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my case was so rare-------one surgeon has seen it 6 times out of 3000 and another one 1 time out of 1000.
with the low g score and low pre-op psa, my guy thinks its all gone. me, i am unsure----my psa returned to zero within 2 weeks. anybody have any thoughts
You might want to check my story under open surgery. I was originally diagnosed with a gleason 7 with a PSA of 6.5. The surgeon thought the cancer was confined to the prostate. However after surgery, the pathology showed the cancer had escaped the prostate and the seminal vesicles contained about 40% cancer. This was quite a shock. After a third pathology report by the University of Washington Prostate Cancer Center, I learned that there was even a microscopic invasion of the lymph nodes. My first PSA test a month after surgery came back as undetectable.
Because of the seminal vesicle invasion (and the lymph node) I was placed on ADT a month after surgery and scheduled for radiation treatments also. I have now had 39 radiation treatments and am on my eighth month of ADT. I will be on it for 2 years.
So far my PSA remains undetectable as expected while on the ADT. Hopefully, the radiation was able to catch the cancer before it spread. I won't know for sure for several years.
I don't know the extent of your invasion, but you may want to pursue the need for secondary treatment because of the invasion.
Wendell,
My c grade is low 90% 3 and the psa was 4.5----my seminal invasion was miniscule, both the good news it was not extensive, and the flip side that it upgrades my class. what to do? my psa returned to zero within three weeks and has stayed there---my urologist also did the surgery, he says we should wait until we see what happens in the first six months. if it appears at all, then we pursue your strategy, if not, we merely observe.
i too went in expecting a lay-up and got hammered. thanks for your story and advice. WE
I am in a similar situation but with a PSA of 12.7 and a Gleason of 4&3 going in. With a PSA of less than 0.02 after the operation but seminal vesicle involvement I decided to wait until the PSA started to go up before having more treatment. There are at least three papers that found that recurrence doesn't usually occur for at least 5 years if one can get a PSA of 0.01 (ultrasensitive PSA test required)or less after the operation. My PSA did start to go up after 6 months and I started on hormone and radiation before the PSA hit 0.2. According to the Sloan Kettering nomogram delaying the start of treatment shouldn't change your outcome.
I would get tested monthly with the ultrasensitive PSA test and wait until the ultrasensitive tests started to show a consistent rise in the PSA before going for the next round of treatment and don't let it go above 0.2. I would also follow my surgeons recommendations if he disagreed with this plan though.
Dear Frank,
Where are you in the effort? For me, my g-score was so low---it was a freak! Well, I hardly believe in probability any more, with a 4% chance of having seminal invasion---he told me it was an old growth, very slow, and quite "lazy." He reviewed the slides personally and told me that he believes it never penetrated the muscle. So? Now, I'm stuck on the needle---I'm taking the super PSA test every month. Still at .0000--------can you send me those papers. I was shocked to learn that only 5% ever return to zero. Thanks from Philadelphia. WE
Dear Frank,
My PSA was zero about three weeks after the RP and has stayed at zero. My guy tells me that's a good sign that he's correct about the cancer "weakness." But, still, you know the dark demons of doubt and deception. Thanks. WE
My surgery was in November 2009 (See story under Watchful Waiting)
After surgery pathology showed left seminal vesicle invasion and two positive margins Gleason 4+3. I saw a radiation oncologist two days ago and she recommended adjuvant radiotherapy asap. My latest PSA was undetectable (<0.01).
I was also offered a chance to participate in a clinical trial where 50% would have radiation and 50% would wait and see. There was no choice as to which group one would be in.
The RO also said that no one knows for sure whether the radiation would result in a longer life or not. However she did mention some of the side effects of radiation including, rectal bleeding, urinary problems, pain, erectal dysfunction etc.
Right now I am feeling really well, better than anytime in the last year or two. Continence is 99.99% after two months. Still no joy in the ED dept although surgeon said he spared both nerves (some bruising that takes months to heal).
With that information I have decided to wait and see. The good news is that if PSA does not rise no further treatment is needed. If it rises when I am much older, no probs. If it does rise I can still have EBRT as it will most likely be confined to the prostate bed area.
If 'normal' PSA is around 4, what is the danger level for us guys? Does anyone really know?
Still hoping for a 'magic bullet' to be found in the next 10 years. Meanwhile life is meant to be enjoyed so its time for wife and I to spend some time doing that. Best wishes for your treatment and it is true that we have to be our own experts on our condition.
Dear Les,
Thanks----a killer vaccine is being tested here in the States. A huge clinical trial wrapping up in June 2010,
my local guy says the stuff works---we will see. Try to stay well. WE