th.

Sorry for the extensionof my post. 

I'm grateful to you for your responses.

Cograts on your living in such a beautiful place.O Algarve is beautiful. I'll be very close to your place in July as we are going to Huelva.

Best wishes.

P.S. You are American or Portugues?

VascodaGama said:

Be patient and hopeful

Lola (Dolores ?),

Thanks for the added info. I understand that the cancer was found via a guided biopsy done with the info from the MRI. The fact ascertains the veracity of the MRI results.

Please tell us how old your husband is (quantos anos de idad). What was the PSA before surgery (and ten years ago when the all saga started, if you still remember)?

I understand your confusion and worries when seeing the PSA increasing while all other tests report being negative. On top of that, the doctor seems not worried with the situation. However, as I commented above, traditional CT (CAT scan) and Bone scans do not detect cancer if this is small in size (less than 1 cm). When comparing the detection capability via the level of PSA, CT manages to provide positive results at PSA above 10 and Bone scan above 20.

The next CT exam (CAT before visiting the uro  June 27th) will most likely be a false negative too. In my opinion this is unnecessary in guys with similar history to that of your husband with so many negative CT perfomed along the previous ten years. I see it as a farce test required by doctors just to prove that they are actively involved in the best care of that particular patient. It is a cover-up (NCCN guidelines specifically does not recommend CT exams in guys with PSA lower than 10 ng/ml).

I recommend you to discuss with the doctor on the PET exam I indicated above. The PET 18F-choline is available at Seville so that you can try consulting the facilities on your way to Huelva. Surely if your husband is being treated under the National Health system (NHS), there will be restrictions but you should insist. The NHS covers this exam for cases similar to yours. However, for assurances of a true positive result, the test should be done at a much higher level from the present PSA, probably when this reaches the 0.4 ng/ml mark. Be patient and hopeful.

Here are links about the capabilities of PET scans. For your husband's case the F18 choline or superior (68Ga-PSMA) is recommended. Make copies of the links and show it to the doctor;

http://jnm.snmjournals.org/content/52/1/81.full.pdf

https://cancerimagingjournal.biomedcentral.com/articles/10.1186/s40644-016-0072-6

I am Portuguese. My acronym and avatar tells everything. The acronym "VascodaGama" refers to my willingness in navigating the rough waters of the prostate cancer without fear, and the avatar is the Portuguese guitar representing the "Fado" which means my destiny.
In this forum I use the English language (with certain difficulty) to try helping the many reading our exchanged posts. They do not participate in the discussions but surely are grateful for what we write.

Do some researches on the above issues and prepare your list of questions to get answers from the doctor.

Enjoy your trip to Huelva.

VG

Dear Vasco, 

I'm glad you are Portuguese as I love this country. Until I married and came to La Coruña I was living in Badajoz, where we are from,on the border with Portugal, close to Alentejo. Elvas was our  favourite place for a frequent  get-a-way. Close relatuoshionship with my favourite country.

First, ,my husband (Paco) is 69.

His PSA during the last 12 or 14 years was in between 4 and 7, aproximately, I can´t remember well, but it was about those figures.

Our uro in Coruña, during this period, never did MRI or PET or SCAN, excepting for the routine sonography at his own consulting room. And still it wasn't a rectal sonography. He still said that PSA wasnt that high for Paco's age. Nevertheless, he suggested a third biopsy.

By that time we heared about the Multiparamétrical MRI. We went for it to Madrid as the one here was too new and we were afraid there still  existed some lack of experience in using and reading it. You already know about the PIRADS5.

Oh, wait, I'm being repetitive. As your are Portugues and I'm Spanish you may well undestand something. I would like you to see the results of all this matter from the paper itself. Is it possible to send private messages containing pictures? If yes, it would be helpful... "helpful", thats what you are being to me and I want you yo know how much I do appreciate it.

Your avatar is beautiful. And of course I know who Vasco De Gama was. We both have relevant sailors and conquerors in our history.

Ok now, I'll wait until you tell me about sending you the information itself in a JPG file.

Un grande abraço,

Lola

VascodaGama said:

Let's be positive

Lola,

I do not know how to paste pictures in this thread. Grinder, a participant survivor, has done such in some of his posts so that you can inquire with him via the CSN mail (on the left bracket above). In any case I could not opinion more about your husband's situation. Please note that I am not a doctor. I have a keen interest and enthusiasm in anything related to prostate cancer, which took me into researching and studying the matter since 2000 when I become a survivor and continuing patient.

In regards to the PIRADS, this is just predictive test calculating possibilities for having aggressive cancer. This could be related to the grade 4 found in the biopsy and later on the gland as a specimen. At the moment one still doesn't know but most probably the whole cancer was  dissected during the surgery. Be hopeful.

I will try helping you to understand things when you are in doubt.

Best,

VG

 

Moito obrigada, Vasco.

Você me ajudou moito.

Best wishes.

Lola.