PSA. after surgery.

Yes... that make me think now !...  

It was an over the phone result.  I will call the nurse in the morning to check it again !....

Will post result asap...

Thanks

0.164 is not a great post-prostatectomy PSA reading, and I am afraid that you will likely have adjuvant hormone and radiotherapies to look forward to ☹️.

On a more positive note, I and two friends all had prostate surgery about the same time three years ago, and whilst my PSA was and is still undetectable, they both had recurrence, but following the treatments mentioned above they are both cancer-free now.

Best of luck.

Cheers, John.

Edited by member 22 Apr 2021 at 11:22  | Reason: Not specified

Viseoby ... Did the pathology report for you at the time was a Negative Margin ?  

This is why I am curious if this happen to others !...

They said that below 0.2 it is not to be consider as a recurrence !  But a bit concern about it.... will ask to do another PSA sooner than 3 months to be sure it is not rising !

Berni, you can have recurrence with a negative margin - it could have tracked along the seminal vesicles or the nerve bundles that control erections or it could already have reached a nearby lymph node before your op. I have to say though that with a post-op PSA of 0.16 it could be more than just a little bit left behind in the prostate bed. Hopefully the onco will check for micro mets in the bones or spread to the wider lymphatic system.

Edited by member 24 Apr 2021 at 00:39  | Reason: Not specified

Yes, someone should have explained that to you Visoboy. Urologists have to publish their data on how often they leave a positive margin - it means that there is a strong possibility that some cancer has been left behind in the prostate bed. Your PSA confirms that. 

The difference between you and Berni is that because you had a positive margin, they can work out fairly reliably where to target the radiotherapy. In Berni’s case they would need to run scans and hope that the active cancer cells show up. 

Edited by member 23 Apr 2021 at 21:06  | Reason: Not specified

 12/03/2021 u/k SERUM

PROSTATE SPECIFIC ANTIGEN 0.10 ug/L ( Comments :

Please note amended age specific thresholds in accordance with the Updated Pan London Suspected Cancer Guidelines. Effective from 05/12/2018

Here’s the latest test. They said it was still classed as undetectable. 

Edited by member 28 Apr 2021 at 01:26  | Reason: Not specified

From an Analytical Chemistry point-of-view "undetectable" is a horribly incorrect phrase to use in this instance anyway since we all know that PSA IS detectable to 3 dps (but not on all systems) and they've quoted precision of 0.10, meaning the true value is between 0.095 and 0.104

My understanding is that all the labs have the capacity to test to the lower limit - it is just that many Trusts choose not to report it beyond 1dp. No doubt if there was an exceptional reason for doing it, any lab would be able to pull an usPSA out of the bag because they are testing all samples to that sensitivity and then rounding up. 

.... and / or it could just be that the person typing up Mike's result didn't know what the funny little sideways hat meant so didn't included it on the record - we have seen that happen here a number of times and it once happened to John :-/ 

Update on my PSA level. 

it stayed at .1 for a couple of the tests but the latest one was .2. Waiting on oncologist appointment. 

Presumably my options are limited and there’s not some new magic bullet.

We all live in hope. :-)

That is great news that it’s gone down. I’ve been told aside from the doubling time they look at the Gleason score and earlier treatment is frequently used if it’s high. What was yours? Mine was 9. 

Hi Lyn,

Sorry I should have made my post a bit clearer, I've been under a consultant oncologist for nearly 2 years, ever since my psa went up to 0.2 and it is he who is happy to monitor my psa every 3 months.

Thanks Rob, every case is different so we have to rely on their expertise to guide us through. That said I’m going to hit them up with a lot of questions!

Wishing you all the best and a positive outcome. 

Hi all.

I had my prostate removed in July 2020 and biopsy indicated the cancer had remained contained within the prostate gland.

My  first PSA post operation in January 2021 gave a reading of 0.014 ug/L , my second reading in September 2021 showed a reading of 0.025 ug/ L.

I have to go for another PSA test this month so we will hopefully get an idea as to what is going on.

Yeah I also  thought that my PSA after radical surgery and a confirmed biopsy of not leakage out of the prostrate would mean my PSA would remain stable and not rise.

I accept its a low reading, but as I understand it should not rise ? lets see what my reading is in the next week or so. fingers crossed.

Goforarun, with that 4+3 +margin and 0.1 you should be under an oncologist not a surgeon.

I'm under a MDT at a leading Urology centre in London. The surgeon is the one I speak to at the moment. The trigger for salvage RT at that hospital is three consecutive rises above 0.1 or PSA of 0.2 or above. This hasn't happened yet. It's a concern, obviously, but I think they know what they are doing.

Edited by member 04 Dec 2021 at 10:14  | Reason: Not specified

I'm not sure if it was Covid related ? In terms of a delay in the timeline , or whether the surgeon  felt that when performing the operation he commented I was clear of any potential spread to the lymph area around the  prostate>

I also assumed that he'd had the biopsy back before I had my six month PSA and was reassured that this confirmed the cancer was contained and had not spread out of the prostate ? 

I will post the question to him though on my next visit.

Thank you so much. Its complicated stuff this. Here's my pathology report:

MICROSCOPY
This radical prostatectomy specimen shows acinar adenocarcinoma, Gleason score 3+4=7 (approximately 90% Gleason pattern 3).
The tumour is present as bilateral nodules, with a dominant nodule estimated to measure 20mm in maximum diameter, located in the right posterior quadrant. The focus on the left is minimal, much less than 1mm in diameter.
Estimated tumour volume: 1.25cc (5% of prostate volume).
No extraprostatic spread is seen.
No bladder neck invasion is seen.
No invasion of the seminal vesicles is seen.
No lymphovascular invasion is seen.
Margins: The apical and base margins are clear. The circumferential margin, where sampled for frozen section, showed a 4mm positive front, right posterior, towards the base, as reported at the time. The tumour also abuts the diathermied circumferential margin immediately anterior to the frozen section site, right posterior, over a 4mm area (slide A12).

The separately submitted proximal right neurovascular bundle sample shows no involvement by prostatic carcinoma and the true surgical margin at this location is therefore regarded as clear.

DIAGNOSIS
Prostate, radical prostatectomy:
Acinar adenocarcinoma, Gleason score 3+4=7
Margins: Apical and base margins clear. Circumferential margin positive over a 4mm area within frozen section (but right neurovascular bundle negative) and a 4mm area adjacent to frozen section site (right side, tumour showing diathermy
artefact)
Staging (TNM 8th ed.): pT2

So, I have a 4 mm margin, but it looks like this is mostly 90% Gleason pattern 3, which I guess is positive news.
I also know its a good thing the the positive margin was diathermied (cut with a hot knife killing many cells in the process and this is likely to have killed off any cancer cells at that site)
My decimal points are all correct! ;-)

During the operation they performed a 'frozen section' and they thought, at that time, I had a positive margin on this part they did a frozen section on. So they did a 'reselection' at this site (went back to take some tissue away).  Only turns out this wasn't a positive margin at all but there was a positive margin right next to it! So the re-selection at that site was unnecessary and they missed the positive margin that was there.

I guess once I've had a good number of PSA blood tests and they don't show much of an increase I'll start to rest a bit more. Its on my mind a lot, too much it feels like.
I've had a chat with one of the specialist nurses and they are truly great. Perhaps I should have another conversation to mull it over.

thank you so much for your replies.
Matthew

Edited by member 17 Feb 2022 at 19:07  | Reason: update