PSA after surgery

[toyman79912]

I was diagnosed with prostate cancer on September 2022 with a Gleason score of 8 and my PSA was 35. I had my prostate removed along with all of the lymph nodes in January of this year. The pathology shows no signs of cancer in all of the lymph nodes, but had invaded my seminal vesicle and had spread to the prostate bed; no signs of the cancer in the margin tissue. My first PSA test after the surgery was 0.33 and I had another one done three weeks ago, and it was 0.22. The PSA number is coming down, but should the number be somewhere around 0. I have an appointment to see a radiation oncologist next Monday. Does the number at this time indicates I still have cancer cells in my body?

[Justfor_]

Are these two the only PSA counts that you have had since RP? If yes, you should proceed with monthly tests in order to have after some months a valid PSADT. This may be the only reliable guide you can rely on. In the meantime start inquiring about a PSMA PET/CT.

[toyman79912 in reply to Justfor_]

Thank you for your reply. Yes, the two PSA test are the only test I have had since my surgery. I will ask my urologist about monthly tests

[Tall_Allen]

There is nothing in your profile, so I have a few questions:

How soon after prostatectomy was your first PSA test? You have to wait 3 months for the PSA released during RP to dissipate.

Did you have a PSMA PET/CT when you were first diagnosed?

How many lymph nodes were removed?

[toyman79912 in reply to Tall_Allen]

Hi Tall_Allen. Thank you for your reply. I had the PSMA PET scan prior to my surgery and it indicates no signs the cancer had spread. I had my surgery on Jan 25 and my first PSA was done on Feb 20 with the result of .33. I had my second PSA test done on April 17th and that result was .22. According to my Urologist, all of my lymph nodes near the prostate were removed and they test negative for prostate cancer

[Tall_Allen in reply to toyman79912]

Only the April 17 PSA is important. The Feb 20 PSA was taken too soon after your prostatectomy and should not have been taken.

I'm glad your PSMA PET/CT was able to rule out distant metastases. That means your cancer is potentially still curable.

Ask your Uro how many lymph nodes were removed. "All" is vague and only means he removed what he could find. The reason I ask is if it was,say 5 lymph nodes, you can proceed with whole pelvic radiation now, but if it was, say 20 lymph nodes, you will have to go on ADT now and stay on it for 6-9 months to give the tissues time to heal before starting radiation.

At any rate, you should be talking to a radiation oncologist.

[toyman79912 in reply to Tall_Allen]

So, the April 17 PSA number should be near 0? I do have an appointment with a radiation oncologist next Monday. Thanks again

[Teacherdude72 in reply to toyman79912]

Statically 0.22 after a 35 is near zero. Take a deep breath, relax, enjoy your life and the next testing will give the radiation oncologist the information they need and you the explanation you seek. Check my bio if interested.

[Tall_Allen in reply to Teacherdude72]

That is incorrect - it is definitely not "near zero". 0.22 after 3 months is a signal that SRT is needed.

[Gabby643 in reply to Tall_Allen]

thanks T A, it’s great to have you here.

[Justfor_ in reply to toyman79912]

PSA's half-life is quoted to be 2.5 to 3.5 days. If your PSA was 35 at the day of surgery, 26 days later, with negligible post surgery new PSA addition, it must have decayed to less than 0.2. Your first 0.33 can be attributed to higher pre-surgery PSA, but most probably to a combination of newer plus preexisting PSA in decay. Your second 0.22 points towards the latter.

[toyman79912 in reply to Justfor_]

can you explain what is PSA half-life and how is that related to my psa number

[Justfor_ in reply to toyman79912]

Half-life is the time period it takes a substance (your PSA in our case) to decay to half. If at the day of your surgery your blood had 40 PSA units in it and all the sources of it were taken out along with your prostate, it wouldn't just go down to zero the next day. 2.5-3.5 days later 20 PSA units would still be in your blood, after another 2.5-3.5 days 10 PSA units would still be there and so on so forth. Simple calculation that tells us that either your September 35 had gone up to almost double by January when you had surgery, or most probably that all the PSA originator was not taken out during surgery. Sorry can't explain it better.

[toyman79912 in reply to Justfor_]

No, that make sense now. Thank you for explaining

[lhall2]

my standard PSA was 4.5 when my urologist found 3 of 6 prostate biopsies contained cancer. I had a prostatectomy in 3/2021 resulting in a Tb3N1M0 grading with a Gleason score of 4+3=7, seminal vesicle involvement and 1 of 10 removed lymph node’s containing cancer. During the next year my 1st two standard PSAs were <0.1. Since cancer had escaped the capsule, I wanted greater detail so switched to ultra sensitive PSA resulting in the next two readings of 0.028 & 0.026. At that point, I had a decision to make. The ultra sensitive PSA could be wrong (used the same labs throughout), the surgeon could have left some benign prostate tissue behind (surgeon had performed over 10,000 prostatectomies), salivary glands can produce minute amounts of PSA or I still have some prostate cancer cells floating around in me. Not wanting to play Russian roulette with cancer, I elected to have 6 month eligard injections and 40 rounds of whole pelvic radiation a year after my prostatectomy. During the next year, I had 6 ultra sensitive PSA test. One was 0.006 and the rest were all 0.014. At the end of that year, I expressed my desire with my MO to continue to be aggressive with my cancer treatment. Consequently, we continued with 6 months eligard injections and begin a 2 year treatment of abiraterone and prednisone. With one year into this treatment, I have had 4 ultra sensitive PSAs with all being 0.014. My MO has said “we will not know how effective my treatment has been until we stop”. Hope my journey helps in your decision making

[toyman79912]

Thank you for your comment. I was more in a state of denial than anything else, hoping for the best. I now come to accept the fact that it is most likely I still have the cancer cells in me. I am now ready for my next course of treatment. Thank you again

[tn12 in reply to toyman79912]

Wishing you the best, please keep us updated.

[j-o-h-n]

It may best to see a Medical Oncologist as your main man who can tell you which batteries are good for your toys and for your Pca. Take many deep breaths and hold a couple for the roller coaster ride we all endured and still do. When you see your docs take someone with you to act as your scribe.....since you'll be like a deer in the headlights. Anyway enjoy yourself and try to laugh and don't forget to post here.....(boys and their toys, geez)....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 05/06/2023 6:33 PM DST

[Harleylover]

I am confused by some of these comments. I had a RP at the end of November and my followup PSA test have both been 0.03. My urologist told me anything below 0 is good. So, as I said some these comments have me confused. It sounds like even below 0 may not be good.

[tn12 in reply to Harleylover]

Below 0? Where do you see that mentioned?

[lhall2 in reply to Harleylover]

your urologist is probably saying a standard PSA test of >0.1 is good which it is. However, I evaluated the condition of my cancer from my prostatectomy, which was a more aggressive Gleason score, cancer being found in 1 of my lymph nodes meaning it could also be in others not removed. I could have waited to see if my PSA grew above 0.1 before treatment which was ok with my doctors. However, even though my ultra sensitive PSAs were below yours, with the results of my prostatectomy, I decided for a more aggressive treatment approach. Therefore, my suggestion is to talk to your doctors about all the details of your RP & all test results as you make decisions on your treatment approach.

[Harleylover]

Ok, thank you for explaining it to me. I am new to this and honestly I had never heard of a ultra sensitive PSA test.

[lhall2 in reply to Harleylover]

unless the dismal point was in the wrong spot in your PSA, the 0.03 was a ultra sensitive PSA

[Harleylover]

Oh, ok. No it is in the right place, I have seen the results myself. Thank you again for explaining it.

[JrTOO]

Short and sweet: 1 in 2 or 3 prostatectomies, ie UK vs US stats, suffer biochemical recurrence, ie return of PC despite prostate absence. Some experts consider any detectable PSA biochemical recurrence, but official standard is .2!!

3 years after my indetectable PSA post prostatectomy, PSA DT zoomed to 9 months. Urologist and 3 primary care docs didn't TELL ME PC had recurred. NOW knowing about biochemical recurrence, I realized docs were STUPID. Even my 2016 surgeon--considered No. 1 in USA--failed to advise me about biochemical recurrence. Now mHSPC I test every 30 days and am on Orgovyx now, Firmagon for short period before.

Test companies report all tests 4.0 and less as NORMAL. Idiots never heard of prostate cancer or biochemical recurrence! So labs repeat Test companies' idiocy to us PCers.

TO YOU: Test every month for a year. If indetectable, test less frequently, in consultation with your docs. Gittuit if you rise above indetectable. Sooner adjuvant therapy started after primary therapy fails the better your survival! If your docs are recalcitrant go to best cancer center near you. Not all docs are equal.

In retrospect I would choose targeted treatments including radiation over surgery for initial primary treatment.

[RMontana]

PSA doubling time (PSADT) is key, not PSA numbers per say.

Check this out; healthunlocked.com/active-s...

Also, what values you pick to calculate the PSADT matter. See Min 15:45 from this podcast (and watch it; its a free Phd on PCa); healthunlocked.com/active-s...

See if you are getting PSA from 'benign margins.' Did you have nerve sparing procedure for example. See Min's 6:35 and 23:30 from the above podcast. An MRI may be needed.

Last, make sure you dont have PSA from prostate gland tissue...once you get ADT treatment and sRT there is no going back. Make sure you need to proceed before you do, but DONT delay a decision to act! Good luck

[toyman79912]

So my journey begins. I just received my first dose of Eligard today. They also gave me a CT scan to map out my radiation treatments which will start in about two weeks. Evidently, my insurance company did not approve Lupron but did approve Eligard. Is one better than the other. I am assuming the insurance decision is based on cost. Also, what should I be look for in the next few months as far as having the Eligard injection. I workout regularly; is this going to affect my workouts. Thank you very much for you reply