Post RP PSA

rooster02
rooster02 Member Posts: 12
in Prostate Cancer #1

History:

April had de Vinci radical surgery. The post operative patholoical report of the gland was not what I had hoped for: 70% tumor, Gleason's grade 9 (4+5). Of more concern was the margins: bladder neck - positive bilaterial, perineural invasion-positive, extraprostatic extension-positive, seminal vesicles-positive right.

Patologic stage: pT3b. NX.

About one month since the surgery, first PSA test came back <0.1; this is good news. Metting with the surgen, he has scheduled another PSA test in August, making a determination on future RT treatment, healing required first. The postoperative gland results above give cause for concern; there is a high risk small micoscopic cancer spots remain in and around the prostrate bed but, the first PSA results after surgery shows no trace of the beast. We are in a wait and see mode but, the first steps taken to beat the beast have proven to be good choices for our situation. Thanks for your input and support.

Comments

  • Will Doran
    Will Doran Member Posts: 207 Member
    #2
    Best of Luck

    Rooster,

    Best of luck.  I had Robotic Assisted Surgery in December of 2013.  I had a PSA of 69, with a gleason of 3+4-7.  Post surgery, 40% of Prostate involved, and one very small spot in one lymph node. I was a pT3b N1  That spot didn't even show up in the pre surgery MRI's.  Then I was on Lupron for two years and had 8 weeks of Radiation, 5 days per week, post surgery.  Today, my PSA remains at <0.010.  My PSA dropped to .6, 4 weeks post surgery, then to .2 in two months, and then to <0.010, where it remains today.  I just had a check up with my Urologist/Surgeon today and he is happy with my tests and results as am I.  I have been off the Lupron for 4 months at this point.  My Total Testosterone Level was clear down to 17.  Normal is between 250 & 1,100.  As of this week, my testosterone has started to come back up a little and is now at 134.  That is still very low, but is an improvement.  Plus, my PSA is still at "0".  So we have a little more hope that we might be making head way against this beast.    All my doctors and oncologists are pleased.  However my Urologist still keeps things real and reminds me that my cancer was very aggresive.  We are hopeful but we try to keep the reality of this in focus.  I gave my Urologist a great big "BRO HUG" as he came in the room today, and he hugged back.  My wife also gave him a hug. 

    So, make sure and study and learn all you can.  Expect ups and downs, but don't give up hope.  You will probably have more treatments to go through, so make sure and learn all of what you will experience during those treatments.  Learn the side effects and ask as many question as you can.  It's a hard fight.  So, Fight like the dickens.  There is hope.

    Enjoy all the simple things in life.  And I hope you start to see lots of "0's" in your tests soon.

    Peace and God Bless

    Will

  • bob33462
    bob33462 Member Posts: 76
    edited May 2016 #3
    BEST OF LUCK

    Rooster -

    Had my di Vinci 4/20/16 - pT3a, N1 - will do first PSA in two weeks - our pathology differences are you had seminal  vesicles positive and I had 2/10 nodes positive.

    Best to you and hoping your PSA stays where it is.

    Bob

  • rooster02
    rooster02 Member Posts: 12
    #4
    Post Pathology Differences

    Bob:

    Wishing you the very best numbers with you initial post surgery PSA testing. Our RP pathology results are close; I doubt you have any second thoughts as to the choice you made to remove the gland, I don't. My pre-surgery Gleason was (3+4) 7; I was even more secure in my choice to remove the gland after the post surgery pathology report came back. I feel like it is just the first step, although a big one, in attempting to beat or bring the beast under some form of managment.

    Keep the faith,

    Rooster02

  • VascodaGama
    VascodaGama Member Posts: 3,641 Member
    #5

    Rooster,

    In your initial thread, I have laid down my opinion regarding options for any (?) salvage treatment. I noticed that you had a low PSA (6.9 ng/ml) even at the presence of an aggressive cancer, Gleason s9, voluminous and apparent metastases. This low PSA condition is typical in Gleason paterns 5 because these poorly differentiated cells have lost the ability/function one may expect to occur in a living cell. Many Gs9 guys confront similar situations of voluminous cancer but low PSA. (https://csn.cancer.org/comment/1538123#comment-1538123)

    The last PSA post op this time may confirm the case, indicating a low PSA of < 0.1, which one regards it as good but in fact may not serve as suitable. We need to wait for your next PSA to confirm success; however that time I would recommend you to get the ultra sensitive (0.XX ng/ml) with two decimal places to judge better your case. I would also recommend you to have a testosterone test done now to serve you as base marker in your future ADT treatment, if any.

    In any case your PSA news also confirms that surgery did its job in knocking down the bandit. I hope it stays that way for the many years to come; in Remission for ever.

    Best wishes.

    VG

  • rooster02
    rooster02 Member Posts: 12
    #6

    VG and All:

    I have asked my surgeon about a PSA test to two decimel places but, I think it is too soon after the RP. In August, I hope to complete a more sensitive PSA battery test. Based on the post surgery pathology results, August will be the likely start of a conversation with MD Anderson on some form of radiation treatments, ADT to be determined by the MD Anderson team. AS does not make sense to me with the facts as we know them specific to my situation. I agree with you, the numbers can "lie", I would rather be proactive with a salvage treatment. The pre-surgery biopsy Gleason score was lower than actual; to wait and have a greater problem before starting salvage treatments seems a less than desirable choice to me. Quality of life comes into play as well, my age, 63, has a bearing on the choices also.

    Before the RP surgery, I had visited with a kidney specialist. At that time my kidney function was only operating at 51 percent. Based on recent testing, post surgery, my kidney function has improved about 20 percent to 62 percent. It is nice to get news of a secondary improvement after the RP. The inlarged gland was inhibiting kidney/bladder funtion. With the gland removed, the kidneys/bladder are able to function much better, I hope the improved performance percentage continues to rise. Smile, my leakage is much stronger now that my kineys/bladder are improving - Ha, Ha! I feel like I should have a 1/4" steel plate for the back side of my pads, it has been a while since I had a stream this stronge with volumn. Got to laugh - enjoy the small things in life post RP.

    Keep the Faith,

    Rooster02

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