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PSA. after surgery.

User
Posted 21 Apr 2021 at 09:59

I had surgery 4 Feb 2021.  

Pathology report came back as negative margin. So that was a good start.

My first PSA test done may be a bit too soon was 0.164 

Surgeon asked  me to do another one 1 month later... ie 13th April.  PSA result same .... 0.164

He said not too worry and to do another test in 3 months time.  For him the concern would have been if reading was over 0.2.

Has anyone experience the same ? 

User
Posted 21 Apr 2021 at 17:44

I'm a bit surprised it is the same right down to the last digit. I think someone has read the same result back to you twice. Have you seen the print out and checked the dates? If you got the result over the phone, it might be worth phoning again and asking them to read both sets of results with the dates back to you.

I'm not saying the chance of getting the same result down to three decimal places is one in a thousand, but I'd willingly bet £20 against £1 that you have been given the same results twice. 

Dave

User
Posted 22 Apr 2021 at 18:53
Sorry - I wouldn't be waiting for another PSA test in 3 months, regardless of what the surgeon or nurse said. If you were my husband or father we would be asking for a referral to oncology right now.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 21 Apr 2021 at 17:44

I'm a bit surprised it is the same right down to the last digit. I think someone has read the same result back to you twice. Have you seen the print out and checked the dates? If you got the result over the phone, it might be worth phoning again and asking them to read both sets of results with the dates back to you.

I'm not saying the chance of getting the same result down to three decimal places is one in a thousand, but I'd willingly bet £20 against £1 that you have been given the same results twice. 

Dave

User
Posted 21 Apr 2021 at 19:02

Yes... that make me think now !...  

It was an over the phone result.  I will call the nurse in the morning to check it again !....

Will post result asap...

Thanks

User
Posted 22 Apr 2021 at 08:54

Hi Dave.

Well,,,,  you lost £20 ....     

The nurse confirm that result is correct ... both reading at 0.164

And she said the same...no worry unless it was 0.2

So booked another PSA test in 3 month now.

Anyway , i am curious to know if anyone else as same sort or reading after a Negative Margin result from pathology ?

Cheers.

 

User
Posted 22 Apr 2021 at 10:34

0.164 is not a great post-prostatectomy PSA reading, and I am afraid that you will likely have adjuvant hormone and radiotherapies to look forward to ☹️.

On a more positive note, I and two friends all had prostate surgery about the same time three years ago, and whilst my PSA was and is still undetectable, they both had recurrence, but following the treatments mentioned above they are both cancer-free now.

Best of luck.

Cheers, John.

Edited by member 22 Apr 2021 at 11:22  | Reason: Not specified

User
Posted 22 Apr 2021 at 16:43

 D'oh!!

Oh well, rather than go through all the hassle of sending you £20 I shall just take it to the nearest pub, and hand it to the barman. You can then walk into your local pub order £20 of beer and when he asks for the money just say it's on Dave.

Anyway as Bollinge says, it is not a great result. It does seem to imply that there are some prostate cells lurking somewhere. If you are lucky it will just hold steady for a while, but I think some additional treatment will be required soon.  

 

Dave

User
Posted 22 Apr 2021 at 18:53
Sorry - I wouldn't be waiting for another PSA test in 3 months, regardless of what the surgeon or nurse said. If you were my husband or father we would be asking for a referral to oncology right now.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 23 Apr 2021 at 17:31

I had my op just over 2 years ago, psa was undetectable after 1st psa test but since then it has slowly started to rise - currently gone up to 0.5 recently, so due a MRI scan shortly but I'm not sure if it will detect anything. I think I will opt for RT even though my Oncologist said we could wait until my psa has risen to 1.0 when a PET scan will pick up any areas that need treatment.

User
Posted 23 Apr 2021 at 17:55

Viseoby ... Did the pathology report for you at the time was a Negative Margin ?  

This is why I am curious if this happen to others !...

They said that below 0.2 it is not to be consider as a recurrence !  But a bit concern about it.... will ask to do another PSA sooner than 3 months to be sure it is not rising !

User
Posted 23 Apr 2021 at 18:10
No my path report said positive margin with staging of pT2c pN0, although I must admit to being unsure what the difference is between positive or negative margins - I guess it could be if the tumour is or isn't close to breaking out of the prostate but I could well be wrong!
User
Posted 23 Apr 2021 at 19:04
Just checked what positive margins relates to - seems I was wide of the mark, so no wonder my psa is rising after surgery!!
User
Posted 23 Apr 2021 at 20:02

yes exactly that ... with a negative margin First PSA result should be 0 ( zero)...    that I why I post this question to see if anyone else had this experience !.

 

 

User
Posted 23 Apr 2021 at 20:56

Berni, you can have recurrence with a negative margin - it could have tracked along the seminal vesicles or the nerve bundles that control erections or it could already have reached a nearby lymph node before your op. I have to say though that with a post-op PSA of 0.16 it could be more than just a little bit left behind in the prostate bed. Hopefully the onco will check for micro mets in the bones or spread to the wider lymphatic system.

Edited by member 24 Apr 2021 at 00:39  | Reason: Not specified

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

User
Posted 23 Apr 2021 at 21:00

Originally Posted by: Online Community Member

yes exactly that ... with a negative margin First PSA result should be 0 ( zero)...    that I why I post this question to see if anyone else had this experience !.

No; no one gets a zero PSA as tiny amounts are made elsewhere in the body - even women can have measurable PSA. But with no prostate, your PSA should be undetectable - depending on the hospital this is usually reported as <0.1 or <0.04 or similar. I think that you have misinterpreted the significance of a negative margin - it doesn’t guarantee that the op was successful. 

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

User
Posted 23 Apr 2021 at 21:03

Originally Posted by: Online Community Member
Just checked what positive margins relates to - seems I was wide of the mark, so no wonder my psa is rising after surgery!!

Yes, someone should have explained that to you Visoboy. Urologists have to publish their data on how often they leave a positive margin - it means that there is a strong possibility that some cancer has been left behind in the prostate bed. Your PSA confirms that. 

The difference between you and Berni is that because you had a positive margin, they can work out fairly reliably where to target the radiotherapy. In Berni’s case they would need to run scans and hope that the active cancer cells show up. 

Edited by member 23 Apr 2021 at 21:06  | Reason: Not specified

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

User
Posted 23 Apr 2021 at 21:15

Hi,  It is strange to have 2 tests the same result.   I had 2 tests within a week at initial diagnosis and they were 0.01 different, the last one lower as I'd been very well behaved I think.   It's a very small change granted but after a month I'd think it'd be more than that.    If you could go another month unchanged and then another it would look promising.

I'm not sure about this, but the bit left behind doesn't need to be cancerous.   0.164 is about 5% of normal and higher than you'd expect but nothing is certain.

Also whether 0.1 or 0.2 are significant seems to be another rough guideline.   I'd be worried if my psa was rising reasonably quickly if it was much less than 0.2.  If went up by 0.1 every year I'd be worried but then think I could last 30 years at that rate.  Rate of increase is important, and doubling often important.

One thing to note is take the tests at the same place as fractional differences are more likely.  I'd be pushing for a test after 1 month and as said above be looking at contingency.

All the best, Peter

p.s. I've just read Lyn's new comments and haven't factored them in.  I try to think of the better outcomes although I'm one of the world's worst worriers.

Edited by member 23 Apr 2021 at 21:17  | Reason: Not specified

User
Posted 27 Apr 2021 at 20:11

I found your thread after searching after a discussion re my most recent PSA test today.

I had my prostate removed in 2018.

I am have been on 6 month tests, my previous one was .03 but the latest one is .1

They are bringing my next PSA test forward to 3 months.

I’m still in the ‘undetectable’ range but worrying a little about the increase nonetheless.

Hopefully the next test won’t show a further increase.

It seems to be a waiting game.

User
Posted 27 Apr 2021 at 22:30
Mike, it can't be undetectable and 0.1 so can you confirm? Either it is <0.1 in which case they have just changed the reporting from 2 decimal places to 1 decimal place OR your PSA has risen to 0.1 and is now detectable.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Apr 2021 at 01:23

 12/03/2021 u/k SERUM

PROSTATE SPECIFIC ANTIGEN 0.10 ug/L ( Comments :

Please note amended age specific thresholds in accordance with the Updated Pan London Suspected Cancer Guidelines. Effective from 05/12/2018

Here’s the latest test. They said it was still classed as undetectable. 

Edited by member 28 Apr 2021 at 01:26  | Reason: Not specified

User
Posted 28 Apr 2021 at 07:39
Who are they? 0.1 is not undetectable. <0.1 is undetectable.

With a G9 and a rise of 0.07 over 6 months in the mix I would be asking to see the oncologist now.

User
Posted 28 Apr 2021 at 15:20

Originally Posted by: Online Community Member
Who are they? 0.1 is not undetectable. <0.1 is undetectable.

From an Analytical Chemistry point-of-view "undetectable" is a horribly incorrect phrase to use in this instance anyway since we all know that PSA IS detectable to 3 dps (but not on all systems) and they've quoted precision of 0.10, meaning the true value is between 0.095 and 0.104

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User
Posted 28 Apr 2021 at 15:38
In historic terms of PSA measurement anything less than 0.1 was considered undetectable. Ultra sensitive testing has muddied the water but old terms die hard.

My last USPSA test 2 years ago was 0.03 I have chosen to revert to the standard test because my medical team said they would not consider doing anything unless I got to 0.1 and I agreed with them hence I only have the standard (old) test now.

Next one is due soon already stressing!

User
Posted 28 Apr 2021 at 16:24

Originally Posted by: Online Community Member

 PSA IS detectable to 3 dps (but not on all systems) 

My understanding is that all the labs have the capacity to test to the lower limit - it is just that many Trusts choose not to report it beyond 1dp. No doubt if there was an exceptional reason for doing it, any lab would be able to pull an usPSA out of the bag because they are testing all samples to that sensitivity and then rounding up. 

.... and / or it could just be that the person typing up Mike's result didn't know what the funny little sideways hat meant so didn't included it on the record - we have seen that happen here a number of times and it once happened to John :-/ 

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

User
Posted 30 Apr 2021 at 09:16

Just to update. Unless it goes over the .1 they don’t think it’s worth seeing an oncologist as they won’t do anything more than monitor at this stage but the fact it was G9 T3b obviously does put me at higher risk of residual disease or recurrence so they’re bringing my next test forward to two months after my last one which is now in about two weeks time. This will hopefully give further insight into the trend.  

 
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