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I'm having A Retropubic radical prostatectomy in April. My biopsy had 1 core in 12 showing 5% of that single core to have prostatic adenocarcinoma. I was under the assumption that once the prostate was removed the cancer would be gone. Now i'm reading in several stories about post surgery PSA readings.
My question is was I incorrect in my assumption? Are PSA readings always taken after surgical removal?
Your biopsy finding is the same as mine was back in October 06. 5% of 1 core in 12, Gleason 3+3, T1c. I had RRP in February 07. It might vary slightly base don your doctor but expect a PSA at 1 month after surgery, at 6 months, at one year and then annually after that. After 7 years, if PSA remains undetectable, you are considered cured (but I believe the PSA tests will go on). Even though the prostate has been removed, there could be cancer cells that migrated out of the prostate - continuous PSA testing will identify that.
It always distresses me to read messages from people like you who have clearly not been fully advised by their doctors about their options or indeed the potential outcomes.
One of the major difficulties in dealing with prostate cancer is that there is no certainty anywhere – the process of diagnosis is pretty hit and miss and the choice of treatments is not easy to make, mainly because the various specialists almost always recommend their procedure and often dismiss others.
To answer your two specific questions:
1. …..was I incorrect in my assumption [that once the prostate was removed the cancer would be gone? Yes, you were incorrect - or maybe you weren’t. No one can guarantee the outcome of any surgery. Removal of the prostate may result in total remission, but it may not because with current tests it is simply not possible to say for certain if the disease has spread beyond the prostate capsule or not.
It is important to understand that there is a difference between what is termed metastasised disease – this is where the disease has spread beyond the gland and is actively gowing in another area of the body – usually in the bones and systemic disease where some cancer cells may have escaped the gland and are residing elsewhere, although they are not active. It is these cells that cannot be detected but which may cause problems after surgery (or other treatment).
2. Are PSA readings always taken after surgical removal? Yes they are – usually for the rest of the man’s life because there are instances of failure being recorded 20 years and more after surgery – and the same would apply with other treatment, although of course, most treatments that do fail do so sooner rather than later.
The actually timing of the tests varies from doctor to doctor. Some take the first test within four weeks of the surgery, others feel that is too soon and there may be an artificially high reading and leave it for three months. They then do further tests every three months and if those are all OK – they should be “undetectable” then they move to six monthly tests for a year or two and finally an annual test.
Sorry if this is bad news for you, but you need to know it. Did your doctor discuss all your options? Are you aware of the fact that there is a definition of “insignificant tumour”which is:
1. Nonpalpable (negative DRE (Digital Rectal Examination)
2. Stage T1c
3. Percent free PSA 15 or greater
4. Gleason less than 7
5. Less than three needle cores with none greater than 50% tumour.
Men who have this diagnosis should not hurry into treatment without a clear understanding of what is best for them because the chances are high that the disease will be what is known as an indolent disease and it may never create a threat to their life.
You were in correct in your assumption. I have known people that had an RP and their PSA was down to zero, but six months to 1-year later, their PSA went to .8 and 1.0 and higher; then there is me, I had an RP, and I average a PSA between .1 to .2 going on six years. You never know and you have to continue testing for life and hope for the best. Good luck
My numbers were also almost identical to yours. PSA 4.2 and Gleason 6. I had the DaVinci RP January 24 2008. The surgery went well, but the pathology report came back with a positive margin. Am awaiting the first post surgery PSA which will be March 3 2008, then will meet with the doctor March 13 for the results. So even with low numbers, there is a chance that there will be some left behined. My tumor was on the top edge and according tot he patholoy, some cells may be present on the bladder. The PSA next week will tell if my body was able to deal with it.
(Lee Cal. USA)
Sorry to hear about your diagnosis.
However, it sounds like your case was caught early and the tumor appears to be very small.
You are correct that once the prostate is removed, the cancer will be gone, IF the sum total of the cancer is contained within the prostate.
In your case that seems very likely.
During the operation the surgeon will biopsy the lymph glands and the tissues around the prostate.
After the operation, the removed gland will be checked by a pathologist to make sure that no cancerous tissue is found near the outer surfaces of the prostate.
If the margins are clear and nothing turns up in the nodes and adjacent tissues, it's likely that it's over and you are cured.
You should understand though, that only time will tell for sure.
Within a month or so after your operation, your PSA should fall to near undetectable levels and stay there.
The reason for the lingering concern is the possiblity that microscopic bits of the original tumor may have broken away and migrated to other parts of the body.
Because of this, you will not be considered "cured" until your blood provides a low and stable PSA reading over an extended period of time following the surgery.
That's why the testing will go on.
I don't want to discourage you because your chances for a surgical cure appear to be excellent.
The odds are overwhelmingly in your favor.
You should also know that even if the PSA begins to rise after surgery, there are other treatments such as radiation that may yet provide you a cure.