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Rising PSA following radical prostectomy

User
Posted 21 Jan 2020 at 16:35

Hi

I had a radical prostatectomy just a year ago. First PSA reading 3 months after op was 0.008 which I was pleased with as it seemed that the op had worked. However subsequent readings have been 0.017, 0.027 and 0.031. Surgeon says not to worry and only if it hits 0.1 should we review. However I am slightly worried that it is gradually increasing. Has anybody else experienced the same sort of increases? Or am I just worrying unnecessarily?

Regards 

Mike

User
Posted 21 Jan 2020 at 19:26

It is very worrying if you see PSA rising after prostatectomy, the rise seems quite slow which is hopefully encouraging but I’m sure you would like to see a fall at the next reading.

I’m in no way suggesting it is t something to worry about.

My rise was more dramatic, see my profile. I was devastated, good that is being monitored closely.

Here’s hoping it settles. 

Ido4

User
Posted 22 Jan 2020 at 07:22
I saw an onco and a different surgeon they both said wait until 0.1.

Key to your decision is your final staging if you had positive margins and an 8+ Gleason score it's likely an onco might recommend salvage radiotherapy regardless of PSA.

One more thing if those PSA figures are every 3 months your doubling time is actually reducing significantly. Cancer doubling times are normally steady or increase.

PSA anxiety is something all PC patients have to come to terms with!!

User
Posted 22 Jan 2020 at 10:09

Thanks IDO4.  Your situation was not satisfactory but you seem to be pretty clear now after lots of treatment - hope it stays stable for you.

User
Posted 22 Jan 2020 at 10:24

Hello,

I had the RP surgery 4 years ago, then RT & am now waiting to see  Oncologists soon to determine whether to start HT because of PSA rising into double figures.

Oh & in the meantime I have to ISC every month for the rest of my life because of a Stricture , that said still enjoying life.

Best wishes

James

 

User
Posted 25 Jan 2020 at 15:54

Thanks - saw the Prof today who didn't seem too concerned and felt it may be a lab error or equipment change (or something), but to be sure I need to have another test in 2 months. I have to say, testing every couple of months never lets you off the hook does it?

Overall not sure how I feel. Seems I have a low Gleason score with negative margins after surgery so why the blip? I guess I will know in 2 more months, but I think we all know the fun of waiting...I need to gain a coping strategy when it comes to the waiting part I think!

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User
Posted 21 Jan 2020 at 16:40

Read my profile it's almost identical.

Basically you need to keep an eye on it but don't start panicking yet.

You might want to update your profile to include post op pathology as they could make earlier intervention more likely.

 

Edited by member 21 Jan 2020 at 16:45  | Reason: Not specified

User
Posted 21 Jan 2020 at 17:12
Yes thanks for responding francij1.

Yours seems to have stabilized at 0.03 so hopefully mine does the same.

cheers

Mike

User
Posted 21 Jan 2020 at 19:26

It is very worrying if you see PSA rising after prostatectomy, the rise seems quite slow which is hopefully encouraging but I’m sure you would like to see a fall at the next reading.

I’m in no way suggesting it is t something to worry about.

My rise was more dramatic, see my profile. I was devastated, good that is being monitored closely.

Here’s hoping it settles. 

Ido4

User
Posted 21 Jan 2020 at 23:23
Tiny amounts of PSA are generated elsewhere in the body so your PSA is now at about the same level as a woman that has just had a great orgasm and double the amount that can be measured in breast milk. It may be that your body is just settling to its new normal and it stabilises around 0.05. However, the rise is fairly consistent and the cynic in me thinks that it is in the surgeon’s interest to underplay this; keep a close eye and if it rises over 0.1 ask for a referral to oncology.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 22 Jan 2020 at 02:10

Mike

i had a post prostatectomy PSA of 0.014.  Over the space of 12 months, it steadily increased to 0.023.  I paid for a PSMA scan and cancer was found in some nodes.  I had subsequent radiotherapy and hormone therapy.

en your PSA, like mine, seems to be exhibiting steady rises so it needs to be watched.  My oncologist warned me I could be wasting my money getting a PSMA scan because my PSA was so low, it was unlikely to pick anything up.

the other thing is that I had positive margins, extra capsular extension and so on.  My oncologist always knew I was going to need subsequent treatment and so pressed ahead.  All of this, as well as a rising PSA needs to be into account.  We can’t see from your profile your staging and pathology.

based on my experience, I’d be asking to see the oncologist sooner rather than later.

ulsterman

 

Edited by member 22 Jan 2020 at 02:13  | Reason: Not specified

User
Posted 22 Jan 2020 at 06:38
My local hospital only tests down to 0.1 = ‘undetectable’, so I might be in the same boat as others here, but I don’t know it. Am I bovvered?

Ignorance is bliss.

Best of luck.

Cheers, John.

User
Posted 22 Jan 2020 at 07:22
I saw an onco and a different surgeon they both said wait until 0.1.

Key to your decision is your final staging if you had positive margins and an 8+ Gleason score it's likely an onco might recommend salvage radiotherapy regardless of PSA.

One more thing if those PSA figures are every 3 months your doubling time is actually reducing significantly. Cancer doubling times are normally steady or increase.

PSA anxiety is something all PC patients have to come to terms with!!

User
Posted 22 Jan 2020 at 10:09

Thanks IDO4.  Your situation was not satisfactory but you seem to be pretty clear now after lots of treatment - hope it stays stable for you.

User
Posted 22 Jan 2020 at 10:16

Thanks for your response Ulsterman. 

My pre-operative diagnosis was Gleason 4+5, PSA 7.53, prostate volume 40cc. Histology - Gleason was downgraded to 4+3 pT3a, posterior circumferential resection margin was positive (tumour had gone through the prostate capsule coming up to the margin of resection). So there is a danger that there is some cancer floating around - therefore I will be keeping a close eye on the PSA level.

User
Posted 22 Jan 2020 at 10:24

Hello,

I had the RP surgery 4 years ago, then RT & am now waiting to see  Oncologists soon to determine whether to start HT because of PSA rising into double figures.

Oh & in the meantime I have to ISC every month for the rest of my life because of a Stricture , that said still enjoying life.

Best wishes

James

 

User
Posted 22 Jan 2020 at 10:29

Thanks for the advice Lyn - I will take action if it goes up much more and certainly if it hits 0.1.

User
Posted 23 Jan 2020 at 14:32

Hi - I have had two tests in 6 months that were at 0.006 and this week (10 months post-surgery) I had a result of 0.016 so now slightly nervous of the rise! I guess we all get scanxiety but do most people's settle down or can there be a 'blip' on occasion??

Thoughts welcome!

Mark

User
Posted 23 Jan 2020 at 17:58
Have they changed labs? Had the machines calibrated? Did you do anything particularly different in the 24 hours before? Do you have a bit of infection?

It could be anything, at the minute.

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

User
Posted 23 Jan 2020 at 18:16

What was you final pathology mark? If you were still 3+3 then my profile may give you some reassurance. 

You are still very low, the next test will be interesting. My numbers would jump then drop back then jump again, last test I had was 0.030 4 years after diagnosis.

Now on yearly tests as I couldn't stand the anxiety. May even switch to the standard test next time and do a Bolinge!

 

User
Posted 23 Jan 2020 at 19:35

Hi, not sure if they changed labs as it doesn’t show lab info...had a nasty cold recently, that’s about it!

final score on the door was Gleason 6 t2a

M

User
Posted 24 Jan 2020 at 07:18
Mark the final pathology is very good news, there are some folks who would say you didn't even have cancer with a T2 3+3 .

My surgeon told me a residual persistent PSA that doesn't significantly increase over time is usually caused by normal prostate cells left behind where the prostate is sliced off the bladder. Obviously this is not ideal as they could turn nasty in the future but that is why you will have PSA Tests for the rest of your life "just in case".

User
Posted 25 Jan 2020 at 15:54

Thanks - saw the Prof today who didn't seem too concerned and felt it may be a lab error or equipment change (or something), but to be sure I need to have another test in 2 months. I have to say, testing every couple of months never lets you off the hook does it?

Overall not sure how I feel. Seems I have a low Gleason score with negative margins after surgery so why the blip? I guess I will know in 2 more months, but I think we all know the fun of waiting...I need to gain a coping strategy when it comes to the waiting part I think!

 
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