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Question about post RP PSA

leadsled
Posts: 5
Joined: Oct 2018

I've been on this board sporadically since my diagnosis in Frb 2018, and my RP in March 2018. I am taken aback by what some of the posters have been through, and are continuing to fight. 

So I'm almost hesitant to post this...... My post RP readings were 0.00 for a few tests, up to 0.01, then back to 0.00 until July of this year. A reading of 0.03, followed by a reading yesterday of 0.04. I see the doc next week for a previously scheduled appointment.

Considering some of the posts/experiences I read here, it feels like I shouldn't be worried, at least not yet.

Post RP, my doc said he couldn't have written a better pathology report than the one I got.

I'm 67 years old. I assume this means that PC is hiding somewhere. 

What should i expect next week when I talk to the doc? 

Thanks, Bill

Georges Calvez
Posts: 297
Joined: Sep 2018

Hi there,

You can take the early rise from 0.00 to 0.01 as a bit of machine noise or as an omen, PSA assays are not that reliable and depending on the day and the machine set up the machine may not give a true zero.
I think you may take the latest readings as being the beginning of an upward trend or maybe they are not. The doctor may want to wait for another reading or two, the rule is that you need three readings above zero to show recurrence.
At this level there is no way of detecting anything at all except by PSA levels so no scans, etc.
I think it is odds on that some of the little beggars have escaped and are now up to mischief but you may get lucky, it is hard to tell.
The good news is that 70% of recurrence is in the pelvic region, often in or around the prostate bed so it can be treated with usually six months of hormonotherapy and radiation.
So he might start you on that straight away or you might have some more waiting around to see what happens in December.
What was your Gleason Grade, etc, high scores are more likely to have set up outposts than low grades despite a favourable pathology report.

Best wishes,

Georges

Clevelandguy
Posts: 462
Joined: Jun 2015

Hi,

Normally considered by most people when the PSA rises above .2, re-occurance has occured. If you see a rising trend over your next few PSA tests I would be concerned if it was me. George is right, normally a .01 or .02 difference could be just noise and not too concerning. Hang tight for the next few reading to see if a possible upward trend is starting to develop(hopefully not), good luck.

Dave 3+4

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3311
Joined: May 2012

Bill,

All of your results (the ones listed above) indicate no recurrence of PCa. By most lab protocols, your PSA is clinically undetectable. Virtually no one ever has a PSA result of 00.000. The machines are just not that absolutely precise. Based upon what I have been taught and read, your results are perfect -- much as your doctor suggested.

leadsled
Posts: 5
Joined: Oct 2018

Thank you, George, Cleveland, and Max. Your responses are much appreciated.  I understand that we are all cancer patients for the rest of our lives. I teased my doc last year after the .01 reading that he should use a lab that cleaned their instruments more carefully, instead of the cheapest one, and that I wanted negative numbers from now on. Actually, I'm not sure they don't do routine labs in house. He just laughs at me. Thank you again for responding to my post. Bill

Georges Calvez
Posts: 297
Joined: Sep 2018

Hi there,

I am suspicious of PSA assays that report zero results, there are limits to any assay technique so I think it is probably more correct to report a less than result.
For instance, paper chromatography will let you detect very low levels of heroin, certainly the levels that are found in the urine of a person who takes the drug are easily detected. Gas liquid chromatography with conventional detectors will let you go even lower and a technique like GC-MS will detect the morphine found in the urine of someone who has eaten a poppy seed bagel.
Currently my analyses are done on an Architect Abbott chemiluminescence CMIA ( sérum ) machine and my latest result was reported as less than 0,05 ng/mL.
This is the level that the manufacturers and the lab are prepared to set as the confidence limit for their assay, anything less than this is due to interference from other things in the serum, electronic noise, etc, etc.
Bearing in mind the size of the PSA molecule which varies between 28 and 35,000 Daltons depending on if it is bound to something or not then this is a tiny amount in terms of molecules per millilitre.
You can get something of an idea of the difficulties associated with PSA assays and the problems of interpretation of very low levels of PSA from this paper.
http://clinchem.aaccjnls.org/content/clinchem/42/6/849.full.pdf

Best wishes,

Georges

leadsled
Posts: 5
Joined: Oct 2018

Saw my urologist this morning, he's sending me to a radiation oncologist now. he alternated between optimism over a reading of .04 at 18 months post RP, telling me it would have been undetectable a few years ago, to reminding me that it's cancer, and it's back.

I'll see what the new guy thinks soon.

Thanks for all the replies, Bill

Georges Calvez
Posts: 297
Joined: Sep 2018

Hi Bill,

I am happy to help.
It looks like it is nothing much yet and hopefully it can be knocked out.
Even if it cannot it is very likely that you will be a long term survivor and something else will get you before the prostate cancer.
7b is not very aggressive or fast moving so look out for the Number 11 bus!

Best wishes,

Georges

Clevelandguy
Posts: 462
Joined: Jun 2015

Hi Leadsled,

If it was me I would go see the Oncologist and wait before I did anything for another PSA reading or two to make sure it is going up.  Sounds like you have had a .03 & .04, I would want a couple more readings to determine a trend before I let the Oncologist go at it.

Just my 2c worth.

 

Dave 3+4

leadsled
Posts: 5
Joined: Oct 2018

Took my first radiation treatment this morning. Radiation oncologist hasn't told me how many, or many details, but I'll see him again on Monday. During the first exam, he did tell me that 70% of surgery patients will eventually have radiation and/or hormone therapy.

I thought that number seemed a bit high, but he was touting radiation instead of surgery during our whole conversation. I reminded him that my uroligist was a surgeon, too, so his opinion differed. Then I was reading studies about the percentage of RP patiernts who had regrets later, and wished they'd not had the surgery, due to less than stellar results in quality of life.

Me, I just wanted the damn stuff out of me. Also read about radiation side effects here and elsewhere, and don't know what to expect. Still working full time in my business, Bike shop owner, mechanic, flunkie, and hope working won't become a problem.   Bill

VascodaGama's picture
VascodaGama
Posts: 3033
Joined: Nov 2010

Lead,

You may be flunkie (as you comment above) but at least you are mentally prepared for whatever outcome arises from the salvage radiotherapy (SRT). Though still at the beginning of the treatment, I think that you will manage and will continue your business as usual. Probably you will need to visit the toilet more frequently so that I advise you to repair the bikes at close facilities.

Your concerns seem to involve more questions on matters that could interfere with your daily life than on the details on the treatment. I can just say that SRT usually develops into approximate 35 sections of RT administration done every day except on Sundays. Each section takes about 20 minutes which will allow you time to continue your work if the clinic stands close to your shop. I am surprised that they did not inform you in advance what SRT is about and what it involves.

Best wishes for luck.

VG

Your previous thread; https://csn.cancer.org/node/318237

 

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