Post surgery PSA Test

[Dreamweaverman]

Hey Fellas, I am reaching out because I just got my PSA test results back. I am going to schedule meeting with the primary doctor but was wondering if any of you knew what my PSA level should be if cancer free? My PSA, TOTAL is 0.7 ng/mL, In your experiences is this normal, has anyone ever done more treatment with this level? Thanks again for all the support.

[Roger2Dodger]

I just recieved my PSA results from my oncologist. After 18 months post EBRT.

Mine was 0.414...Doctor Said that was excellent. My first reading after 6 months was 0.814.

BTW... with your score why would you think more treatment??

[Dreamweaverman in reply to Roger2Dodger]

Hey Roger, Thanks for the reply. I am just being thorough as I wish I had found this site months before I had actual surgery. I feel good, but I know some people did hormone therapy after surgery. thanks for feedback

[Bcgkelly]

In my experience it’s best to discuss with the doctor as I was told there were five different PSA tests provided by different companies and that depending on which Laboratory you had it done what was considered acceptable would be different. That’s the case in Ireland anyway. My consultant advised me that I wouldn’t be getting radium treatment until at least six months after surgery but that if necessary I might be put on hormone treatment before that. Mine was 0.035 at three months and I’m having the six month PSA test tomorrow. It would appear if it’s not on the increase it’s okay for now and if it is increasing further treatment is required. Do let me know how you get on. Bill

[Dreamweaverman in reply to Bcgkelly]

Thanks so much Bill, Will do

[Bcgkelly in reply to Dreamweaverman]

Your welcome, sending you positive thoughts and best wishes.

[Tall_Allen]

No, that is definitely not normal - they call that "persistent." You should definitely be discussing salvage radiation with a radiation oncologist.

[Dreamweaverman in reply to Tall_Allen]

Hi Allen, Thanks so much for your feedback. I have contacted my urologist who seems to think it’s a bit early to tell. However I want to veer on the side of caution and speak with a radiation oncologist. I also thought I should be closer to zero by now. Perhaps I should take PSA test again as well.

[DanWinters in reply to Dreamweaverman]

I believe 0.1 is usually where you would want further evaluation to take place. .08 is considered undetectable and just continue routine follow up

[Jeff85705 in reply to DanWinters]

Some labs, such as Labcorp in the US, don't break down beyond tenths. So my results are always (so far) <0.1 ng/ml, or "undetectable." I think the reason is to account for range of error.

[dentaltwin in reply to Dreamweaverman]

I don't remember how "high risk" your tumor was pre-op. Yeah, I was told that if you have a competent surgeon there should be NO normal prostate tissue remaining--which means any residual PSA needs to be investigated. But there are all kinds of variables--like how any intent at "nerve-sparing" led to residual tissue. And yes, there are all kinds of PSA assays--I see lots of the guys here are getting very high-sensitivity tests that read down to 0.003 ng/ml. For reference, last week I got my six-week post-surgical PSA, and it was read as <0.05, which i take to mean it was undetectable, but on a test that wasn't particularly high-sensitivity. I had what was considered "intermediate risk" disease.

[klancaster in reply to Dreamweaverman]

Mine was .08 after three months, which concerned my urologist. It indicates that they did not get all of the cancer, and sure enough, my PSA went to 0.18 in three months. I had salvage radiation and it is now < .1 (different doc, so the labs are less granular). For the latter test, < .1 is considered undetectable. What they actually look at is the trend, not the absolute numbers, so it will depend on what the tests look like over the next few months. One word of caution: the literature on PSA and recurrance seems to indicate that it is most effective to have salvage radiation when the psa is 0.2. It gets less effective in the long term if you wait longer.

EDIT: I just realized you said 0.7, not 0.07. You should, as others have said, look at salvage radiation as 0.7 is too high. You might also ask about hormone therapy using lupron in conjunction with the radiation. Lupron is not fun - knocks your testosterone to 0. That is standard practice at M.D. Anderson where I had my radiation, and it has been proven to enhance the chances of the radiation getting it all.

[AlanMeyer Moderator]

I agree with Tall_Allen. PSA after surgery should be very near zero. Radiation is different. It doesn't kill the cancer right away but damages it and it dies over time. But surgery, when it's successful, gets all the cancer out and should leave no prostate tissue behind to produce PSA. I seem to remember that after surgery PSA should go down within a few weeks to < .03 ng/ml - though it's possible I've got that wrong.

[Dreamweaverman]

Thanks for feedback. I am in agreement

[Jeff85705]

My understanding would be that, depending on the kind of PSA test you took, anything less than 0.10 ng/nl is considered undetectable (that is, no test can be perfect, so that number equates to zero). 0.7 sounds like detectable, but you don't state what initial treatment you received. Surgery? Radiation? Please be more specific.

[Dreamweaverman in reply to Jeff85705]

Hi Jeff, The initial treatment I received was surgery. thanks again for feedback

[Tall_Allen]

Your urologist does not have a clue. Why would he? - he NEVER treats anyone with recurrent/persistent PSA. His job was over after surgery, except for actual urological issues. Even so, I can't imagine that any competent urologist wouldn't refer you immediately to an RO with a persistent PSA of 0.7. It is NOT normal, and it is already WAY too high. Michael Zelefsky at MSKCC would be my top choice in the NYC area. Do this quickly!

Your first step should be an Axumin scan, which will rule out distant metastases hopefully. if it is negative. He will probably start you on hormone therapy and follow-up two months later with salvage radiation to the prostate bed and the pelvic lymph nodes.

[Dreamweaverman in reply to Tall_Allen]

Im on it! Thank you so much Allen

[dentaltwin in reply to Tall_Allen]

I wouldn't be so harsh. After all, he JUST got the result. Maybe he should have gotten the result from his urologist, but last week I didn't--they cancelled my 6-week followup appointment at MSKCC after I had been waiting for the doctor for an hour after having my blood drawn. Then the result went up on the patient portal. Had it not been good, I would have been hopping mad. But then they might have called me first--I guess there's no way to tell. Not necessarily ideal handling of a nervous patient's anxiety, but overall my family's experience there has been more comforting.

[Tall_Allen in reply to dentaltwin]

"I have contacted my urologist who seems to think it’s a bit early to tell. " 0.7 at 3 months post surgery, or even 6 weeks, is not too early to tell.

[dentaltwin in reply to Tall_Allen]

Probably not. Still, as you and I know, tests sometimes screw up. So the referral is in order, but so is a repeat PSA. Yes, I've heard that random assays may differ up to 30%, which means he still gets the referral.

[Jeff85705 in reply to dentaltwin]

Not harsh, just direct. We're not playing around here. PC is a serious issue, and 0.7 PSA after surgery is cause for further investigation and treatment. Tall_Allen is doing due diligence. After prostatectomy, PSA should be at undetectable levels and continue that way. Increase to 0.2 is considered chemical recurrence. If my urologist received that PSA, he would have been on the phone to me right away. I disagree when Tall_Allen says why would the urologist have a clue? He is a surgeon, etc. That is irrelevant. The uro should be contacting him with suggestions for referral for further treatment.

[EaNa]

Hi. I'm just reading your post, I guess 4 years after it was posted, and wondering if you have further updates on it. I hope you followed the advice here and consulted with an oncologist.