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high PSA reading 6 weeks post OP

User
Posted 29 Aug 2020 at 11:07

Hi All

I had Radical Prostatectomy on July 14th 2020, all went well, continence good, unfortunately it was non nerve sparing. I now have my follow up appointment with the surgeon this coming week, on  the telephone. I called his secretary and asked if I should have a PSA test, she said yes, so I did. Now here is the worry, the PSA came back as 8.3, exactly 6 weeks after the operation. I was 11.3 Gleason 7 with 3+4 and 4+3 before the operation.  I have had 2 course of antibiotics, for urinary tract infection, and am now on my third course, and waiting for a urine sample result. I have been told that this infection, which hasn't really gone away since the op, is the probable cause of my PSA test result being high, worryingly  high and not what I had expected at all. 

Has anyone else had a similar experience or can give some words of advice, so I can prepare for the telephone consultation. I have lots of questions, Maybe I was too early for the PSA test, why would an infection keep my PSA high? Did they miss something?

Very interested to hear your thoughts as there seems to nothing much online about this.

Many Thanks

Ian

User
Posted 29 Aug 2020 at 14:15

Hi Ian, it is usual to wait 6-8 weeks after surgery for the first post op PSA test.

If it is really at 8.3 that would suggest a potential problem. Sorry you are having to deal with this. Was the cancer near the edge of the capsule?

I would suggest getting a repeat test once your UTI is cleared up.

I doubt you can arrange this before your telephone appointment.

Your surgeon will give you more information on how the op went and what the post op histology showed. Once you have had this appointment next steps should be more clear.

 I am sure others will come along and Reply to you too. 

Ido4

User
Posted 29 Aug 2020 at 14:55

Hi Ian

Have you have post-op histology back yet? They will be the first stop I suspect.

Hope everything goes well with surgeon call and you can get some answers.

Simon

User
Posted 29 Aug 2020 at 18:05

Hi

No post OP histology, that will be this week, from what I have been told so far it is treat the infection first as that can affect PSA levels

User
Posted 29 Aug 2020 at 19:56

Hi Ian, I just checked your previous posts, we talked about how consultants can be blunt, and we decided we prefer it that way.

So bare in mind I don't know more than any lay man who reads the internet will know.

Psa has a half life in your body of a couple of days, so a psa test a week post surgery may show residual psa from prior to the operation but this would have dropped to negligible after a few weeks

UTI can increase PSA if you have a prostate. If all prostate cells have been removed from your body which a RP should do, then even with a UTI I can not see how you would have a psa much above 0.1 unless you have prostate cells somewhere in your body.

So do not let them fob you off with sorting out the UTI first. This needs answers now! Hopefully histology will give some clues.

Sorry, I can't be more positive. I hope someone with more experience can post and find errors in my logic. 

Dave

User
Posted 29 Aug 2020 at 20:32

Hi Ian

My initial reaction, is  very odd  not heard this.

You have been given someone else result .  Or a prev . Result of yours.  Decimal place in wrong place.  Ie could be 0.083  considering you have UTI.

 

 Clarify and get a new test done.

Dave explains clearly , work out the maths you would have had to had PSA in thousands pre op.

Yes there's residual tissue and with inflammation maybe could be producing this. 

UTI ? Has that been confirmed then, not clearing up ? Are you well otherwise? 

I was non-nerve sparing and fine, incidentally, took 3 years re. ED recovery. 

Get another test sorted, agree ?

 

Regards Gordon

 

 

Edited by member 29 Aug 2020 at 20:37  | Reason: Not specified

User
Posted 29 Aug 2020 at 20:52

Hi Ian,

It might be clutching at straws a bit but you had your first psa test in March and it was 11.3 which isn't a very high number.  Your latest test is 8.3 which is only a drop of 3 post operation.  We don't know if it had increased since March or if it was all in the prostate but there is a case that the psa test might be in error and ask for a repeat test.

In theory a psa test is only a phone call away, you'll need a form probably, and the result is usually same day if you arrive early enough.

If you have a Macmillan Nurse they can provide the form.

You could wait for the consultation as the histology could give a clue.

All the best,
Peter

User
Posted 29 Aug 2020 at 22:15

I agree with the others here -
- check with the GP, receptionist or whoever gave you the results that it is definitely 8.3ng/mL and not 0.083ng/mL or 8.3ng/dL
- if it is confirmed as 8.3ng/mL, I would expect the urologist to refer you to oncology without delay; don't accept anything else
- the onco should request scans to see where the problem might be - if it is suggested that Gallium 68 or Axumin PSMA scans might be better but will take a while to arrange, take a choline PET scan in the meantime. PSMA scans have significant benefits for suspected recurrence at very low numbers but at 8.3, a choline PET scan may be more than detailed enough.

I am not usually one for suggesting that men should put themselves in conflict with their medics but if you were my brother or partner and they suggest waiting for another round of antibiotics or another PSA test, I would politely insist on that oncology referral.

Did you have a bone scan before the op?

Edited by member 29 Aug 2020 at 22:21  | Reason: Not specified

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

User
Posted 29 Aug 2020 at 22:39

Hi

Many thanks for all your replies. I will be checking with my GP surgery that the result was not mis-read. I had no bone scan pre-op, I was told it was contained,. I do agree with you all, its either 'get back there quick and get sorted' or some error along the line. The results of my urine sample should be back early next week, but the rise in my temperature and left side kidney ache etc. seem to suggest infection. If it is that infection, I just don t understand how it can affect PSA levels and stop them dropping to near undetectable as I was expecting after prostatectomy. I have read an infection can affect PSA results and cause elevated numbers and you have to wait for it to clear, but that is if you have a prostate.

As I said earlier I have found very little information on this and I will be sharing all I learn here so maybe it will be of help to others too, even if its 'do not always trust what you have been told'.

Ian

User
Posted 30 Aug 2020 at 11:09

Hi Ian,

Was infection post op ?

Ie Are you generally  fit, well and no history of UTI before op.

I assume no pain or swelling in perineum area. How is bladder control, day and night ?

 

Regards Gordon

Edited by member 30 Aug 2020 at 11:12  | Reason: Not specified

User
Posted 30 Aug 2020 at 11:15

Hi Gordon

Yes I am generally fit and well and no UTI history before the OP. I have no swelling just a constant ache in my left side kidney area, and just one pad a day to catch the little bit of leakage I have, also just a pad at night, so I am pleased with that side of things.

Ian

User
Posted 30 Aug 2020 at 11:37

Hi Ian,

Maybe others will also comment.

Umm.  Has this all been done over phone ?  Why and who prescribed antibiotics, on what basis ?

I'm not a medical professional, often and certainly after this major op there's deferred pain, I like many others on here still get 'random' groin, lower back ache, even after 5 yrs. 

You do need a complete appraisal of where you are now, don't you. 

Hope this helps

Gordon

 

 

Edited by member 30 Aug 2020 at 11:38  | Reason: Not specified

User
Posted 30 Aug 2020 at 15:52

There is a worrying aspect of the situation, if as suggested your result has been mixed up with another person. That person may have been given very low PSA result and be unaware of the true condition they are in.

Thanks Chris

User
Posted 30 Aug 2020 at 17:08

Hi

Yes I agree , I will call the GP on Tuesday and double check.

Ian

User
Posted 30 Aug 2020 at 20:54

Hi Ian, my husband is 5wks post op tomorrow and has to have PSA checked tomorrow so that the result is available for telephone consultation on Friday with pathology.

I hope you get it sorted out, an added worry you definitely don’t need. Best wishes.

User
Posted 30 Aug 2020 at 22:32
Perhaps also get a retest
User
Posted 30 Aug 2020 at 23:15

Just a suggestion but maybe ask for a copy of the PSA blood report. It’s a formal single page report Generally from the lab with your details, time test was received/completed plus the result. Lots of scope for numbers to get misread en-route or transcription error by someone in a rush. Pretty much any of the admin staff at your GP’s should be able to print this off for you as this is how they receive the data. I popped in and got mine last week as I prefer to see the result in hard copy from the lab then file it.

Good Luck!

User
Posted 01 Sep 2020 at 12:35

Hi again

Just called the GP to confirm my PSA reading and was told 8.3 ug/l. Does this make sense to anyone out there. 

Many thanks for all your replies

Ian

User
Posted 01 Sep 2020 at 13:19

Ian

Still looks like a mistake somewhere along the line. When is you next test ?

Thanks Chris

User
Posted 01 Sep 2020 at 13:27
I suggest you go straight to the hospital and spin up a conversation there. The GP isn’t really a player in this any more. Recommend a retest and a talk with your consultant ASAP.
User
Posted 01 Sep 2020 at 13:47
8.3ug/L is the same as 8.3ng/mL - too high for someone with no prostate. You are speaking to the surgeon this week anyway and s/he may be able to explain the high PSA in the context of your pathology. If not offered, request an immediate referral to oncology but I would hope that the surgeon or GP will be contacting the lab to check your results haven't been mixed up with someone else's.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 01 Sep 2020 at 14:47

The level should be <0.1 max. Thats the threshold for being proactive. Ideally you should be discussing this your urology consultant who would make the call on referral. 

TG

User
Posted 01 Sep 2020 at 16:43
Technically, <0.2 - that's the actual threshold in the NICE guidelines. For biochemical recurrence, they use 0.2 or three successive rises over 0.1.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 02 Sep 2020 at 15:19

Hi

Just to update you all. Had my telephone consultation and Histology. Cancer had gone to the seminal vesicles, but still all organ contained with negative margins, but cancer upgraded from Gleason 7 to Gleason 9, so more aggressive than the biopsy suggested. Consultant wants a CT and Bone scan and a repeat of my PSA test in 2 weeks to check it wasn't a red herring. He says infection can interfere with PSA but not to the extent of my reading.

 

Ian

User
Posted 02 Sep 2020 at 15:44

Hi Ian,

If he sends the form for you to have a psa test I don't suppose you need to wait 2 weeks.  Although perhaps he's thinking any effects from the UTI or anything else might have declined by then.

It's common to have Gleason upgraded, mine was upgraded to 4+4.  A nine could be 4+5 or 5+4.  The former being marginally better.

Negative margins is good although I don't know how that squares with seminal vesicle involvement.  Perhaps someone else will comment.

Carry on hoping the reading is an error.   I had one strange test which I got retested to get the right result.  Although the odd test was at another lab and they advise you to use the same lab.

All the best,
Peter

 
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