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Cancer: Prostate Message Board
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Old 07-10-2012, 08:12 PM   #1
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High PSA after Prostatectomy? Need some input.

Reporting for my Dad:


I recently(3/21/12) had a prostatectomy via the daVinci method and all went well.
My recovery was good, all post op biopsies were good with cancer contained in prostate and lymph nodes were clear.

Last week I returned for the 3 mo checkup. PSA was taken prior to visit and the results were unbelievable to the doctor. The PSA was 6.5, 7.7(retaken) and 7.7(retaken).

My doctor, who has performed thousands of prostate surgeries, has no explanation other than to say that prostate cancer does not perform in this manner. He has ordered additional CT scans of bones and pelvic area which are negative and are identical to those taken pre-op. There is nothing unusual in these tests.

I have met with an oncolgist who is recommending Hormone Therapy.

I am reluctant to begin this therapy based upon information which is not conclusive or understood and without precedence since the cure could have more side effects than the cancer(if it is cancer) and additionally based upon the fact that the PSA test results could be false readings. My blood is being checked for antibodies which could interfer with the PSA test.

Has anybody encountered very high post-op PSA readings and what was the treatment?

 
Old 07-11-2012, 06:39 PM   #2
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Re: High PSA after Prostatectomy? Need some input.

What was the gleason score? What was your pre-op PSA?

Good idea to check your blood for interfering antibodies.

 
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Old 07-12-2012, 02:50 AM   #3
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Re: High PSA after Prostatectomy? Need some input.

My Gleason Score was 8 pre-op and after biopsy of prostate post -op was 4+3=7.

pre-op PSA was 12.4 and is now 6.5 post-op. Waiting for the anti-body PSA.

 
Old 07-31-2012, 06:17 PM   #4
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Re: High PSA after Prostatectomy? Need some input.

Any update?

 
Old 08-01-2012, 08:17 AM   #5
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Re: High PSA after Prostatectomy? Need some input.

The blood tests for the interfering antibodies came back negative.
I am still seaching for a reason.
Sent medical package to Johns Hopkins for second opinion on treatment.

Presently, my oncologist has not started HT. We are going to take additional PSA tests at 1 mo and 3mo intervals to see if there is any movement before we start HT.

 
Old 08-06-2012, 05:06 AM   #6
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Re: High PSA after Prostatectomy? Need some input.

Hi jobriski,

Welcome to you and your dad to the Board!

Did the surgeon advise your dad before the surgery that the odds of cure with surgery, based on a Gleason 8 and PSA greater than 10 were about 50% at best and possibly half that? These odds are based on the very well known and widely used Partin Tables. Do you know how much experience your dad's surgeon has had doing Da Vinci robotic prostatectomies? The doctor seems quite experienced based on your initial post, but I'm having trouble figuring out why he was surprised the surgery did not work based on the odds.

I'm just learning about interfering antibodies that distort PSA results. They seem to exist but be extremely rare. I'm doubtful they will prove useful, but it is another base to touch, and your dad has now ruled out that explanation.

I'm a layman, not a medical professional (no enrolled medical education), but I have learned that the lymph nodes that are sometimes checked during prostatectomies are just a sample of lymph nodes that could contain prostate cancer. Moreover, CT scans only catch rather large tumors, about the size of a pea (and larger) as I recall; it is quite possible your dad has cancer in a lymph node that was not sampled and that is too small to be picked up by a CT scan. Nor are conventional bone scans all that sensitive; it takes about 10% of cancer involvement at a site before the conventional (technetium isotope) bone scan will pick up a likely problem. Therefore, unfortunately, it is quite possible your dad has some prostate cancer that is beyond the prostate and causing that unexpected PSA.

I'm glad he is consulting at Johns Hopkins, at least as far as understanding the problem is concerned. On the other hand, in my opinion as a layman survivor of 12 1/2 years of a challenging case treated solely with intermittent triple androgen deprivation therapy (IADT3, aka hormonal therapy, plus supportive drugs and lifestyle tactics but no surgery, radiation, etc.), having consulted with Johns Hopkins experts and being familiar with experiences of some patients treated there, I am not impressed that Johns Hopkins consistently uses the most effective ADT approaches. Among other problems, in my view, some surgeons do not believe in using ADT early. Some do not understand the importance of monitoring and greatly reducing DHT (dihydrotestosterone) as well as testosterone. The experts in ADT I have followed for years believe in using ADT fairly soon when the patient is strong but the cancer is still weak. When your dad sees someone at Johns Hopkins, I recommend he consult a medical oncologist there rather than a surgeon.

He might also want to consult a radiation oncologist. Salvage radiation is another option. Has your dad talked to anyone about that? ADT is typically combined with radiation for higher risk cases. It would first be important to figure out if the cancer is still in range of radiation. The fairly new Na (sodium) 18F PET/CT bone scan is much more reliable than the technetium bone scan for checking for any bone mets. There are a couple of scans, C11 choline and feraheme Ultrasmall Superparamagnetic Iron Oxide high resolution (3 Tesla) MRI scan for lymph nodes that are quite effective for checking for prostate cancer in lymph nodes. The latter is just emerging and is being used by just a few doctors.

Is your dad familiar with nutrition and other lifestyle tactics to help make the job easier?

There is great hope for prostate cancer patients treated these days, even for those for whom the initial treatment failed to cure the cancer. Well done ADT alone has given many of us many years of excellent control, and for most of us the side effect burden can be managed and is quite tolerable.

Take care,

Jim

 
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Old 08-07-2012, 05:07 AM   #7
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Re: High PSA after Prostatectomy? Need some input.

Thanks for your input. I am expecting a second opinion from Johns Hopkins oncology deptment within the next 10 days. With that and my local doctors we will plot a course for my recovery and management of the prostate cancer. I am also looking into Dr Myers recommendations and nutrition to aid in recovery.

jobriski's Dad, Joe

 
Old 08-31-2012, 02:49 PM   #8
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Re: High PSA after Prostatectomy? Need some input.

Any new update?

 
Old 08-31-2012, 03:55 PM   #9
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Re: High PSA after Prostatectomy? Need some input.

The 2nd Medical Opinion I have received from Johns Hopkins stated that the cancer has spread outside the surgical field and the high PSA readings represent prostate cancer that was not removed by the prostatectomy. The prostate cancer is not evident now since it has not yet reached the threshold for positive imaging studies at this time.

We are montitering the PSA levels for the next few months to see if there is a rise or a doubling of the PSA value. Should the PSA increase and double, hormone therapy will be started.

 
Old 08-31-2012, 04:20 PM   #10
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Re: High PSA after Prostatectomy? Need some input.

You should talk to a radiation oncologist. It's possible they can get what your surgery left behind. I would go to someone not recommended by your urologist. You aren't far from Memorial Sloan Kettering which has one of the best radiation oncology departments around.

- Allen

 
Old 09-03-2012, 05:49 AM   #11
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Re: High PSA after Prostatectomy? Need some input.

Quote:
Originally Posted by jwejr View Post
The 2nd Medical Opinion I have received from Johns Hopkins stated that the cancer has spread outside the surgical field and the high PSA readings represent prostate cancer that was not removed by the prostatectomy. The prostate cancer is not evident now since it has not yet reached the threshold for positive imaging studies at this time.

We are montitering the PSA levels for the next few months to see if there is a rise or a doubling of the PSA value. Should the PSA increase and double, hormone therapy will be started.
Did Hopkins talk about radiation therapy?

 
Old 09-10-2012, 07:05 PM   #12
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Re: High PSA after Prostatectomy? Need some input.

They said that radiation theraopy would not be effective since the location can not the identifyed through imaging studies.

 
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