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PSA 0.79 3 months after RARP

Posted 18 May 2019 at 13:51

Question on behalf of a good friend who has just had his first PSA test 2 months post-op.

He had a RARP in Bristol following a PSA of 6.6, MRI and biopsy. Was considered to be organ confined. I don’t know the Gleeson scores.

Op appeared to go well and his recovery has been excellent. I was quite jealous of that, but not jealous of his first PSA score of 0.79 or the description of the cancer as “aggressive”.

Understandably he’s now very worried, especially as his father died of PC (albeit at a fair age) I assume there will be salvage RT on the agenda, but wonder whether more scans would normally be done first to try and locate the PSA source?

Scary how common this is - half the men I know seem to be somewhere in the process.....



Posted 18 May 2019 at 15:36
When I first read your note, I thought you had recurrence!

Luckily, Professor Whocannotbenamedhere did a good job on me, and I am now cancer and erection free😉☹️

I have discussed the possibility of recurrence with eminent oncologists who say that in the event, immediate hormone therapy should be started, followed by Dan Dare’s ray-gun. But they did say a Choline scan or preferably a Gallium-68 PET-PSMA scan (£2600) would be preferable so Dan knows where to point his gun.

There is a guy here who has had all these scans, but they have failed to pinpoint any metastases, yet his PSA continues to rise. He has eschewed any indiscriminate radiotherapy so far.

Cheers, John

Posted 18 May 2019 at 16:20

If he had Radiotherapy only a few months after the operation it would be classed as adjuvant rather than salvage.  Results are better the quicker it is done. Adjuvant has better results than salvage in terms of time to recurrence.  

Aggressive cancers are generally higher Gleason.  I don't know if that effects what they'd offer but if he had the op it should be treatable unless it came out a lot different when they gave it a post op check.

Also the studies on this might have used cases that were different from your friend.   I'm not an expert it's something I recall reading.

As to whether he'd have more scans, if it's not too long since his last one you might think that would be enough and they'd do prostate bed RT.  0.79 seems high but not massive like a major spread so another scan could show it.  I think I'd be looking for another scan before doing several weeks of Radiotherapy.  I'd be wanting more psa tests as well to find a trend but not be wanting to delay RT.


Posted 18 May 2019 at 20:54
He may be advised to have adjuvant RT to the prostate bed and pelvic area. Personally, with such a high post-op measurement I would want the best scan I could get, to check whether there are distant lymph nodes or other mets. 0.79 sounds like more than just a few stray cells in the prostate bed, which would make pelvic RT a bit pointless.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Posted 19 May 2019 at 08:47
Thanks all. Lynne particularly has captured my thought that 0.79 is rather high for a first post-op test and probably represents more than a few stray cells in the prostate bed. I don’t know whether the pathology from the op showed negative margins even.

Also that proper assessment of the remains problem via new scans has got to be better than a random “nuking” of the whole pelvic area..... He’s only mid 50s.

Will try to get some more real data and suggest he pushes for further diagnostics. He has another appointment this week but not sure whether it’s a urological or oncology at this point.


PS. thanks for your concern John. My last (a week ago) was 0.02, so I’m ok! I did update my original thread but haven’t updated my profile yet.....

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