time to reach undetectable PSA after prostate removal

[PorscheKing]

All, I am nervous about my post RALP PSA results reaching an undetectable level and wondering if anything has been published in this matter. For context, I am 65 and was diagnosed G8 with ECE and elected to have surgery which occurred on June 23rd. The surgery pathology indicated clean margins and no lymph nodes. Had a PSA test on August 16 (approx.7 weeks later) and the value was 0.29. My Surgeon, is optimistic that my PSA should continue to fall and ordered a followup PSA test for Aug 30th. I am very anxious about this and have not been able to find any documented ranges of time to reach nadir? Some docs says 4 weeks and others 3 months? Please, what were your experiences and any feedback to calm me?

[Tall_Allen]

If your prostatectomy was successful, your PSA after 3 months should be undetectable. If it isn't you should talk to a radiation oncologist about salvage radiation.

[PorscheKing in reply to Tall_Allen]

Thank you for the feedback!

[Justfor_]

Sorry to bring you bad news, but your sole hope is a lab error. Error excluded, the new test will be close to the one you already had +/- the 20% test variance.

[PorscheKing in reply to Justfor_]

Thank you for your candid feedback. Are you inferring that there will not be any further decline in PSA beyond the first result albeit less than 90 days to Tall_Man’s point?

[Justfor_ in reply to PorscheKing]

You will soon know who is right and who is wrong. I have abandoned contradicting TA a couple of years ago. We are just incompatible.

[PorscheKing in reply to Justfor_]

Wishing you were wrong, but you weren't! Number is essentially the same. Now waiting to speak with the Surgeon. Any advice for approaching radiation/hormonal treatments. My morale is way down, but realize I cannot wallow in self pity. Thank you in advance. This note is just between us.

[Justfor_ in reply to PorscheKing]

I am very divided into offering advice. Before uttering anything I think of what I would have done in a similar case. And here lies my problem. If you see what I personally do, I try to push into the future sRT because it is not a breaze walk in the park as most will tell you is. There are late toxicities and the measurable probability of a second cancer. On one hand you are almost a decade younger than I and this ought be of greater concern for you than for me. On the other hand, it took me 2.5 years to reach PSA 0.17 where I started my Bicalutamide experiment. Compare this to 7 weeks of yours and our cases are anything but similar. My best advice would be to do your due diligence. You have got time. Six months for healing after surgery is min recommended. One RO I met wouldn't irradiate before 9 months. This forum is biased in favour of irradiation. You will get a number of posts advising you that they had no problems or SE. Check how long before they had been irradiated. Anything less than a decade should not be considered. Sorry, I can't be of help.

PS One thing I am adamant about is PSMA PET/CT before sRT. I have a thread related to this entitled: "Contradicting silly doctors' parrots".

[PorscheKing]

thanks, just trying to garner if things are as they are and should prep for the salvage process sooner rather than later.

[PCJourneyman]

there are typically two outcomes from surgery - immediate undetectable (0.1… or three consecutive rises… etc then termed BCR or BioChemical Recurrence. Good luck!

[Murk]

I suggest you request another PSA test 30 days from your last one and see results. My Urologist says that if after surgery your PSA bounces up to .2 ng/mL that he sends his patients off to radiation.

So start researching a Oncologist now, get on their calendar and have a second test to confirm.

Having a going forward plan with dates in mind will help calm you. What your feeling is normal.

PCa after Prostate removal doesn't move any faster. You had clear margins which means to me it hadn't metastasize. But it doesn't mean a small amount escaped undetected.

[PorscheKing in reply to Murk]

Thank you very much for the feedback! Actually vetted Radiation Oncologists prior to deciding to go with surgery. Reaching out to restart dialog ASAP.

[London441]

Keep getting tested! Lab error is always possible. If still detectable will be some good options, but the surgeon’s optimism that your PSA will ‘continue to fall’ is just wishing and hoping.

[PorscheKing in reply to London441]

Thank you!

[RJAMSG]

The standard I’m familiar with is to wait till 90-days after surgery then do the 1st PSA.

[PorscheKing in reply to RJAMSG]

Thank you for the feedback. Challenge is the literature, like most things in this area, is all over the place in terms of post surgery psa testing and expectations. Any documentation that discusses the science/anatomical processes the body does to remove PSA?

[RJAMSG in reply to PorscheKing]

I have only Seen recommended times for the body to clear it and the higher it was before surgery the longer it will take to clear. Mine was 5.21 before surgery and I waited 90 days.

[MNFarmBoy]

In my case PSA 5 weeks after prostatectomy was reported as <0.01 ng/ml (below the limit of detection for the equipment & method in use), versus 14.2 ng/ml 3 months before RP. I do not recall for certain what was said about the reasoning for performing the PSA test at that time, but my impression was that it was intended to indicate whether adjuvant treatment would be called for, considering that the pathology report contained some adverse indications. The result did provide short-term reassurance.

I feel extremely fortunate to now be sweating out the PSA results every 6 months, which have remained below the limit of detection (currently reported as <0.014 ng/ml) 4.5 years following RP.

If PSA begins to rise, I plan to begin researching radiation oncology facilities and doctors for likely salvage radiation treatment.

Best wishes for the best possible outcome for you!

[FMOH_N in reply to MNFarmBoy]

MNFarmBoy can you give us some details about your PCa? GS, patalogi report after RALP,

[CANAMA]

Diagnosed on December 6, 2016 with PSA GL 8. Around January 19, 2017 PSA was at my max reading of about 21.5. RP on May 23, 2017 following a MSK protocol that included 2 Lupron injections starting about January 26, 2017. First PSA reading post RP was on about August 27, 2017 and was <.02 (undetectable). As a precaution, I had around 40 rounds of SBRT to my prostate bed, lymph nodes etc. in October and November 2017. I hope this helps.

[Rams91 in reply to CANAMA]

I'm sure you meant 40 IMRT sessions. Any side effects during/after Lymph node treatment? Bone Marrow issues?

[CANAMA in reply to Rams91]

None that I can specifically remember as relating to IMRT. But I was on Lupron at the same time, so I experienced SEs that I ascribed to Lupron. The worst part of the IMRT was having to fill your bladder before treatment.

[CANAMA in reply to CANAMA]

Sorry, but I found an error in my comment immediately above. Please substitute "IMRT" for "SBRT".

[CANAMA in reply to CANAMA]

Sorry but I'm correcting another error - pls. substitute "PC" for "PSA".

[Cetma]

90 days would be a better time to wait to test that first post RP or RALP PSA, I would think ya gotta let things clear out abit, mine was 5.5 pre RP, then <.006 at three months post RP, now at 5.5 years its .04, and Im hoping it stays there , ,remember there is a ton of error possible on these Ultra PSAs

[tn12]

Hopefully it's lab error. My husband's first PSA 4 weeks post RALP was <0.02

[cpcohen]

What was your PSA before surgery?

[CANAMA in reply to cpcohen]

Mine was .3 the day before my RP.

[cpcohen]

PorscheKing -- What was your PSA shortly before before surgery ?

Like several others, I'd suggest waiting until the 3-month post-surgery mark, and getting a PSA measurement then. I think my PSA (8.0 before surgery) had fallen to "undetectable" by then.