Prostrate cancer PSA

Thanks for sharing.

I presume that the PSA of 4.1 was the first done after RP. The last one of 3.71 would represent a decline. In any case, all the results signifies biochemical failure and probably recurrence as our body takes about two to three weeks to dispose/clean the PSA serum in circulation.

In my case of Gleason 6 diagnosis (back in 2000) I had a high PSA of 24.2 ng/ml with negative imagery tests but a voluminous cancer occupying 2/3 of the gland which justified the initial high PSA. However, like in your case, I had biochemical failure soon after RP with PSA of 0.20 ng/ml at the 5th month.

Oncologists considered me having micrometastases which seems to be typical of Gleason rates 3 and below that do not forms solid tumors. They are thought to exist at the urethra and prostate bed, not spreading to distant areas. Tradional MRI or CT scans would not detect these metastatic colonies. I would suggest you to repeat the PET scan using a PSMA isotope. The F18-PSMA would be my choice in the area adjacent to the bladder.

Please read this andthe links attachedtothearticle;

bestwishes and luck in your journey.

VGama

You can read details about my long story in surviving PCa through my threads listed here:

VascodaGama — Cancer Survivors Network

One should agree that treatments' protocols have improved along the years and each case is different even if thought to be similar. My story is not to be compared but you can use it to educate on the matter and be better prepared to discuss with your doctor on your next steps.

I did RP followed by SRT and then ADT in a sequential manner. Nowadays doctors choose combination therapies which seem to have higher success. Though therapies are not free from risks and side effects so that you need to find what gives you comfort and trust and then advance wisely.

Guys here will help you understanding the facts.

Best,

VG

Hi,

If it was me I would wait for a few more PSA tests to see if your PSA number is progressing at a high rate or just hovering around the 3-4 level. You would think with gland removal your PSA should be undetectable, hard to tell the cause at this point. I would think something is definitely going on if your next few tests indicate an ever increasing PSA #. Sometimes you have to wait a while for the cancer to shows itself on any type of scan.

Dave 3+4

I am in the lead at "misunderstanding" all of this - you'll have to catch up. (or fall back) ;-)

The last biopsy done in early December 2021 and was definitely guided by an MRI.

Here are the results:

==============================================================

Pathologic Diagnosis

Malignant neoplasm of prostate [C61] - primary.

A. Prostate, right lateral base, biopsy:

Prostate tissue with no significant pathologic change

===> all remaining right side prostate samples (B through E) repeat above.

===> Below are the findings on the left side. (F through J)

F. Prostate, left lateral base, biopsy:

Prostatic adenocarcinoma, Gleason score 3+4=7,involving 2 of 2 cores and 40% of the tissue

Perineural invasion

G. Prostate, left lateral mid, biopsy:

Prostatic adenocarcinoma, Gleason score 4+3=7, involving 2 of 3 cores and 10% of the tissue

H. Prostate, left apex, biopsy:

Prostate tissue with no significant pathologic change

I. Prostate, left mid, biopsy:

Prostatic adenocarcinoma, Gleason score 3+3=6, involving 1 of 1 core and 5% of the tissue

J. Prostate, left base, biopsy:

Prostate tissue with no significant pathologic change

-------------------

K. Prostate, ROI #1, biopsy: (ROI = region of interest)

Prostatic adenocarcinoma, Gleason score 4+3=7,

involving 3 of 3 cores and 60% of the tissue

• Perineural invasion

=========================================================

That's it .... I'll be getting another PSA measurement at the end of January and then consulting with my medical wizards on how to proceed. Surgery?

BPH = https://www.mayoclinic.org/diseases-conditions/benign-prostatic-hyperplasia/symptoms-causes/syc-20370087

"Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement — is a common condition as men get older. An enlarged prostate gland can cause uncomfortable urinary symptoms, such as blocking the flow of urine out of the bladder. It can also cause bladder, urinary tract or kidney problems."

The three letter abbreviations never end!!!

Thanks. ;-)

Congratulations for reaching to a decision. This is always a stressful moment in our PCa journey. I will cross my fingers with you for a successful end.

One hour before each RT section I used to drink water to have the bladder filled as means for protection.

I wonder if you had a testosterone test done before the Lupron shot. Surely this is not important in the overall combination treatment but it can be useful as a reference database in your journey.

Best wishes,

VG