Is there anyone out there that has or knows someone with stable post-radical prostatectomy non zero ultrasensitive PSA levels?

[jronne]

If post-radical prostatectomy non zero ultrasensitive PSA levels are sometimes harmless I hope to be able to find someone that has safely traveled this path.

My current uPSA level 0.011

I am 60 years old

My uPSA was first detectable at 17 months (with b7 vitamin supplements being used)

These b7 vitamin supplements were subsequently eliminated with uPSA being detected again at 26 months post-op RP

Radical Prostatectomy 11/19/2015 with Gleason 3+4 at age 56

uPSA test result history

12/27/19 12/20/19 12/13/19 12/6/19 12/4/19 7/15/19

0.011 0.010 0.012 0.011 0.011 <0.006

4/3/19 11/29/18 11/16/18 9/21/18 7/16/18 4/30/18

0.008 0.007 0.009 0.007 0.007 <0.006

2/24/18 1/8/18 11/14/17 10/11/17 9/16/17 9/15/17

<0.006 0.008 <0.006 <0.006 0.009 0.010

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

<0.006 <0.015 <0.015 <0.015 <0.015 <0.02

12/27/19 12/20/19 12/13/19 12/6/19 12/4/19 7/15/19

0.011 0.010 0.012 0.011 0.011 <0.006

4/3/19 11/29/18 11/16/18 9/21/18 7/16/18 4/30/18

0.008 0.007 0.009 0.007 0.007 <0.006

2/24/18 1/8/18 11/14/17 10/11/17 9/16/17 9/15/17

<0.006 0.008 <0.006 <0.006 0.009 0.010

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

<0.006 <0.015 <0.015 <0.015 <0.015 <0.02

my medical history is as follows

Genomic Health Decipher test score 0.22 below-average risk, 0 to 1 scale

Genomic Health Decipher test predicts metastasis risk and longevity for 5, 7 and 10 years out.

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

[AlanMeyer]

I know two men who I think had very low but stable PSAs for many years with no treatment. Both eventually had recurrences, one after about 9 years and one after about 15. However we typically don't hear about men unless and until their cancer recurs and they come back to support groups. So I expect there are others who have had longer remissions, including some who died of other old age diseases without ever experiencing a recurrence.

There are several possible sources of PSA that are not prostate cancer. An obvious one is tiny amounts of non-cancerous prostate tissue that were unintentionally left behind by the surgeon. However tiny amounts can also be produced by other than prostate tissue. If you search Google or Pubmed for ( non prostatic sources of prostate specific antigen ) you'll see some articles about this. They're hard to read through because most of them don't seem to be about prostate cancer and, in fact, a number of them are about women.

There can also be variation caused by changes in test conditions. Machines can be calibrated differently and I think that even the same machine can produce different results at different times if they are not calibrated identically each time. I expect that some labs do a better job than others.

Most doctors don't declare a recurrence unless and until PSA reaches 0.2, though some use 0.1. Your highest reading was 0.012, eight times lower than the low threshold of 0.1 and 16 times lower than 0.2. With your PSA I think it is significantly safer for you to watch and wait than to enter any kind of treatment. Any treatment you get has side effects and if it turns out that you didn't need it, you'll experience those side effects, in some cases for the rest of your life, unnecessarily. I don't think you'll be risking treatment failure by waiting at least until 0.1.

I recommend that you stop the weekly PSA tests. They're not showing you anything useful now. Test using a greater interval and try to enjoy your life and not be a slave to cancer fears.

One thing you can do to reduce your fears is to make a plan for what you would like to do if you do have a clearly detectable recurrence. Do some research. Determine the best number like 0.2 or 0.1 as a threshold before which you won't do anything. Pick a treatment and a doctor, for example, salvage radiation with Doctor Wizard or Doctor Fantastic. Find out how long it will take you from the time you request treatment to the time that Wizard can perform it. Learn about whether you should get ADT before treatment (that also makes it easier to wait since it will usually halt any cancer progression while you're waiting for Wizard to come back from his Hawaiian vacation and take care of his already scheduled patients. Show the plan to your doctor and/or people here to get comments or criticism. You'll have your ducks in a row, ready to move if you have to and with knowledge of when, how, and with whom you want to get treatment. If worst comes to worst and you need treatment, you'll be ready, and there is a fine chance that you'll be able to tell others 10, 15, or 20 years from now how to get over their fears and handle a recurrence like yours.

Best of luck.

Alan

[JavaMan]

I am 54 this month. I was 3+4, T2a and had a prostatectomy 11/18. My decipher test showed low end of the high risk category. Recurrence of PSA in January ‘19 so had radiation and Lupron this last Spring and Summer. I have had 2 uPSA tests showing PSA undetectable at <.01. I will have another in 3 months then spread out longer. You have had many and even if present at a 3rd decimal, they are stable. Be happy and enjoy it.

[Longlines8]

I am with the others. My Dr tells me my PSA is what it should be post surgery. Saying is 0. When I see the tests they are saying 0.01. Was told that is fine. Think you wte over worrying.