I ask because of a persistent PSA that seems remarkable to me:
- 5.2 and 4.6 in May, before RP
- 4.7 and 4.6 a few weeks post-RP
I'm guessing that a post-RP PSA decrease of less than 15%
implies one of the following:
- I was born with ten prostates; only one was excised. :-)
- I have a lot of non-prostate tissue that makes PSA.
- I have some non-prostate tissue that makes a lot of PSA.
- The serum half-life of my PSA is vastly more than 3 days.
- Almost all of my prostate cells were extraprostatic,
AND my actual prostate had been manufacturing no PSA,
AND my nonprostatic prostate cells are not doubling.
- The lab mixed me up with someone else on both occasions,
or put the decimal point in the wrong place on both occasions.
My question is this: What other explanations might there be
for this phenomenon, if any? How rarely does it happen that
RP has no effect on PSA? Is there any literature on it?
I find it intensely frustrating that whenever I ask the question,
"What could explain this phenomenon?" I never get a reply to the
question I asked. Instead, I'm told that the doctor is concerned,
I'm told about followup tests to be done, I'm told what kinds of
treatments might be considered, but am never told the possible
cause(s) of the phenomenon.
In the past six months since my initial diagnosis, I've read
several thousand pages on prostate cancer and read the stories
of hundreds of men, without encountering even one case resembling
mine. And yet my case is lumped with the cases of the thousands
of men whose RP decreases their PSA level to near-zero, followed
by slow relapse over the next months or decades. Perhaps this
lumping is appropriate; but maybe it isn't -- how can I know?
Thanks in advance for whatever information or reference
you can provide!
Paul Carpenter
PaulC1956@yahoo.com
Below is a summary of my case to date.
PSA values before prostatectomy:
- 0.9 on 2002-04-19, per general practitioner, lab#1
- 0.8 on 2004-01-15, per GP, lab#1
- 1.3 on 2005-05-20, per GP, lab#1(?)
- 5.2 on 2007-05-09, per GP, lab#2 (Hybritech)
- 4.56 on 2007-05-21, per urologist (different lab)
- PSADT: ~14 months (as computed in May by me)
Biopsy (performed 2007-05-29):
- Prostatic volume: 19 cc
- Dimensions: 30mm x 41mm x 29mm (height x width x length)
- Hypoechogenic lesion, right mid
- Three samples positive out of 12 total --
- {A,B,C} = left {base,mid,apex}; GHI=lateral
- {D,E,F} = right {base,mid,apex}; JKL=lateral
- A_CD_FGHIJ_L neg: "benign prostate glands and stroma"
- B (left mid) : G3+3, measuring 1mm(=10% of tissue)
- E (right mid): G3+3, measuring 4mm(=10% of tissue)
- K (right mid lat): 43+3, measuring 4mm(=70% of tissue)
Pathology report from RP performed 2007-08-24:
- Lymph nodes (three L, three R): no evidence of of carcinoma
- Neurovascular bundles (right base and right mid):
"No evidence of carcinoma or prostatic glandular tissue"
- "Prostatic adenocarcinoma, Gleason score 5+4=9,
involving the right prostatic lobe and extending
extraprostatically to involve the right posterior
adipose tissue"
- "Resection margins free of carcinoma"
Diagnostic imaging has been uniformly negative:
- Bone scan in June - negative
- CT scan in early October - negative
- Repeat bone scan in mid-October - negative
- [18F]FDG PET scan in mid-October - negative
