rising psa after radical prostatectomy

griff 1 said:

paul
what side effects did you have after the radation treatments. thanks griff

ezra99 said:

my experience
Sorry to hear of rising PSA. I never got the chance to have a time of undetectable PSA so not sure how I'd feel if I was in your shoes. I too had negative margins although I was a T3B with seminal vesicle involvement. I'll let you know what I did. I met with a radiation oncologist and a medical oncologist and would encourage getting appointments with both. I talked extensively about the appropriateness of radiation with negative margins. I wanted some "magic test" to tell me that cancer cells would be in my prostate bed which is what is going to be radiated. Prostascint was discussed but I chose not to do that and it wasn't encouraged by either MD as they felt it would not give me useful information with a PSA of only .37. The biggest discussion was whether to do ADT concurrently with IMRT. Some indication that doing ADT for 2 months before, 2 months during and 2 months after radiation increases chances of staying undetectable for 5 years after. I really struggled with the decision but chose to do IMRT only. IMRT alone option for me was 35% chance of 5 year undetectable and 53% chance of 5 year undetectable with ADT andd IMRT concurrently. Two biggest reasons I choose IMRT only was I'm concerned about weight gain and impact on my diet & exercise controlled diabetes. Hate of survive prostate cancer and die from complications of diabetes. Also I was worried that I would not know if a post radiation undetectable PSA was due to radiation or ADT and that thought bothered me. I figured I can handle it if my PSA is still detectable after IMRT but not sure my "head" can handle not knowing if it is due to success of radiation or temporary undetectable due to ADT. I may have made a stupid decision not to do both ADT and IMRT but I'm okay with it and really feel like it time for me to get a decent break so I'm betting IMRT will work. Whatever the outcome is I will be okay with it because I made the informed decision. No one told me what I had to do. I haven't started IMRT yet so can't tell you if it was a good decision based on my outcome. I start within a week.

Prep for radiation is another one of those "experiences". Not that bad but I really get tired of "exposing myself" to so many different people. Keep thinking it would get better but ever time they tell me to remove "all your clothes and put on a gown" I cringe. Anyway, only uncomfortable part was they put contrast liquid into the ureathra and placed a plastic clamp on the penis to do a scan. Rest of prep was fine.

Good luck to you.

ezra99 said:

5 year
Don't get concerned about the 5 year thing. I'm a couple years older then you. All my MD's kept throwing that 5 year failure rate term around. I finally stopped the medical oncologist and ask what he was saying "in plainer English". He said that he wasn't saying that I was looking at advancing metastatic disease in 5 years....just that I would had a 30-35% chance of non-detectable PSA in 5 years -so a 65-70% of detectable PSA. He said it's entirely possible that I would have a PSA low enough that I wouldn't need to start ADT for several years. He said that if my PSA approached 10 they would recommend ADT. He briefly talked to me about intermittent ADT and said he has had similar patients like me that have lived 20 or more years with out advancement. He said it's still highly likely that I would die WITH prostate cancer but not FROM prostate cancer. I am trying to do some things like avoid meat and dairy, exercise and living health lifestyle.

dalindg said:

5 years post op, double lab PSA tests, one rising
My DH had a radical prostestomy March, 2005 at age 38, PSA 7.2, Gleason 3+3=6, Stage T2, prostate was 2cm X 1.2cm, clear margins, not spread to lymph nodes. Mayo Clinic, Minnesota.
We have had PSA tests every 6 months. The Spring tests are mailed to the lab at mayo, and results have all been <.1 "undetectible", The Fall tests are the more sensitive tests from our local Nebraska lab.
August 2006 - .00?
August 2007 - .00?
August 2008 - .012
August 2009 - .021
August 2010 - .052
Local Doctor is freaking out. Calling for Nuclear Bone Scan, CAT Scan, and repeat test in 3 months. Call to mayo in 2009 told me not to worry until .1 is breached.
I personally want to go back to Mayo and schedule the diagnostics there.
Liver enzymes also were high, so now my husband is worried that the cancer is in his liver. I think it is a side affect to the zoloft antidepressants he is on.
Any advice?</p>

dalindg said:

Getting follow up tests locally
Thank you Kongo for your reply. I hope the test variances are because of calibration, but wish one of results had gone down, instead of up.

I just got off the phone with the Mayo clinic urology department. They would like us to get the tests as suggested by our local doctor. The tests can be performed here in Nebraska, and they will accept those results. Our RP doctor (Robert Myers) is no longer at mayo, so I havn't made an appointment with them yet. Surprisingly, they could get us in tomorrow, two weeks, and three weeks from now with another urologist.

Just trying to stop crying at work right now. At least we had 5 years with no worries.

Kongo said:

Upsetting
I know how upsetting this is but if you research the background on recurrence you will see that about a third of the men who have RP experience a rising PSA within 10 years. Many times, if the PSA rise is very slow, no treatment at all is required. If the PSA doubling time is less than 2 years (which your numbers suggest)it may be an indication that the cancer is starting to grow along the margins which is very easily treated. There are several treatment options that provide excellent long term results. Typically treatment includes some form of hormone therapy or radiation treatment or a combination of both.

There could also have been a small amount of prostate material left behind at the time of surgery that could be causing the rise in PSA.

While the tests your local doctor is suggesting are prudent, given the readings you have described I would be astonished if they showed anything but I think what they want to do is rule something out. If the cancer had moved someplace else where it could be detected by those tests, I believe your husband's PSA score would be much, much higher.

As you did before when your husband was first diagnosed, you have to take this one step at a time and make sure you are getting second opinions and doing your homework.

This forum is an excellent place to get good information and many men who post here have dealt with similar circumstances and you will receive a lot of strong support.

dalindg said:

Thanks hopeful
I love your name! I checked webmd, and "abnormal liver function tests" is a side effect of zoloft. I will have to point that out to our doctor when we go in to have the other test results.

The Nev said:

Dont mean to Hijack
I don't mean to hijack this thread but just took a gut punch myself this morning.I'm 55 yrs I had robotic surgery last Sept lymph nodes clear negative margins Gleason 7 3+4. All PSA since 0 then this morning PSA .75 so I guess its radiation now. I had my surgery at MD Anderson Houston Tx and have a call into them for the next step; any idea's on what tests they may run and what I can expect from here?

Wanttoknow said:

Billybumps:
Same story with
Billybumps:

Same story with me. I was seen every three months post surgery and when my PSA comtinued to rise from .14 , my oncologist recommended radiation therapy which I did undergo. Since then it continues to rise (now at 1.67)and the recommendation is Hormone Therapy. Still haven't decided to go this route because of the side effects. I am on a homeopathic diet right now. Every case is different. Trust your doctor but also research all you can. A PSA at this level is still just a number and we are treating just a number at this stage. My bone scan and MRI recently were both negative.

J

lewvino said:

I don't think that the
I don't think that the biopsy causes the relapse. For many it comes down to two factors:

The Gleason score post surgery when they examine the complete speciman and if you have what is referred to as a positive margin post surgery.

The higher Gleasons 7, 8, 9 and 10 have more risk then a Gleason 6.

When the surgeon removes the prostate there is a very fine line between 'how much to cut'.
If you cut to little you may leave cancer behind and if you cut two much then you get into other problems. Or on examining the surgical speciman cancer is found at the very edge or 'positive margin'.

I'm Gleason 7 and a positive margin. Tomorrow morning I get my 14.5 month PSA result. I'm being monitored about every 4 months on blood work and will post in the morning.

Larry