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Back in 2013 my psa was 22.1

ROADKING04HD
Posts: 2
Joined: Oct 2015

I had my prostate removed in 2013 after my byopsie came back pos. for cancer in 3 of the 12 taken and was told it was contained to the prostate. 1 year after I had my psa done and it was 00.0... 1 year after that I had it done again and it came back 0.22  The Dr. told me we would recheck it again in 3 months and at that time it came back at 0.29. Once again we waited 3 more months and now it came back at 0.40. He said I need Radiation treatments. Don't understand why I have to have radiation if , according to the Dr. I was cancer free 2 years ago. Any suggestions , going crazy in Ohio

Old Salt
Posts: 720
Joined: Aug 2014

The simple explanation is that not all cancer was removed with the surgery. This (biochemical relapse) is not at all uncommon, unfortunately.

Irradiation of the prostate bed (and nodules?) is the usual approach for this problem, sometimes combined with hormone (Androgen Deprivation) treatment to kill prostate cells that have spread elsewhere. I believe that the current (!) action level for this kind of treatment (salvage radiation therapy) is a PSA of 0.03 or greater. Hence, you should be treated ASAP.

 

http://www.medscape.org/viewarticle/744220_4

hopeful and opt...
Posts: 2226
Joined: Apr 2009

Sorry for your rising PSA results which is a marker for recurrence. 

 

http://www.pcf.org/site/c.leJRIROrEpH/b.5837041/k.8FFF/The_Role_of_PSA.htm

 

At the time of your surgery, there was cancer outside the prostate, which has multiplied in the last few years.  Your PSA at that time of 22.1 was very high and an indicator of something going on. You did not indicate your gleason scores, or the extent of the cancer within the prostate. I don't know if you had any image tests at that time which might have shown extracapsular extension.

 

At this time, Imaging tests  may be done to get a better idea about where the cancer is. This may include, but not limited to bone scan and MRI. 

 

http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-recurrence

Please come back with any questions that you might have.

H

Old-timer's picture
Old-timer
Posts: 196
Joined: Apr 2011

I experienced the return of prostate cancer after radical prostatectomy. I understand that no two prostate cancers are alike. But yours seems to be behaving much like mine did. Following is a brief summary of what has happened with me. I think it is interesting and, hopefully, it is worth telling.

 

I had radical prostatectomy in 1991 at the age of 65. Gleeson score of 7 (3+4) and PSA at 4.0. PSA dropped to 0 after surgery and remained at that level 11 years. In 2002 it was 0.2. It began a gradual rise and reached 1.16 after wo years. I took 36 sessions of radiation in 2004. My PSA continued to rise, indicating that radiation had been ineffective. My urologist said I should go on hormone therapy when the PSA reached 5.0. In 2005 I moved to another city and changed urologists. The new person said we could wait until the PSA reached 10.0. It reached that level in 2007. For reasons too lengthy to explain, we ended up waiting until 2008. By then the PSA was at 20.4. In June, 2008, I went on hormone therapy. The PSA dropped to less than .01. After more than seven years of hormone therapy, my PSA is still at that level. (It is said to be undetectable.) The side effects of hormone therapy have been tolerable. I expect that this would be more of an issue if I was a younger man.

 

I do not recommend this schedule of treatments; I am not qualified to do that. But it has worked well for me. At 89, I am no road king, but I still get around!

 

Good luck to you.

 

Jerry

ROADKING04HD
Posts: 2
Joined: Oct 2015

Thank you for your follow up and good luck to you also.

 

 

 

                                                       Larry

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3328
Joined: May 2012

Larry,

As I understand things, Old Salt's simple and clear response is what you are dealing with:  Despite the doctor and pathologist's best ability to analyze the surgically removed tissue immediately following your surgery, somehow, from some location, cancer had escaped the gland prior to its being cut out.  I had my prostectomy in January, and have remained "undetectable" for PSA thus far, and pray that it forever remains undetectable.   But I have studied what the normal sequence of events is should PSA return, and yes, most likely (following some scans) irradiation of the prostate bed and possibly adjacent areas would be the first step.  Clinically, this is still usually regarded as potentially "curative," or a reasonable technique to kill "all" of the cancer.

The avenues usually mentioned for "escape" are perineural (the cancer followed a nerve bundle out of the capsule), a positive margin (some cancer went through the capsule lining itself, although that seems the least likely prospect, given that the patholigist studied the tissue for positive margins), and travel into the seminal vesticles (two glands conturing the bladder, which feed into the prostate itself).  The seminal vesticles nowadays are virtually alweays cut out with the prostate itself, but there are cases in which the surgeon will leave them in.

If you re-read the pathologist's report it might provide you with some clues regarding these possibilities, or just ask your surgeon.

Regardless, radiation is the most common "first step" in cases similiar to yours for "salvage therapy", sometimes called "second line therapy."

My surgeon told me last office visit that things look very good for me, and said that it is "90% likely I would never have detectable PSA again." Of course that means that a 10% chance does remain.   There are no guarantees with this stuff, no written warranties.   But is sounds like you do still have a good shot at curative treatment.   I personally would speak to both a radiation oncologist and a medical oncologist (a doctor who is trained to use hormonal therapy and all the versions of chemo) to get more than one opinion, and then get going on undetectable PSA results again.

Love the screen name !  (For guys who don't know, the 'Road King' is a beautiful version of the Harley Davidson Electra Glide.)

max

Will Doran
Posts: 207
Joined: Sep 2015

RoadKing,

Keep fighting.

I was diagnosed with Prostatre Cancer in October of 2013.  I had a radical Proststatectomy on December of 2013.  My PSA was 69 with a Gleason Score of 7. 40% of my prostate was involved.  I had one lymph node involved.  Thus I was diagnosed as a Stage 4.  I was put on Lupron two months after the surgery to weaken what cancer might have been left.  According to the pathology there was no other cancer in any of the margins or other lymph nodes that were removed, and my MRIs are clear and there is no involvement in my bones, at this time.    Then, I was treasted with 40 Radiation treatments a month later.  I am still on Lupron .  This last 4 month shot (Oct 2015) is supposed to be my last.  Then I am to go off the Lupron.  And we will monitor the PSA and see if it stays at <0.010, where it has been for two years.  My doctor, and Oncologists told me from the beginning they were going to be very aggresive with my treatments.  And, they have been, and so far it is working.  We are hopful that all will stay in Remission.  My doctor has just started using Remission in his talking, at my last appointment.   We are talking about all the "what ifs", etc, and the plans for 10+ years from now.

So, make sure and follow up with your doctors and make sure you have good Doctors and Oncologists working on you.  Keep Fighting hard and do what your doctors tell you.  Also make sure you research as much material as you can, and keep yourself imformed about treatments and all the side effects.  Its' a hard fight and there are times of complete frustration and worry.  But hang in there and enjoy every day.  One day at a time.

Best Wishes, and I hope you hear the word REMISSION soon.

Peace and God Bless

Will

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