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Post surgery follow ups

I am 61 and had my prostate removed almost 2.5 years ago. Low Psa of 3.35, Gleason 6 ( changed to 7 at surgery pathology ). PSA undetectable to date. My Urologist apparently offers patients the option to switch to once a year follow ups rather than every 6 months if everything is well after the 30 month check up. Should I do this or is it safer to stay with every 6 months? I have mixed feelings.

Re: Post surgery follow ups

If I was you, I would stick with the 6 monthly tests.

Why was your Gleeson score increased to a 7 after surgery? was it 3+4=7 or 4+3=7? 7 is always a question mark, as it is between non agressive and agressive, sort of on the cusp.

With this desease it is usually better to be shure than sorry.

Re: Post surgery follow ups

Good advice John. Thanks. I'm not sure if I was 4-3 or 3-4. I'm now going to ask when I see the doc in June. He told me that I made a good choice to have the cancer treated as it was obviously getting more perky. I think I read before my procedure that about 30% of patients have their PSA upgraded upon post surgery pathology. Coupled with my younger age, this was the main reason I didn't opt for watchful waiting.

Re: Post surgery follow ups

Stick with the 6 monthly psa's, particularly if your Gleason was a 4+3. Even with the Gleason upgrade to a 3+4 I wouild suggest 6 monthly psa's

It gets back to your personality. Some worry about it others don't even think about it. Me, I would rather know my psa than not even after 5 years (RP) as in my case.
I still do my psa every 6/8 months and I was not upgraded from 3+3

Joe (Aust)

Re: Post surgery follow ups

Good advice Joe. Two of my buddies here in Canada were Gleason 7's and both had RP's a year ahead of me by the same surgeon ironically. I even visited one in the hospital and decided that that was never going to happen to me. Things change and one adapts. My buddies went to 1 year testing and are wishing now (as their one year check up approaches) that they had stayed at 6 months. My amateur understanding is that cancer cells get constantly flushed from the prostate into the bloodstream but Gleason 6 cells rarely are strong enough to set up camp elsewhere in the body. Gleason 7's are stronger and sometimes unfortunately are successful. This forum's advice is very helpful. Thanks again.

Re: Post surgery follow ups

bobbyboy

Joe’s response really sums it up – do what is comfortable for you. If you want to get your PSA every month (and can afford it!!) and it gives you comfort, why just go ahead.

Do you need to have frequent PSAs? I don’t think so, given what you have posted so far. If there is biochemical failure, as a rising PSA is called, after surgery it occurs most often sooner rather than later. Although there is no guarantee that failure will not occur at some time in the future, the chances of that happening get lower and lower as time goes by. That is why the doctors usually follow a pattern of 3 monthly tests for about 18 - 24 months; six monthly tests for 12 – 18 months and then annual tests.

In passing, you are right when you say ……about 30% of patients have their PSA I think you meant their Gleason Grade upgraded upon post surgery pathology. but by the same token about 30% have their Gleason Grade downgraded. Diagnosis is a very inexact science and the position is confused even further if it is not the same pathologist who examines the material from the biopsy and the surgery!

Finally, I think you may have the wrong end of the stick as far as the cancer cells getting flushed from the gland into the bloodstream. The way in which the tumour normally spreads out of the gland is by extending into nearby tissue and then into the next spot and so on – like weeds growing into a flowerbed! Once you’ve had your gland removed, there should be no cells to spread, especially if your post operative report shows negative margins.

As I say, there are no guarantees, but….there are some situations where the probabilities of a good outcome are better than others. Yours seems to be one of those. Good luck to you.

All the best
Prostate men need enlightening, not frightening
Terry Herbert - diagnosed in 1996 and still going strong

Re: Post surgery follow ups

I guess I was just wondering Terry if an extra 6 months would be important if salvage radiation is eventually required. My son gave me a copy of Dr. Peter Scardino's book entitled 'Prostate Book' for Christmas ( unusual gift ). Dr. Scardino is Chairman of Urology at Memorial Sloan-Kettering Cancer Center. On page 241 it mentioned that " Virtually all cancers large enough to be detected on Biopsy constantly shed cells into the bloodstream and lymphatic system." That is the first time I had heard that particular theory but coming from someone of his background it captured my interest. That same page discussed a watchful waiting group that was monitored there with rather encouraging results. Enjoy your get away Terry. Thanks for what you do for us all.

Re: Post surgery follow ups

Bobbyboy,

One of the memorable quotes attributed to Dr Scardino was in the Wall Street Journal some years back when he said that about 30% of the prostates removed at Sloan Kettering showed either no sign of prostate cancer (despite the positive biopsies) or only an insignificant amount that would never threaten the man’s life. He also had this to say on another occasion:

Thanks to regular PSA screening, we're diagnosing more prostate cancers these days. Many of these are very small; some are so early that it's reasonable to look on them not as actual cancers but as histological indicators that early malignant changes are going on. What we have then is a problem with language; we call these areas ‘cancers,' and it scares people to death. As a result, many men want aggressive treatment when the benefits would actually be extremely small.

Radical surgery and radiation are great forms of treatment if a patient has prostate cancer that's posing a threat to his health. But for tiny, early cancer, you are trading your worry about a lesion that may never become a problem for the immediate complications of surgery or radiation. It's important to remember that even the best, most modern techniques of brachytherapy cause about 50% of men to become impotent over five years; radiation can also cause radiation proctitis, strictures, and long-term bowel problems. People also underestimate the morbidity factor of surgery.


Was Scardino perhaps discussing the issue of potential spread after biopsy in the chapter to which you refer (I haven’t read his book). Studies show that the biopsy releases cancer cells into the bloodstream but there is no evidence that these cells ‘take up residence and grow’ – they are dealt with by the immune system. But of course it is unlikely that you will have any such cells being shed if your prostate has been removed.

My personal view is that six months ‘head start’ wouldn’t make any real difference to the outcome if you had 12 monthly tests instead of six monthly tests, but, as I said, you should do what you feel happy with, not what I feel happy with – or anyone else. We’re all different, physically and mentally, and all our diseases are variants. The Golden Rule of Prostate Cancer - There Are No Rules.

Good luck

All the best
Prostate men need enlightening, not frightening
Terry Herbert - diagnosed in 1996 and still going strong

Re: Post surgery follow ups

It was from the chapter on 'watchful waiting' Terry. He went on to say that from a study of 84 patients at Memorial Sloan-Kettering Cancer Center on watchful waiting " on average" they lost only 1% a year probability of their cancers remaining curable. Results varied of course. Small study yet sounds like a positive one for the option of watchful waiting to me - but you would be able to better guage this than myself. This book is the best I've ever read on this topic of Prostate cancer as he takes the time to explain things in such a way that non medical people can better grasp.

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