Advise welcome.

[Ali-P]

After my radical prostatectomy October this year. My pathology report was as follows.

Diagnosis:

Prostate cancer Gleason score 3 +4 = 7 stage pT2c Nx R1 (apex less than 3 mm)

Robotic assisted radical prostatectomy, 5 October 2022

Most recent PSA 0.02 g / L on 5 November2022

The concern I have is that my PSA 4.8 was never reflective of the progression of my cancer. It remained at this level until April this year and then jumped to 9.7 until I had my operation.

You will note my PSA post surgery is 0.02g, with positive margins. My surgeon says I do not need and follow up treatment until my PSA goes to 0.4g. What do I do if my PSA remains low but cancer continues?

Many thanks.

[Tall_Allen]

It won't. Your pre-prostatectomy PSA was 9.7, which isn't low.

[Ali-P in reply to Tall_Allen]

Sorry you mean it will not continue to grow?

[Tall_Allen in reply to Ali-P]

No. No one can possibly know if it will recur. You wondered if PSA is a good indicator of recurrence for you - it is.

[MNDodgerFan]

You had your post-surgery PSA only a month after your surgery, so it’s possible that your system still had a few remaining antigens (from when you had cancer) that were not fully flushed out of your system when the post-surgery PSA was performed. Every doctor has a different philosophy, but I’ve found it’s more typical to wait at least 6 weeks post surgery before having your first PSA. I’m assuming your doctor has scheduled you for another PSA 3 months after your last PSA, and you may find that result comes back undetectable.

Something else to know is that you can get varying PSA results from different labs. That is, the same sample tested at different labs can have varying results…not grossly varying, but .2 or .4 can be common. Try to ensure you have your PSA lab work done by the same lab every time if possible. I don’t know what the possibility is of getting a .2 lab variation result when it actually is undetectable, but wait until your next PSA to see if there is consistency in the results or if it changes…up or down. It’s extremely unlikely that anything significant will happen cancer-wise in that time.

[Ali-P in reply to MNDodgerFan]

Thank you very much for your reply, that all makes a lot of sense.