My 69 year old father is preparing for his forst PSA January 8th after RP early October.
His stats are in my BIO.
Given the positive margins, EPE and possible Cribriform pattern, I would like to come into this appointment with as much information and as empowered as possible to be his best advocate.
Question for all, could we be doing anything prior to his appointment with the surgeon that will give us more information to make the best decisions? Perhaps Decipher testing or a second opinion pathology done at John Hopkins or another center?
Also if anyone is being treated in Miami and would recommend a RO or MO I would love to receive those recommendations. He is currently being treated at University of Miami.
*** Also, 2.5 weeks post RP his primary doctor ordered a PSA by mistake aling woth other tests that he had to have done, and it was at 0.2, but I guess 2.5 weeks was too soon anyways.
Thank you.
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Egvb
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His "by mistake" PSA looks good. 2.5 weeks at a 3.5 days max PSA half life, decays his pre surgery PSA of 7.3 to 1/32 or 0.23. By your next test it will be at the limit of detectability. One piece of advice though. Insist on PSA reporting to, at least, two decimal places (three decimal places even better).
Anything preceded by the less than "<" sign. BUT, <0.1 is grossly deceiving. Aim for <0.01 or <0.02 depending on the lab's analytical precision. Best of all <0.01x for a lab reporting to the thousands.
it is more about the change over time. If for example he gets a 0.05 the surgeon is likely to say dont worry, we will test again and see if it is going up down or sideways. If it doesnt change from test to test then they will he satisfied. Cancer grows without treatment, after all.
If you get an ultrasensitive PSA test from Quest, the threshold is <0.02. I’d recommend a uPSA from Labcorp (if you are in the U.S.), as their threshold is <0.006. Believe it or not, there is plenty of recurrence probability information in those low thresholds in many cases. Don’t be deceived by docs or others that say there isn’t.
If you had 0.1-0.2 at the 3 month mark, that wouldn’t be classified as BCR. It would be persistent PSA. There are plenty of studies that show how the shorter term (most are done over the first 3 years) recurrence odds shift if your 3 or 6 month PSA is in various buckets below 0.03. The probability differences for recurrence in those buckets are stark. However, the trend in the PSA is also important. For example, if you start at 0.015 after three months and it sits there for two years, maybe it is just benign tissue left behind. But if you start at 0.015 and then go to 0.018 in 6 months then 0.020 three months after that, cancer probably remains. I’d like to see more longer term studies (like 7+ years) done on recurrence odds given various uPSA levels 3 months after surgery, but those are harder to find. In my case, I’m <0.006 after a year, but I was a 4+3 and had some cribiform component and possible small positive margins, so I’m always leery that the disease is still lurking.
Thank you for such valuable information! My father is 3+4 but also has a Cribiform component I believe (Pathology says presents cribiform morphology, but then says no cribiform glands present - surgeon didn’t mention anything so I’ve put it on my list of questions for next appointment. Also a 1mm margin present.
I noticed that it seemed conflicting about the cribiform in what you had typed. Cribiform just increases the odds of recurrence, as you probably know. Not a slam dunk for anything. Just an adverse finding. I’m sure there are plenty of cribiform dudes walking around 20 years later with no recurrence.
I was treated in Miami. Very happy with Miami Cancer Institute at Baptist Health. Started my journey at Moffitt Cancer Center in Tampa and after going to visit RO Dr Weiss in Miami for a second opinion immediately switched my care to him and his team. Couldn't be happier with the care I received there and the facility itself. Know other people being treated there for other cancers as well and all say the same.
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