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First PSA test after a RP

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User
Posted 11 Jan 2017 at 16:18
Hi all, my first PSA test after my RP, taken at 6 weeks post op, was 2.9.....not what I was expecting.....anyone else been in this position please and what came next?..

Cheers, Paul.....

User
Posted 12 Jan 2017 at 14:23

Sounding good Paul
Your next test will be really telling as to what is happening. Fingers crossed and let us know

User
Posted 11 Jan 2017 at 17:14

Hi Paul
Sorry to hear this indeed. Read my profile. Six weeks is quite early for first test , normally eight weeks.
My post op psa was 1.5 and rose to 2.4 in 12 weeks post op. It was the worst result they had had in 2 yrs. unknowingly I was already locally advanced at surgery and had spread to bladder and 5 lymphs. Although positive margins at bladder they felt not enough left behind to be causing these results. They offered RT immediately but basically stated I was no longer on a curative path , so I have rejected it twice. We are all different yes , and I never even wanted the op for personal reasons , and I did not want even more ED , probable incontinence problems and RT risks of bladder / bowel cancer on a whim really. They admitted at my age they were just throwing everything at me.
I went on HT for 11 months but they decided further scanning is now the way forward along with medicines etc. I'm presently allowing psa to climb again ( six week doubling at the mo ) until it reaches 3 , then going for a choline or PSMA PET scan next month. I may end up having RT yet , and will definitely need further HT or chemo or lymph surgery. I guess it's not good at all but I've accepted it now tbh. I'm sending you my best wishes. You have time to make informed choices so make sure you get the facts straight and prognosis and cure chances established before picking a treatment path. Keep in touch

User
Posted 11 Jan 2017 at 17:57
Hi Paul

If you check my profile you will see how things have progressed since RALP in August 2015.

Kind regards

Kevan

User
Posted 12 Jan 2017 at 18:00
Hi Paul,

I hope this means everything is ok.

Good luck with the next PSA tests.

Steve

User
Posted 13 Jan 2017 at 07:35
Hi Paul

I'm not a medical person. But I would have thought there are nerves and blood vessels etc that travel throughout the prostate. I suppose if this is the case they could potentially provide a means of escape for PCa cells

See what the blood test results are and take it from there

Here's hoping your consultant is right with his opinion though

Bri

User
Posted 13 Jan 2017 at 18:58

I have everything crossed for good results Paul

Bri

User
Posted 25 Jan 2017 at 08:53

Good news Paul
My team suspect a rogue lymph node with similar results to you. Difference is , your lymphs were clear as were the margins. The fact that your psa has dropped is really good news. Yes it's high but the fact it's not growing quickly like mine is a good thing. Choline PETS don't tend to pick up much at psa less than 3. Good luck and best wishes.

User
Posted 25 Jan 2017 at 17:25

Chris J, I must disagree. At 2.4 PSA, my Choline PET scan picked up three misbehaving lymph nodes, which subsequently also showed in CAT scans. It was the first events we had of distant mets. You know the old saying - the only rule with PCa is that there are no rules....
AC

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User
Posted 11 Jan 2017 at 17:14

Hi Paul
Sorry to hear this indeed. Read my profile. Six weeks is quite early for first test , normally eight weeks.
My post op psa was 1.5 and rose to 2.4 in 12 weeks post op. It was the worst result they had had in 2 yrs. unknowingly I was already locally advanced at surgery and had spread to bladder and 5 lymphs. Although positive margins at bladder they felt not enough left behind to be causing these results. They offered RT immediately but basically stated I was no longer on a curative path , so I have rejected it twice. We are all different yes , and I never even wanted the op for personal reasons , and I did not want even more ED , probable incontinence problems and RT risks of bladder / bowel cancer on a whim really. They admitted at my age they were just throwing everything at me.
I went on HT for 11 months but they decided further scanning is now the way forward along with medicines etc. I'm presently allowing psa to climb again ( six week doubling at the mo ) until it reaches 3 , then going for a choline or PSMA PET scan next month. I may end up having RT yet , and will definitely need further HT or chemo or lymph surgery. I guess it's not good at all but I've accepted it now tbh. I'm sending you my best wishes. You have time to make informed choices so make sure you get the facts straight and prognosis and cure chances established before picking a treatment path. Keep in touch

User
Posted 11 Jan 2017 at 17:57
Hi Paul

If you check my profile you will see how things have progressed since RALP in August 2015.

Kind regards

Kevan

User
Posted 12 Jan 2017 at 13:50

HI....my Consultant phoned me just now and the Histology report has arrived and shows the Cancer only within the capsule with negative margins....some good news at last!

He has only seen a reading for PSA post op like mine twice in the last 5 years and thinks that I am one of those rare people who take a bit longer to wash the existing PSA out of their blood...

I'm booking another PSA test next week, as it now 12 weeks since the op, to see what the level has gone to.....

Paul....

 

Edited by member 12 Jan 2017 at 13:51  | Reason: Not specified

User
Posted 12 Jan 2017 at 14:23

Sounding good Paul
Your next test will be really telling as to what is happening. Fingers crossed and let us know

User
Posted 12 Jan 2017 at 18:00
Hi Paul,

I hope this means everything is ok.

Good luck with the next PSA tests.

Steve

User
Posted 12 Jan 2017 at 20:14

Did they take out any lymph nodes when they removed your prostate?

PS A PSA test at 6 weeks post op is fairly standard - there are a few surgeons who did it at 8 weeks but not all - so don't worry that you perhaps had the test too early.

Edited by member 12 Jan 2017 at 20:17  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 13 Jan 2017 at 05:59
Originally Posted by: Online Community Member

Did they take out any lymph nodes when they removed your prostate?

PS A PSA test at 6 weeks post op is fairly standard - there are a few surgeons who did it at 8 weeks but not all - so don't worry that you perhaps had the test too early.

Hi Lyn......they took out 2 lymph nodes and the seminal vessels.....all showed clear of cancer on the Histology report......I must admit that I find it all a bit confusing.....is it possible to have prostate cancer cells elsewhere in your body when you have a report that shows everything was contained within the prostate with negative margins....?

Blood test at 0910 this morning....this result will be revealing I think.....Cheers, Paul....

User
Posted 13 Jan 2017 at 07:35
Hi Paul

I'm not a medical person. But I would have thought there are nerves and blood vessels etc that travel throughout the prostate. I suppose if this is the case they could potentially provide a means of escape for PCa cells

See what the blood test results are and take it from there

Here's hoping your consultant is right with his opinion though

Bri

User
Posted 13 Jan 2017 at 07:54
Hi Bri...will be interesting.....my highish reading of 2.9 PSA 6 weeks after surgery would suggest, if due to another cancer site, something of a reasonably significant size but my MRI and Bones scans prior to surgery were all clear.....and now my Histology is all clear so I am hoping that the 2.9 reading was either erroneous or I am indeed one of those rare people who take much longer to 'wash' their blood of the original PSA....overall though I am optimistic and the Histology news definitely lifted the gloom somewhat.....Paul....
User
Posted 13 Jan 2017 at 18:58

I have everything crossed for good results Paul

Bri

User
Posted 25 Jan 2017 at 06:45
The mystery continues....to recap....RP on 2/11/16....PSA test on 19/12/16 was 2.9.....Histology showed the PCa contained within the capsule with negative margins......lymph nodes and seminal vessels were also clear.

Urologist was of the opinion that existing PSA or PSA generated during surgery was stil in my blood and requested another PSA test.....

Test was done on 13/01/17 and the PSA level has dropped to 2.5.....

I saw the Urologist yesterday and he is still baffled as the PSA situation isn't 'following the rules'.....he still thinks I am a rare example of someone who takes a long time to clear their blood....he has only seen this twice before in the last 5 years....

Good news that the PSA has actually come down....he is arranging a full MRI scan and a PET scan to try and settle once & for all what, if anything, is going on...

Another PSA test in 6 weeks time as well.....

He joked at one point that I might have another Prostate somewhere.......

Anyway overall I am feeling ok about the situation, having this PSA stil in my blood isn't a problem other than I need to get rid of it all so my monitoring can start properly.....

I did mention to him that I have a condition called Lichen Planus, a very overactive immune system, and asked whether that could have an impact on how my blood dealt with PSA, but wasn't qualified to give an opinion......

On we go......

Cheers, Paul...

User
Posted 25 Jan 2017 at 08:53

Good news Paul
My team suspect a rogue lymph node with similar results to you. Difference is , your lymphs were clear as were the margins. The fact that your psa has dropped is really good news. Yes it's high but the fact it's not growing quickly like mine is a good thing. Choline PETS don't tend to pick up much at psa less than 3. Good luck and best wishes.

User
Posted 25 Jan 2017 at 17:25

Chris J, I must disagree. At 2.4 PSA, my Choline PET scan picked up three misbehaving lymph nodes, which subsequently also showed in CAT scans. It was the first events we had of distant mets. You know the old saying - the only rule with PCa is that there are no rules....
AC

User
Posted 26 Jan 2017 at 02:50

I am sorry to see your PSA is still up there. It is good to have a positive outlook but I hope your urologist isn't lulling you into a false sense of security - to have a PSA so high without a prostate is very worrying. I think if you were my partner or brother I would want you to be seen by an oncologist. 

Edited by member 26 Jan 2017 at 02:51  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 26 Jan 2017 at 09:36
My first PSA following RALP was 0.2 and I was referred to the oncologist who believed this to be caused by cells left behind in the prostate bed. All my margins were also clear after surgery. We continued with PSA tests until it hit 0.5 and then started salvage RT. Hopefully this will not be the case for you and PSA continues it's downward movement but be aware that clear margins doesn't necessarily equate to no cells left behind. My surgeon described the 0.2 PSA as being like 'just a few grains of dust left in the corner after a good spring clean'. The oncologist didn't quite share this view 😊
 
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