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my husband had the nerve sparing surgury
tissue was left behind, could this make the psa go up after surgury psa 0.2
6 months later o.7
then radadtion
6 months after 0.2
6 months later 0.7
is there a posasblity that they could go in and remove the tissue ?
It is important to remember that measuring PSA at this kind of level is not an exact science and that there are many reasons for this very small variances.
In answer to your specific questions:
1. tissue was left behind, could this make the psa go up after surgury Yes it could. How do you know that tissues was left behind?
2. is there a posasblity that they could go in and remove the tissue ? It may be possible to surgically remove the tissue, but it is unlikely that this would be a wise move. Radiation causes changes in the structure of the body cells and make surgery very difficult afterwards.
he had the nerve sparing so i thought this meant tissue was left behind
also becuase the doc that gave the radtion treamnents, said his psa might have gone up because a infection might be in the tissue, and there was no way to tell, if that is why
i asked him if my husband would always have a psa reading because of the tissue/ nerve sparing and he said yes ?
this is all so confusiing
thanks so mauch !!!!
You should have got a report from the surgeon (check with your MD to see if he/she has it) and that should show clearly if there was any part of the prostate gland left behind. If there was it was pretty careless of the surgeon!
From what I have read the most likely place for a part of the gland to be left behind is at the apex of the gland, because it is sometimes difficult to reach this with the robotic arms. It is also a difficult area to radiate because it is close to the bladder.
The fact that some part of the gland was left behind - if that is so - will indeed be likely to be associated with a PSA reading. I think what you need to look out for is a continuous rise in PSA values and if there are three in a sequence you might like to consult an oncologist.
Terry, Joyce,
Regarding locations on the prostate, and tissue left behind perhaps being in the apex part: My understanding is that the base of the prostate is the part adjacent to the bladder and the apex is the part more near the penis. I too have heard that the apex is more difficult to radiate, and never understood why, since being lower in the body it would be more distant from other internal organs. Maybe for some other reason it is difficult.
no where in his surgical pathology reprot does it say that tissue was left behind
but can you get a psa reading when they do nerve sparing, they spare the nerve bundle when they did his surgury
Joyce,
The nerves that are spared in surgery are found in a thin almost membrane-like layer that lies tightly up against the prostate gland. With very careful surgery the thin layer can be preserved intact while removing the prostate gland completely.
So if the surgery is done correctly and no cancer has grown outside of the prostate gland then there should be no prostate cells remaining to produce any PSA. So the concern is always that some of the cancer cells may have grown outside of the prostate gland itself. And not have been removed by the surgery. Then those cancer cells, being of prostate tissue origin, can be the source of a subsequent PSA reading.
If surgeons suspect (ahead of time) that some cancer has grown outside then they typically cut a little wider where they are suspicious. And the nerves in that location are not spared during the surgery.
This is just intended as an overview. Others on this site have spoken of situations where a PSA might be detectable after surgery without any remaining cancer. I don't know anything about that. You need to discuss things face to face with your surgeon, if possible. To get his appraisal of your current status.
You still have plenty of opportunity for a complete cure even if the cancer is not all gone already. I had a situation only slightly different.
Joyce,
I had nearly half of my prostate left behind after a DaVinci. There was no indication of that, other than a high PSA, until I had a trans-rectal MRI. That test clearly showed the tissue. No surgeon I talked with would go back in. The chance of damaging the nerves is too great. Scar tissue forms around them after surgery. The surgeon would have a hard time distinguishing the nerves from other tissue and would probably cut through them. I've had to accept the fact that a mistake was made and I hope that the radiation I had afterwards took care of the remaining cancer.
Joyce,
Like Paul A, I too had some prostate tissue left behind after Da Vinci. The first I knew about it was PSA at the same level after surgery as before! Subsequent MRI and TRUS revealed the amount and location.
Unlike Paul A, I did not have so much left as him and to date it appears that mine MAY not be cancerous, since the PSA has fallen each 3 months until now it is 0.42. (Too much, but less than it was).
So yes, tissue left behind will produce PSA as will some other areas in small amounts. First your husband has to get thoroughly investigated to actually KNOW if there is prostate tissue left there (not nerve bundles, but actual prostate tissue). Second, if there is any there is it cancerous. Third, if the answer is yes to 1 and 2, he has to decide on watchful waiting or further treatment.
My uros told me that there was no question of going back in with surgery a second time, and I have not even had radiation, so I don't think anyone will adise that in your husband's case.
The odd thing about all of us here is that whatever form of treatment we have had, we all seem to end up on watchful waiting!
Good luck to you both. And take lots of s"econd opinions".
This is an interesting discussion. I had been under the impression that robotic surgery would leave at least a small amount of tissue behind. The reason I have this impression is that my Surgeon, who has extensive robotic experience, said that I would not qualify for robotic surgery because of the apparent advanced nature of my cancer. He said that with robotic, he could not reach as far as he knew he would need to. Maybe there is some other reason for that statement, however.
