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Re: 1st post PSA after Surgery

Terry,
From what I've read he already has biochemical recurrence.
- Frank

Re: 1st post PSA after Surgery

Frank:

Are you saying that after surgery a non zero PSA is biochemical recurrence? My appointment is next Wednesday for the Oncolgist.

Also I should have the results of the repeated PSA test tommorow.

Wilbert

Re: 1st post PSA after Surgery

Wilbert,

You ask ....after surgery a non zero PSA is biochemical recurrence

And the answer is yes and no - maybe. You have to bear in mind there are no agreed specific definitions about anything in the PCa world, just general broad understandings - and you also need to understand that words sometimes get meanings that are not what we are used to.

Strictly speaking a non zero PSA after surgery cannot be a 'recurrence' since that term really means that, after having an undetectable PSA, the PSA becomes detectable. You are not in that position, so you cannot be categorised as having a recurrence.

If we look back some years, before the ultra-sensitive PSA (with all its shortcomings) was used to measure PSA and before the advent of RALP, the 'standard' approach to tests after surgery was to wait 3 months and then measure PSA using a standard PSA test. After this time the PSA should be undetectable, which was usually categorised as 'less than 0.10 ng/ml'- the lowest level that normal PSA tests can accurately measure PSA. In the absence of any contrary evidence from the pathology results, there was a good expectation that most of the men would not ever have a detectable PSA. The men at risk of having a detectable level of PSA over time, categorised as biochemical recurrence are calculated by using the Han Tables.

Many men may well have had PSA levels measurable with ultra-sensitive tests during this time, but never knew it and went on their way, taking regular tests and living their lives. They still do this - you can see many stories on the site where men are still using regular PSA tests and still report happily that their PSA is 'undetectable' or 'below 0.10'

But since those earlier days, some surgeons have started using ultra sensitive tests and doing the tests much earlier than 3 months after the surgery. In some cases it has been found that these early sensitive tests show a PSA level that is detectable at that time, but is not detectable as time goes by. Hence my saying in my original post Because of the time it takes for PSA to get out of the blood stream after surgery, the result could be elevated because of this circulating PSA

Another point that has only come to light fairly recently is that sometimes there is a part of the gland left behind after surgery. It is suggested that this might be because of the nerve sparing techniques or because the rods used in RALP (which are straight) might not always be able to reach all the parts of the gland. It is important to bear in mind that prostate glands are not one standard size and they are not always in precisely the same place in the body. It is only when the surgeon actually gets in there that he can see exactly what has to be done - and what can be done. Hence my original comment There may be a small portion of your gland left behind - this happens from time to time, especially with the Da Vinci procedure and this may be generating some PSA.

What I didn't know when I originally posted was that you had been staged pathologically as T3b, not T2 with clear margins as originally stated, which puts a different complexion on things and may well point to a greater possibility of metastasis. The points I made in my first post are valid and should be checked. But to them, in the light of this additional information you have to consider seriously that the disease may have escaped the gland, in which case, in my opinion you should be discussing with your oncologist the importance of ADT rather than EBRT and how soon he would recommend your starting the process.

Let us know what your second PSA test was.

All the best

Terry

Re: 1st post PSA after Surgery

Wilbert,
The very short answer is PSA greater than 0.2 is considered recurrence by most of the research studies I've read lately but use that number in the context of all the background information Terry has provided in his post.

Re: 1st post PSA after Surgery

Frank,

You are missing the point. A recurrence can only occur if the PSA went undetectable and then became detectable. The disease is then said to have recurred.

If the PSA has never been undetectable, as is the case with Wilbert, the disease cannot be said to have recurred.

The PSA may still be on the way down to undetectable for any of the reasons I mentioned previously. If it is, then it might be wise to see if the disease recurs, as indicated by a rising PSA. On the other hand, if the PSA does not go down or goes up and there is no evidence of gland left behind, then it is likely that the surgery did not deal with the problem adequately and it would be appropriate to consider further treatment,

I realise that some people will think this is nit-picking, but there is enough confusion as it is and I think it is important to try to use the correct terms as far as is possible.

All the best

Terry

Re: 1st post PSA after Surgery

No Terry, that is not nit-picking, that is clarification and I appreciate it. After dealing with this disease, and this website, for so many years you have a valuable knowledge base to share.

As always I'm the guy that reads this forum daily but rarely posts.

Re: 1st post PSA after Surgery

Terry:

Thank you for the clarification. Also got the results of the repeated PSA test today, .33 , about the same as the test a week ago.Unfortunatly no lab error. In addition to seeing the onclogist. I guess the next think to do is talk with the urlogist also to see how we find out how much prostate material in left in me.

Re: 1st post PSA after Surgery

OK Wilbert, we can tick that one off - regrettably.

I have just come across a paper that you might find useful NINE DECISIONS BEFORE ELECTING RADIOTHERAPY AFTER RADICAL PROSTATECTOMY

There is a good deal to absorb and I haven't had a chance to study it fully myself, but at first read it seems to make some good points for you to consider.

Good luck.

Terry

Re: 1st post PSA after Surgery

Terry,
Good information. My cancer center does always give the combo hormone/radiation for salvage treatment as of recently. They also wouldn't change the amount of radiation I got(66 greys). I tried to get an extra dose.
P.S. - You used the term detectable and undetectable. I was thinking that we all (including my oncologist) could be clearer if we used specific numbers. I believe undectable means less than 0.1 even though the ultrasensitive test will measure down to .008 or even less. (I have read the link on the PSA test)

Re: 1st post PSA after Surgery

Terry:

Thank you for this information. This read has given me a lot of information to consider before deciding to opt for radiation treatment now (Advanjunt), or waiting (Salvage) to see if PSA changes. I think I'll show it to the RO when I go in.

Wilbert

Re: 1st post PSA after Surgery

Well,

Decided to go ahead with the EBRT adjunt therpy will have first treatment next week. Hoping for the best on side effects No ADT for now. Doctors want to see if PSA goes down from EBRT before going on to Hormones.

Wilbert

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