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PSA 0.54 after RP

Andrea zarate
Posts: 1
Joined: Feb 2017

My husband had a PSA rading of 58 before RP and a Gleason 4+4 

after RP Doctor had said he would need radiotherapy because lymphnode biposy came out positive.

today, i month after radical prostatectomy he got a PSA of 0.54?

I dont know if this  PSA result is good outcome or not.

Would radiptherapy help?

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3295
Joined: May 2012

Andrea,

The positive node and the PSA number do suggest that radiation should be done. Sooner is better than later.  The good news is that radiation is still potentially curative -- will potentially kill all of the disease. No other form of treatment (hormonal, chemo) is potentially curative.

Depending on exactly how long his PSA was drawn after surgery the high result could be because the PSA has not yet fully washed out of his system, but I would not assume this, and would follow the doctor's suggestion.

I would go ahead and get rolling on it,

max

Old Salt
Posts: 720
Joined: Aug 2014

and, more significantly, Doctor

VascodaGama's picture
VascodaGama
Posts: 3015
Joined: Nov 2010

I wonder the purposes of your inquire. Is your husband planning to wait longer before engaging in any additional treatment?
If such is the case then I would say YES. He can and should wait to recuperate fully from the surgery. Radiation can be administered at any time. The present PSA (0.54 at one month) already justifies intervention. Without prostate gland the PSA should be nill. There is failure of surgery and one may look for a salvage therapy, which typically involves radiation.

However, radiation is not a treatment without issues. It should be done only after full recuperation of local tissues, in particular the sphincter area that, if affected, can lead to permanent incontinence. Your husband's age, fitness and other health problems should also be considered in the decision.

You did not share details of his initial diagnosis but when the status of the patient (the clinical stage) indicates high probabilities for not being contained, some doctors prefer to debulk the biggest tumour (the whole gland) with surgery, and follow with a series of localized radiation covering the surrounding areas. In such kind of combination therapy, doctors recommend adjuvant radiotherapy the soonest to accomplish full treatment. This is typical. But if the situation regards recurrence from a failed surgery, then salvage treatment can be a protocol combining radiation with hormonal treatment and follow different times of application.

Salvage radiation is "helpful" (as you comment) and it will be successful in killing the bandit if the radiologist has proper targets to define a field of attack. These targets are obtained via image exams (mpMRI, PET/CT). Without such information the radiologist may project this field guessing on cancer's location. He will cover the lymph nodes and prostate bed.

A combination salvage radiotherapy is administered with an initial agonist shot (ex; Lupron) as neoadjuvant followed 3 months later by radiation and continuing hormonal shots during 6 to 18 months (depending on the case).

Here are the norms followed by urologists (your husband's doctor);

https://www.auanet.org/education/guidelines/radiation-after-prostatectomy.cfm

Best wishes,

VGama

Will Doran
Posts: 207
Joined: Sep 2015

Andrea,

I had a Robotic assisted surgery in Dec  2013.  My PSA was 69 when my cancer was diagnosed.  I had had no symptoms and my Gleason was 3 + 4 =7.  My first PSA, post surgery, was done at 1 month.  My PSA was 0.6.  I was then put on Lupron which I was on for two full years and I had 8 week of radiation, 5 days per week.  I started the Lupron several weeks pre radiation to start to weaken any remaining cancer cells.  Next PSA was somethign like 0.15.  Then it fell to <0.010.  It held there for almost three years.  I have been off Lupron for 1 year now, and my PSA is at 0.145, now that my Testosterone is back up in the "normal range".  They had my Testosterone at 17, at it's lowest.  Normal is 250 - 1,100.  My testosterone is now at 380.  That's still low and they tell me it will probably stay that low, becasue of how long I was on the Lupron and the amount of radiation I had.    We are watching to see how fast my PSA comes up.  if it starts coming up too fast, then I will have to go back on intermitent Lupron shots, for as long as that will work.  Or we may do some other drug medication, for as long as that might work. Then , from there on we will decided what is next. 

Also, be aware that there can be side effects from the Radiation.  I am now dealing with a bone density issue in my femurs.  I have gained bone density in all parts of my body, except my Femurs.  So, that has made it necessary for me to be on Prolia to try and correct the bone density problems.  Prolia also has side effects that can be uncomfortable at times.  Muscle and joint aches is the worst of it.  I was just starting to feel better and had had most of the side effects of the Lupron subside, but now I'm dealing with the side effects of the Prolia.  It's a never ending battle. 

So, as was stated above, I would imagine your husband will need radiation as a clean up, post surgery.  Not being a doctor, I can only tell you what I was treated with in my situation, so your doctors will be the ones to ask for a complete understanding of what is next.

Best of Luck

Love, Peace and God Bless

Will

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