PSA Ultrasensitive 0.015 six months after prostatectomy

[SmasherOfAjumma]

3 month PSA was <0.1, but that was not ultra sensitive. How worried should I be? Next steps?

Urologist wants to see what the 9-month PSA test looks like, and to get a second Decipher genetic test. (I had one prior to surgery.)

Pathology from surgery showed margins were positive, but Gleason score was only 3+3. Full pathology reports below.

I'm 63, recovering well from surgery.

---------------------------------

Grade: Grade group 1 (Gleason Score 3 + 3 = 6)

Intraductal Carcinoma (IDC): Not identified

Cribriform Glands: Not identified

Treatment Effect: No known presurgical therapy

Estimated Percentage of Prostate Involved by Tumor: 21 - 30%

Extraprostatic Extension (EPE): Not identified

Urinary Bladder Neck Invasion: Not identified

Seminal Vesicle Invasion: Not identified

Lymphovascular Invasion: Not Identified

Perineural Invasion: Not identified

Margin Status: Invasive carcinoma present at margin

Linear Length of Margin(s) Involved by Carcinoma: 5 mm

Focality of Margin Involvement: Multifocal

Margin(s) Involved by Invasive Carcinoma: Right anterior

Margin Involvement by Invasive Carcinoma in Area of Extraprostatic

Extension (EPE): Not identified

Gleason Pattern at Margin(s) Involved by Carcinoma: Pattern 3

Regional Lymph Nodes

Regional Lymph Node Status: All regional lymph nodes negative for tumor

Number of Lymph Nodes Examined: 7

Pathologic Stage Classification (pTNM, AJCC 8th Edition) : pT2

pN Category: pN0

"There is an area on right near the surgical margin. The grade group remains 1, with negative nodes."

[Tall_Allen]

Congratulations on the excellent path report and PSA!

[LowT in reply to Tall_Allen]

get a second read of the slides from Hopkins.

[Tall_Allen in reply to LowT]

IMO, no need. It’s full mount, not a biopsy.

[SmasherOfAjumma in reply to Tall_Allen]

Tall_Allen, are you saying that Ultrasensitive PSA score of 0.015 is excellent? Because my urologist is concerned that it is still delectable, and is talking about radiation and maybe hormone treatment if the next test is still this high.

[Tall_Allen in reply to SmasherOfAjumma]

Yes, it is excellent. It is close to the limit of detectability and the error of the test. We now have proof that except for patients with adverse pathology, there is no risk in waiting for a PSA of 0.1 or 0.2.

prostatecancer.news/2019/09...

[SmasherOfAjumma in reply to Tall_Allen]

Thanks for the link.

"Most of the men in these trials were originally intermediate risk"

My Decipher score (from an earlier biopsy before the surgery) is 0.63, which is just past intermediate risk and into high risk. Doctor is suggesting a 2nd Decipher test, this time on the surgery sample.

[LowT]

how large was your prostate?

What was the Decipher score.

How high was PSA prior to surgery.

Any other health issues?

[SmasherOfAjumma in reply to LowT]

Prostate Weight (Grams): 37 g. Prostate Size in Centimeters (cm): 4 x 3.9 x 3.5 Centimeters (cm). Estimated Percentage of Prostate Involved by Tumor: 21 - 30%

I am trying to locate my original Decipher score. I recall that it was moderately high risk.

Diagnosed prostrate cancer @ age 60, with PSA 3.1. RALP late in 2022, two years after diagnosis, when PSA shot up to 5.3.

No other health issues.

[LowT in reply to SmasherOfAjumma]

I second Justfor’s comnent below. I believe I’ve read Decipher scores ate not to be used for treatment decisions by itself.

[SmasherOfAjumma in reply to LowT]

I just got a copy of the Decipher results, from my very 1st biopsy, 2.5 years before the surgery:

Score was 0.63, which is just past intermediate risk and into high risk.

[LowT]

3+3 without EPE with positive margins?? Large tumor volume. If a large gland that would mean large amount of tumor. Confusing picture.

[SmasherOfAjumma in reply to LowT]

Prostate Weight (Grams): 37 g

Prostate Size in Centimeters (cm): 4 x 3.9 x 3.5 Centimeters (cm)

Estimated Percentage of Prostate Involved by Tumor: 21 - 30%

Is that considered large?

[Justfor_]

You couldn't do any better! Stay with ultrasensitive and watch out for any rising trend brewing. After 4 to 5 additional uPSA, by the same lab, you will be able to derive a no-nonsence PSADT (Doubling Time). Then and only then you will know where you are standing on. Anything else, including exotic tests, experts' opinions, etc, are just smoke and mirrors.

[Hombre]

Hi Smasher, I agree that PSA doubling time is the key. I had a prostatectomy nearly 20 years ago, and PSA was 0.2 after 4 months but then became undetectable for several years. Then started creeping up with a doubling time of 6 or 7 years so back to 0.2 again and I have been offered salvage radiotherapy which so far I have declined as I am 79 and have other health issues. Difficult to make decisions but I wish you all the best.

[Break60 in reply to Hombre]

based on my experience I think you’re wise avoiding SRT!

[SmasherOfAjumma in reply to Break60]

Thank you for the warning. My continence and sexual function recovery have both been pretty good since the surgery, so I am loathe to give up a good thing. Did your incontinence begin only after radiation, or was it also due to surgery?

[Justfor_ in reply to SmasherOfAjumma]

You are relatively young at 62. Ask your urologist regarding the probability of a second cancer due to the irradiation in 10, 15 and 20 years time.

[SmasherOfAjumma in reply to Justfor_]

I had not even considered the risk of additional cancer caused by the radiation treatment.

[RJAMSG]

Your total Gleason is 3+3 and you are GG1? Highly unusual for 3+3 to metastasize. Slow down and take your time to make informed decisions if any even need to be made ever. Agree about 2nd opinion too on the path report.

[SmasherOfAjumma in reply to RJAMSG]

Thanks. The Gleason 3+3 was a surprise downgrade from the two biopsies I had before surgery that were both 3+4.

I am not sure how to do about getting a second opinion on my surgery pathology, but I'll look into it.

[RJAMSG in reply to SmasherOfAjumma]

I agree it is strange if they found grade 4 on biopsy, and then none after a complete biopsy after removal seems off. You can Google Johns Hopkins 2nd opinion pathology request something will probably show up.