prostate cancer patient, just received my first post RP ultra sensitive PSA reading above testing threshold, looking for advice and support

[jronne]

Hello, many thanks in advance.

Looking for others that are in my situation or have been in my situation in the past.

Ideally would like to find those that have had a non zero low measurable PSA indefinitely for years that have avoided BCR (biochemical recurrence).

I have two friends that have been in my situation with prior RP (radical prostatectomy) and have had BCR a year later following RP followed by SRT (salvage radiation therapy).

I have been 18 months below the ultra sensitive PSA testing threshold of 0.015 and recently in 6/2017 below the new lowered ultra sensitive PSA testing threshold of 0.006. Been exclusively tested at LabCorp.

I am now above the testing threshold of 0.006 having checked twice on back to back days on 9/15/2017 with readings of 0.01 and 0.009.

7 Ultrasensitive PSA tests - 17 months clean

My profile is semi favorable with gleason 3+4 post op pathology with very thin negative margins (< 0.1 mm) and PNI (perineural nerve invasion).

58 years old

7 Ultrasensitive PSA tests - 17 months clean post op RP until positive at 22 months

1/14/15 5/4/16 8/29/16 12/1/16 3/3/17 6/5/17 9/15/17 9/16/17

<0.015 <0.015 <0.015 <0.015 <0.015 <0.006 0.010 0.009

11/19/2015 Radical Prostatectomy UCSF Dr Peter Carroll da Vinci robotic surgery

Synoptic Comment for Prostate Tumors

- Type of tumor: Small acinar adenocarcinoma.

- Location of tumor: Single tumor. Left posterolateral midgland and base (1.2 cc; slides B10-12).

- Estimated volume of tumor: 1.2 cc.

- Gleason score: 3+4=7; primary pattern 3, secondary pattern 4.

- Estimated volume > Gleason pattern 3: 10%.

- Involvement of capsule: Tumor invades capsule: left posterior midgland (slides B10, B11).

- Extraprostatic extension: None.

- Margin status for tumor: No tumor at ink, but tumor into capsule is less than 0.1 mm from ink; slide B11.

- Margin status for benign prostate glands: No benign glands present at inked excision margins.

- High-grade prostatic intraepithelial neoplasia (HGPIN): Present, extensive.

- Tumor involvement of seminal vesicle: No tumor.

- Perineural infiltration: Present.

- Lymphovascular invasion: None.

- Lymph node status: Negative; total number of nodes examined: 1.

- AJCC/UICC stage: pT2aN0.

Johns Hopkins (Epstein) pathology 10/13/2015

Gleason Score: 3+4=7

Left Base

2 cores (60% + 20%) (30% Gleason pattern 4)

Kaiser pathology, 9/1/2015

STAGE: T1c

Gleason Score: 3+4=7

NUMBER CORES INVOLVED/TOTAL NUMBER CORES: 2 / 14

TOTAL CARCINOMA LENGTH: 10 mm

PSA 3.2 6/10/2014

PSA 4.8 6/8/2015

PSA 4.4 8/10/2015 (free PSA 7%)

PSA 5.0 9/28/2015 (free PSA 8%)

A) PROSTATE, RIGHT APEX, NEEDLE BIOPSY

-- ATYPICAL SMALL ACINAR PROLIFERATION

-- TOTAL SPECIMEN LENGTH, 44 MM

B) PROSTATE, RIGHT MID, NEEDLE BIOPSY

-- FOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL

NEOPLASIA

-- TOTAL SPECIMEN LENGTH, 30 MM

C) PROSTATE, RIGHT BASE, NEEDLE BIOPSY

-- FOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA

-- TOTAL SPECIMEN LENGTH, 23 MM

D) PROSTATE, LEFT APEX, NEEDLE BIOPSY

-- BENIGN PROSTATIC GLANDS AND STROMA, 43 MM

E) PROSTATE, LEFT MID, NEEDLE BIOPSY

-- BENIGN PROSTATIC GLANDS AND STROMA, 22 MM

F) PROSTATE, LEFT BASE

ADENOCARCINOMA, GLEASON GRADE 3+4 = 7

ADENOCARCINOMA INVOLVES 2 OF 2 CORES AND 10 MM OF 30 MM

The first involved core from the left base contains 3 mm of Gleason grade 3+3=6 adenocarcinoma and the adenocarcinoma is located 6 mm from the presumed peripheral edge (see note).

The total core length is 17 mm.

The second involved core from the left base contains 7 mm of adenocarcinoma. Greater than 6 mm of the adenocarcinoma is Gleason grade 3 and less than 1 mm is Gleason grade 4. The Gleason grade 4

adenocarcinoma is located approximately 2 mm from the presumed peripheral edge (see note).

The total core length is 13 mm.

NO PERINEURAL INVASION IDENTIFIED

[Don1157]

From what I have read and discussed with my medical oncologist, the PSA is still relatively low even with RP. Not high enough to scan for growth or mets in my estimation, but discuss with your Doc. It has not yet reached the point for GnRH treatment, but of course discuss with your Doc. I did not see Lupron in your history, which I would avoid the side effects of that as long as I could, but it may be in your future. Enjoy the low PSA until, as my med Onc is doing, waiting until it gets between 1.0 and 2.0 and then do a highly sensitive scan to see where any met may be. Everybody is different, but your Gleason score was close, but not necessarily at a highly aggressive number. There are much more knowledgeable people here than me, they will help too. I do know it is scary to see those numbers go up. I was at a great level for six years then a met in a rib showed up for me. I no longer fear an immediate demise, but still scary.

[GARunner1]

My own personal non-medical opinion is we can drive ourselves crazy chasing PSA scores. My oncologist does not do the sensitive PSAs because he is not convinced such minute amounts or changes are meaningful. With such low PSA's I would wonder if it is possible that there is a small amount of prostate tissue that was left. Something to ask your doc about, if you haven't. I too had undetectable (<0.1) PSAs following RRP for 17 months and then got increases up to 0.3 before I started salvage treatment. I did various scans to find the culprit without success but decided to go with ADT. My experience with 6 months of Lupron and 39 sessions of radiation was not bad for me. Each of us is different. I believe Don 1157's view to watch and wait and pursue advanced scans if there is significant movement is good advice. We never know what will be, so if you are feeling good enjoy it. The best for you in the future.

[Dr_WHO]

Hello and welcome! Your post brings back the old argument on the usefulness of ultra sensitive PSA tests. There are many here that value ultra sensitive PSA tests. After all, who would not want to know how low the PSA is which can relate to how the cancer is doing

However, there are a number of hospitals that believe the utility of these tests is of question. My hospital, Henry Ford (Michigan), for example will only take PSA out to one decimal point. I believe that MD Anderson also only takes it out to one point. Their main concern is the potential that a rise in the PSA level in the ultra sensitive range area has no measurable bearing on the progression of the cancer. For them, anything under 0.1 is treated as being undetectable.

In my case PSA is of limited help. Some prostate cancers like Ductal which I have, has a strong tendency for not producing PSA. I still get PSA tests but they have to rely on scans.