Post prostatectomy PSA

User

Posted 07 Sep 2017 at 11:54

Hello. My first post so I hope I'm in the right place.

My husband was diagnosed with advanced prostate cancer back in March (PSA 14 gleason 4+5) with no symptoms.

He underwent a radical prostatectomy in June, lymph nodes were clear but one of the seminal vessels had traces.

He has just had his first post op blood test and his PSA is 32. We have an appointment to see his urologist next week and I'm expecting scans and radiotherapy?

We live in France and I would be grateful for any advice from anyone with similar experiences.

Look forward to hearing from someone!

Jane

User

Posted 07 Sep 2017 at 13:32

Are you sure it's 32 or did you mean 0.32 ?

User

Posted 07 Sep 2017 at 16:28

No it's definitely 32 (or 31.97 to be precise).

We've just been to see our GP to ask for a second blood test in case of error.

Pre op my husband had CT, bone and MRI scans, all of which came back clear.

User

Posted 07 Sep 2017 at 16:38

If you click my picture you can read my profile. Very similar to you in that the post op results are very poor. I'm afraid in your husbands case that result is massively high. Hopefully it is an error or was taken too soon. What was his pre op psa can I ask ?
Like myself , a result as high as that might indicate spread elsewhere in the body and be beyond radiotherapy worth. Try and wait until you get the full pathology report and consultant review. Good luck

User

Posted 07 Sep 2017 at 16:47

Hi Chris, thanks for your input.

His pre op PSA was 14, I can't understand how it can have gone up so radically in such a short time, but what do I know?

He's having another blood test tomorrow and we should get the results on Monday - fingers crossed that there's an error.

Thanks again.

Jane

User

Posted 07 Sep 2017 at 19:21

Just be aware that in the UK the PSA score is given as nanograms per millilitre but in some countries it is sometimes given as nanograms per litre or picograms per millilitre so worth checking that the result is actually 32ng/ml not 32ng/l or 32pg/ml.

A score of 32ng/l or 32pg/ml would be 0.032 in the UK

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

User

Posted 07 Sep 2017 at 19:35

Oooooo. I love you Lyn. I must do more homework !! What a happy ending I hope.

User

Posted 07 Sep 2017 at 20:34

Hi Lyn. Thanks for getting involved, you seem to be someone who knows quite a lot (from my forum browsing).

The PSA is 31.94 ng/ml - I'm struggling here in France, not sure that their protocol is the same as the UK.

Any advice before we see the Urologist on Tuesday would be gratefully received.

Thanks in advance,

Jane

User

Posted 07 Sep 2017 at 21:43

Hhhhmm, if that score is correct and the second PSA returns a similar score I think you might simply be asking for a referral to an oncologist on Tuesday.

If it is that high, it is unlikely to be a few cells left behind in the prostate bed in which case salvage radiotherapy may be pointless. I would want a) a choline PET scan or PSMA (which I think might be more available in France than UK but could be wrong) to see if anything shows up b) to discuss with an oncologist the pros and cons of salvage RT plus their assessment of whether there is still a chance of it being curative c) to know what the protocol treatment path is in France in this situation (for example, do they do early chemo there, and if the scans find a tumour to target, what about things like proton beam therapy, green laser, cyberknife etc)

But let's hope that this is simply a typo and the result was 32ng/l

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

User

Posted 09 Sep 2017 at 15:17

Hello Lyn and Chris.

We've just had the second results:

Total PSA: 30.26 ng/ml (lower than 4 days ago?)

Free PSA: 4.99 ng/ml

Ratio: 0.16

Any thoughts you have, gratefully received.

Jane

User

Posted 09 Sep 2017 at 18:11

I think the free PSA and ratio are less significant when you don't have a prostate. All you can do is clarify with the specialist on Tuesday whether referral to an oncologist is the normal route in France, or whether you stay under his care. The rest of my comments about scans and potential next steps still stand.

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

User

Posted 12 Sep 2017 at 17:47

Hello again.

So, we saw the consultant urologist today who has prescribed a CT scan with contrast (iodine injection) + bone scan. These will be done in the next few days, the interdisciplinary team will meet on Tuesday and we see the consultant again on Wednesday to discuss treatment.

I asked if my husband should be put onto hormone therapy immediately but the consultant said that as the scans are days away, he would rather see the results before hormone therapy starts, if indeed we go down this road.

He said that we would be looking at hormone therapy / radiotherapy and or chemotherapy.

Does this all sound as it should?

Thanks again for reading.

Jane

User

Posted 12 Sep 2017 at 19:10

Yes

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

User

Posted 20 Sep 2017 at 18:26

Hello again.

So, we've had a bone scan and CT scan. Bone scan showed a lesion on his spine that isn't causing any pain, the CT scan was clear.

The team have decided to put him onto Degarelix (Firmagon) as of tomorrow and we're waiting for an appointment for a PET scan which will be followed by chemotherapy.

I was told that they might follow up with Abiraterone (Zytiga) after chemo, but the didn't want to use it yet.

Again, any thoughts / advice.

Many thanks,

Jane

User

Posted 28 Sep 2017 at 15:01

Hello again.

We met with the oncologist today who wants to start chemoterapy as soon as possible.

3 cycles of chemotherapy at 21 day intervals (Docetaxel / Taxotere) and then control before a second series of 3 months.

The oncologist didn't see any utility for a PET scan (although the Urologist said my husband could have one) as he felt that the CT and bone scans showed enough for him to know that cancerous cells were present.

I asked if radiotherapy was an option as I have been reading about IMRT (Intensity Modulated Radio Therapy) for advanced prostate cancer, but the said that the chemo and hormone therapies were correct at this stage.

I am wondering if we should ask for a second opinion?

Thanks in advance for any advice.

Jane

User

Posted 28 Sep 2017 at 15:11

Hi Jane,it is a little surprising that they have only identified one bone met with such a high PSA. They may be thinking that he possibly has micromets?

RT will not be curative at this stage - in advanced PCa it is used more often to control the pain of mets. So yes, it seems the oncologist knows what s/he is doing.

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

User

Posted 28 Sep 2017 at 17:05

Thanks Lyn.

I think you're right and they are concerned about micromets.

Thanks again.

Jane

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