Persistent PSA

User

Posted 29 Jun 2020 at 14:30

Hi, diagnosed March 20, RARP same month, Gleason 7 (3+4), T2c, one 2mm apical positive margin.

Consultant (very highly rated) very happy with pathology, should expect good outcome.

First 3 month PSA 0.12 last week has shocked me, but he says he's happy with that and to speak again in 3 months.

I am now paranoid thinking that it may well have doubled already since the op, would appreciate any thoughts.

User

Posted 29 Jun 2020 at 15:43

Hhhhmm - we don't know all the ins and outs but I would be worried that the surgeon's ego is getting in the way. He might be very happy with the outcome but you really need to be referred to an oncologist to discuss adjuvant RT, particularly as the positive margin means they will know pretty much exactly where to target the zapping.

It may be that in your area, the onco referral cannot be made until there has been another PSA rise but my advice would be to take no sh1t and ask for the onco referral now if you can. What was your PSA at the 6 weeks post-op stage?

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

User

Posted 29 Jun 2020 at 16:04

Hi Trenaman

As Lyn said hard to make a call without details. Did you have neurosafe during the RARP. Was the positive margin confirmed with histology results? I'd certainly be pushing for another PSA sooner to rule out any error. In my case I also just have the 3 month PSA tests (1st year) ie no 6 week test.

Maybe chat with your GP and get referred directly? I seem to remember when talking with my consultant the thresholds are 0.1 for being alert then 0.2 for referal to oncologist should I ever reach those levels. Some of the folks here can probably give a much better informed view than I can.

Hope you get is sorted but you are right not to hang about as if I had waited six months my outcome might have been very different.

Best

User

Posted 29 Jun 2020 at 17:12

Thanks for the responses.

This was my first test post-op, and I had it confirmed a week later. Surgery was nerve-sparing, no idea of the name.

My GP has never really been involved, so i think I will email the surgeon again.

User

Posted 29 Jun 2020 at 17:24

Threshold for biochemical recurrence is:-
- PSA >0.2 or
- 3 successive rises >0.1 or
- signs of active tumour

Threshold for salvage RT is therefore some time after the recognition of a biochemical recurrence, but ideally before the PSA gets to 0.4.

With a positive margin, there isn't the same need to wait for evidence of biochemical recurrence to discuss whether adjuvant RT is appropriate - it could take a couple of months to get the appointment!

In terms of the urologists having to publish their results, I suspect that unplanned adjuvant RT is seen more negatively that salvage RT and so it is in his interest to delay the referral to oncology (but I may be being overly cynical).

As well as the positive margin, it would be useful to know whether there was any seminal vesicle invasion noted in the pathology - do you have a copy of the report or the pathology letter sent to your GP?

Edited by member 29 Jun 2020 at 17:25 | Reason: Not specified

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

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