Cancer still there after prostatectomy

User

Posted 12 Apr 2024 at 06:38

Hello all, my dad had his prostate removed last year after doctors determined that it hadn't spread. Since his op, his PSA levels have increased and so he has had another scan and we have only just been told of the results after nearly 2 months of waiting. There is still something there but they cannot tell us yet where it is - it seems the cancer has spread but not to the bones? Why else would there be 'something there'? I am concerned that he has been told 'it will be fine, its small and you wont be going anywhere soon' however had had already been told it hadnt spread so now i am just trying to figure out what this scan result could mean and what it means next - has anyone else had this and if so what were the results?

User

Posted 12 Apr 2024 at 10:21

Sarah

I’m in the same position - prostate removed December 2022 with the first two PSA checks coming back as undetectable, but is now 0.2. I have been referred to an Oncologist. The nurses have told me what is happening is not unusual as there can be cancer cells that are too small to be picked up by the scans your Dad will have had. It’s not a nice position to be in but it looks as though his increase has been picked up quickly. I’ve been told to expect salvage radiotherapy to the prostate bed which should kill of these cells.

You will get other replies to your post from people with far more knowledge than me.

User

Posted 12 Apr 2024 at 10:53

Sarah, around 30 percent of us who had surgery are or have been in the same position. We don't have the technology yet to guarantee there is no spread.

What scan did he have and what are his PSA test results. It took nearly three years for my post surgery PSA to reach 0.2 and trigger action.

I had have numerous curable intent treatments in the last ten years,and I am not going anywhere soon.

Two month wait for a result is very poor.

Thanks Chris

Edited by member 12 Apr 2024 at 10:57 | Reason: Clarification

User

Posted 12 Apr 2024 at 11:38

Hi Sarah.

Welcome to the forum. I'm sorry that you've had to join us but by doing so, it's a sign that you care so much about your dad.

As Chris says, it's common to find a biochemical recurrence after a prostatectomy. Your dad will probably be given follow up treatment which may include radiotherapy and hormone treatment. It's called salvage treatment, it's a term I dislike as it reminds me of salvage yards, full of clapped out cars.🙂

I wish you, your dad and the rest of your family well. There are loads of kind, helpful, supportive and knowledgeable folk on here who will be able to assist you all on this phase of your journey. Good luck.

User

Posted 12 Apr 2024 at 15:18

Adrian, from the link you posted.

"Following radical prostatectomy (RP) for localized prostate cancer, approximately 30% of patients develop biochemical recurrence (BCR) within 10 years."

There are many variations that need to be taken into consideration.

Thanks Chris

Edited by member 12 Apr 2024 at 15:57 | Reason: Not specified

User

Posted 12 Apr 2024 at 15:43

This isn't a BCR (biochemical recurrence) as the PSA did not go undetectable after the OP. This is a Prostatectomy failure.

The PSMA PET scan is the correct step now, if that has shown nothing the Oncologist should be considering other scans as a PSA of 1.3 after RP is significant.

Fingers crossed the PET scan will find what has been missed.

User

Posted 12 Apr 2024 at 15:58

Originally Posted by: Online Community Member

This isn't a BCR (biochemical recurrence) as the PSA did not go undetectable after the OP. This is a Prostatectomy failure.

If that is the case, I stand corrected, mate. However, surely prostatectomy failures, would only increase the number of cases where surgery was not successful in eliminating the disease, making it even greater than 30%? Whether it's classed as prostatetectomy failure or BCR its still a very substantial percentage where surgery fails?

User

Posted 12 Apr 2024 at 16:07

It's all statistically very interesting, the report someone posted on here the other day had BCR for RP well below 20% while RT was above 30%.

The best statistical predictor of pre treatment outcomes for RP is this tool here:

https://www.mskcc.org/nomograms/prostate/pre_op

Edited by member 13 Apr 2024 at 11:30 | Reason: Not specified

User

Posted 12 Apr 2024 at 16:09

Originally Posted by: Online Community Member

Hi Chris.

By "so many variables" do you mean factors that lead to a greater likehood of BCR like PSA levels, EPE, Gleason score etc?

Hi Adrian, yes exactly those reasons, I have seen 15-40 percent mentioned depending on the level of disease. I also saw mention of recurrence frequently happening within 38 months.

Thanks Chris

User

Posted 12 Apr 2024 at 16:18

I'm particularly interested in these figures. Apparently, although I had a low PSA 6.6, my high Gleason 9 (4+5) plus EPE puts me at 70% risk of recurrence. Touchwood, one year down the road, I'm still undetectable, but I can never put myself as being in the 30% who've eluded further treatment for many years to come.

User

Posted 12 Apr 2024 at 19:37

Hi, his PSA was 10 and as far as i know he didnt have any results of the prostate being dissected - i believe he had a 3/4 for his score. It is all a bit confusing and after such a long wait for the PET results, rather deflating too! No-one has referred to his as a 'failed prostatectomy' which is a bit of a shock. But i guess all we can do is wait for the next consultant call on Thursday/Friday next week.

Thank you all for your comments on this so far, please do keep them coming! It really helps :)

Show Most Thanked Posts

User

Posted 12 Apr 2024 at 10:21

Sarah

You will get other replies to your post from people with far more knowledge than me.

User

Posted 12 Apr 2024 at 10:53

Sarah, around 30 percent of us who had surgery are or have been in the same position. We don't have the technology yet to guarantee there is no spread.

What scan did he have and what are his PSA test results. It took nearly three years for my post surgery PSA to reach 0.2 and trigger action.

I had have numerous curable intent treatments in the last ten years,and I am not going anywhere soon.

Two month wait for a result is very poor.

Thanks Chris

Edited by member 12 Apr 2024 at 10:57 | Reason: Clarification

User

Posted 12 Apr 2024 at 11:38

Hi Sarah.

Welcome to the forum. I'm sorry that you've had to join us but by doing so, it's a sign that you care so much about your dad.

User

Posted 12 Apr 2024 at 11:40

Thank you all for responding. 30% is higher than i expected! His PSA was high when first tested after his prostate was removed in November 23, 1.2 in December rising to 1.3 in early Feb so they did another scan in February after the consultant rang him late evening to tell him his PSA was up again and they needed to send him for a PET scan urgently. I cannot find any answers about this really other than the cancer is somewhere else which is the huge worry. Thanks again guys, this feels like a really supportive community and i will send my dad here when things have settled down as i think he is struggling a bit x

User

Posted 12 Apr 2024 at 12:45

Sarah ,Did Dad get a histology report,this is where they slice up the removed prostate and examine it under a microscope. The result of the histology can help with deciding on further treatment. Do you know what his PSA was before surgery and his Gleason score.

The nurses on this site are brilliant for info and support, the number is at the top of the page.

Thanks Chris

User

Posted 12 Apr 2024 at 12:52

Originally Posted by: Online Community Member

Thank you all for responding. 30% is higher than i expected!

Me too Sarah. The 30% relates to BCR following prostatectomy over 10 years

https://www.nature.com/articles/s41598-023-50434-4#:~:text=Following%20radical%20prostatectomy%20(RP)%20for,is%20the%20only%20curative%20treatment.

Your dad's bound to be struggling a bit. In his case, I assume some cancer cells were not removed during the prostatectomy. It's bad enough to be told you have cancer, it must be worse to be told that your curative primary treatment hasn't been a 100% successful.

If you and your dad are going to be regular contributors, it maybe beneficial to do as thorough profile as possible. This will help others make more guided comment and save yourselves having to repeat diagnosis details.

Edited by member 12 Apr 2024 at 13:00 | Reason: Not specified

User

Posted 12 Apr 2024 at 15:18

Adrian, from the link you posted.

"Following radical prostatectomy (RP) for localized prostate cancer, approximately 30% of patients develop biochemical recurrence (BCR) within 10 years."

There are many variations that need to be taken into consideration.

Thanks Chris

Edited by member 12 Apr 2024 at 15:57 | Reason: Not specified

User

Posted 12 Apr 2024 at 15:36

Hi Chris.

By "so many variables" do you mean factors that lead to a greater likehood of BCR like PSA levels, EPE, Gleason score etc?

User

Posted 12 Apr 2024 at 15:43

This isn't a BCR (biochemical recurrence) as the PSA did not go undetectable after the OP. This is a Prostatectomy failure.

The PSMA PET scan is the correct step now, if that has shown nothing the Oncologist should be considering other scans as a PSA of 1.3 after RP is significant.

Fingers crossed the PET scan will find what has been missed.

User

Posted 12 Apr 2024 at 15:58

Originally Posted by: Online Community Member

This isn't a BCR (biochemical recurrence) as the PSA did not go undetectable after the OP. This is a Prostatectomy failure.

User

Posted 12 Apr 2024 at 16:07

It's all statistically very interesting, the report someone posted on here the other day had BCR for RP well below 20% while RT was above 30%.

The best statistical predictor of pre treatment outcomes for RP is this tool here:

https://www.mskcc.org/nomograms/prostate/pre_op

Edited by member 13 Apr 2024 at 11:30 | Reason: Not specified

User

Posted 12 Apr 2024 at 16:09

Originally Posted by: Online Community Member

Hi Chris.

By "so many variables" do you mean factors that lead to a greater likehood of BCR like PSA levels, EPE, Gleason score etc?

Hi Adrian, yes exactly those reasons, I have seen 15-40 percent mentioned depending on the level of disease. I also saw mention of recurrence frequently happening within 38 months.

Thanks Chris

User

Posted 12 Apr 2024 at 16:18

User

Posted 12 Apr 2024 at 19:37

Thank you all for your comments on this so far, please do keep them coming! It really helps :)

User

Posted 12 Apr 2024 at 20:52

Hi again Sarah,

PSA 10 is relatively low, as is Gleason 7 (3+4). Things could be so much worse. Have you got his cancer staging?

All prostatectomy failure means is not all the cancer cells had been removed. What they'll try and do is establish where those cells are and destroy them. Again, unfortunately this often happens.

User

Posted 12 Apr 2024 at 22:13

Sarah, I think I am right in saying it would be unusual not to have the removed prostate examined in the lab. Some guys get their Gleason score and staging upgraded or down graded and knowing if there are cells at the very edge will help decisions on future treatment.

Thanks Chris

Edited by member 12 Apr 2024 at 22:18 | Reason: Added staging

User

Posted 12 Apr 2024 at 23:03

Originally Posted by: Online Community Member

it seems the cancer has spread but not to the bones? Why else would there be 'something there'? I am concerned that he has been told 'it will be fine, its small and you wont be going anywhere soon' however had had already been told it hadnt spread

Sarah, they have told you that it has spread but not to the bones - that means it has spread somewhere else ... could be his lymph nodes, his bladder, to the flesh around where his prostate used to be, or somewhere else entirely. Wherever it has spread to, the fact that it is small is good news as it means they may be able to target it with radiotherapy (unless it is in the lymphatic system in which case they may not be able to offer RT, just hormone treatment and maybe chemo).

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

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