Patient age 60.
Radical Prostatectomy was done in October 2021. Gleason 4+3. The cancer was contained in the prostate, it had not spread at the time.
After the surgery the PSA has risen:
24 Nov 2021 0.009 ng/mL
17 March 2022 0.027 ng/mL
31 May 2022 0.032 ng/mL
What is the best route of action that should be taken now?
What scans, PSMA/PET or something else, what radiation (would Cyberknife be ok in this case), hormones or no hormones?
Problem is the urologist for the person is not available until August. We are trying to find a different urologist, but I would like to know general opinion of those on internet also.
Thank you for any advice.
________________________ 59M, Gleason 4+3, PSA7.8, T2C. DaVinci Surgery in 2021. PSA rising after surgery. What to do next? |
User
I can't offer any advice other than to say that Addenbrookes where I had surgery to remove my prostate in December 21 only tests PSA to 0.04. My PSA tests in March and June both came out at less than 0.04 so I would be none the wiser if my post-operative PSA was rising or not. According to Addenbrookes they do not test lower than 0.04 because the body, even without a prostate, can still test for small amounts of PSA .
Ivan
User
No action is needed at this point - you are producing tiny amounts of PSA and are not considered to have a recurrence unless your PSA rises to 0.2 OR you have 3 successive rises above 0.1
The prostate is not the only producer of PSA. Your current level is similar to that found in breast milk or a woman who has just had an orgasm.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Originally Posted by: Online Community MemberNo action is needed at this point - you are producing tiny amounts of PSA and are not considered to have a recurrence unless your PSA rises to 0.2 OR you have 3 successive rises above 0.1
The prostate is not the only producer of PSA. Your current level is similar to that found in breast milk or a woman who has just had an orgasm.
Thank you for your feedback.
What could be generating PSA in male organism if the whole prostate was taken out?
Concern here rises from two aspects:
1) Surgeon explicitly said the PSA after RT should be ZERO;
2) The PSA is even though very small, rising.
________________________ 59M, Gleason 4+3, PSA7.8, T2C. DaVinci Surgery in 2021. PSA rising after surgery. What to do next? |
User
Your surgeon should not have told you that PSA should be zero - no one has zero PSA. Small amounts can be produced by the adrenal glands and can sometimes be found in the liver or pancreas. As I said, women can produce small amounts of PSA despite not having a prostate.
Your small increases might be indicative of a problem in future years or may just be your body settling into its new normal level. My husband's PSA has been hovering at 0.1 for nearly 10 years - our oncologist's view is that he may just be a high PSA producer
Edited by member 14 Jun 2022 at 23:57
| Reason: Not specified
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Thank you so much for this explanation. This brings some hope.
Would it be a problem to link to some sources, academic materials, studies or maybe just articles that delve deep into the PSA after surgery and mention these subtle nuances like measurements under 0.1 and how they should be discounted? I would like to read about this, because I always assume zero meant zero. If that isn't so, then I'd like to read literature on the subject.
Thanks again
________________________ 59M, Gleason 4+3, PSA7.8, T2C. DaVinci Surgery in 2021. PSA rising after surgery. What to do next? |
User
There is loads of info out there - just Google or read some of the many threads on here from men who have had the op. The ultrasensitive PSA test that you have has been rather discredited recently and as a result some hospital labs only test to 1 decimal place.
You could also Google women and PSA - rape forensic investigation techniques were changed a few years ago when it was realised that women can sometimes have PSA in their blood.
That's not to say that you shouldn't carry on having usPSA tests and being closely monitored or that you won't rise above 0.1 eventually but your PSA is not rising quickly and the medics are unlikely to be concerned at this stage.
It is definitely 0.032 and not 0.32?
Edited by member 15 Jun 2022 at 00:05
| Reason: Not specified
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Oh no not uspsa debate again. Just because Lyn produces PSA 3 times a week doesn't mean your 3 successive rises are meaningless.
Do you need to be concerned and keep an eye on it? Yes
Do not seek a urologist, they are no use to you now, find an oncologist and take their advice.
Provided they are happy with your final pathology they probably won't do anything until it gets to 0.1.
Stay alert and do your research in case you need to make an informed decision about future curative treatment.
User
I wish franci - can't remember the last time I would have had any PSA floating around 😭
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Yes sure nice try! That is definitely not the Lyn that lives in my fantasies!
Keep up the good work we all luv ya!
User
Intermediate risk disease...ideally do the PSMA PET CT scan when the S. PSA is more than 2ng/mL. The other option is to give a single dose of lupron followed by local radiotherapy of the pelvis. Knowing this is not a high-risk disease, the first option may be prudent.
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PSA rising with 3.3month doubling time after Radical Prostatectomy. Further actions?