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  • Second blood test post - RP

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    Old 01-20-2020, 07:31 PM   #1
    rizzoaus
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    Second blood test post - RP

    Hi there,

    My dad - 67 (almost 68 year-old) just had his second blood test post RP last week and heads to the specialist this week to get his results.

    I used to post on the previous forum before it was all moved here. So unfortunately the information I had in my signature has disappeared.

    Dad had a mix of gleeson 7 (3+4) and (4+3) removed after RP. He was diagnosed in May with surgery not long after following a very high PSA (14ish down to 12ish from memory). There were positive margins following the surgery.

    His first blood test after RP came back with a good result. The doctor was very happy. As mentioned above he is due back again this week.

    What sort of questions should mum and dad be asking? What should they ask if it's a good result? what should they ask if the result isn't as hoped?

    Thanks so much in advance for your advice.

     
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    Old 01-21-2020, 04:11 AM   #2
    DjinTonic
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    Re: Second blood test post - RP

    Hi Rizzo. It's hard to plan for every contingency. I suggest you get a copy of (1) your dad's original, full pathology report that was done on his removed prostate, and (2) written copies of all his post-op PSA lab reports. You will be in a better position to post questions and get questions for your folks to ask the docs.

    The path report will have his final Gleason score, which is either G7 (3+4) or G7 (4+3), but, unlike a biopsy score, not both. It will also have other important info, such as the number of lymph nodes removed and examined, and whether there were any adverse features in addition to the positive surgical margins (SM+).

    The important question is whether your dad's PSA drops and stays at a very low level (essentially "undetectable"), or there is persistent PSA, or an undetectable PSA that soon rises. This will be a major factor in determining if further treatment is needed relatively soon (adjuvant therapy), later (salvage treatment), or never. When needed after a RP, this treatment is usually radiation, especially in the case of positive margins. I strongly suggest your dad's PSA be followed with a test that reports at least two decimal places, not one.

    IF your dad's PSA is on the rise and adjuvant radiation is advised, a consult with a radiation oncologist would be the next step-- the question would then become how much recovery time should allowed before the start of treatment. This consult can be done with a rising PSA even before further treatment has been decided, just to have a plan in place.

    Your dad's pre-RP PSA >10, SM+, and (possibly) G7 (4+3) -- which would put him in the intermediate unfavorable Gleason Grade Group for risk stratification -- do not mean further treatment is unavoidable, but do mean mean careful PSA monitoring, probably every 3 months for a few years, is essential.

    It's not a bad idea to keep an updated copy of your signature text somewhere, in case you accidentally delete it online, or your entire Forum gets deleted

    Best of luck to your dad!

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)0.015 (1 yr. 6 mo.)0.015 (2 yr. 4 mo.)

     
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    Old 01-21-2020, 11:05 AM   #3
    rizzoaus
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    Re: Second blood test post - RP

    Quote:
    Originally Posted by DjinTonic View Post
    Hi Rizzo. It's hard to plan for every contingency. I suggest you get a copy of (1) your dad's original, full pathology report that was done on his removed prostate, and (2) written copies of all his post-op PSA lab reports. You will be in a better position to post questions and get questions for your folks to ask the docs.

    The path report will have his final Gleason score, which is either G7 (3+4) or G7 (4+3), but, unlike a biopsy score, not both. It will also have other important info, such as the number of lymph nodes removed and examined, and whether there were any adverse features in addition to the positive surgical margins (SM+).

    The important question is whether your dad's PSA drops and stays at a very low level (essentially "undetectable"), or there is persistent PSA, or an undetectable PSA that soon rises. This will be a major factor in determining if further treatment is needed relatively soon (adjuvant therapy), later (salvage treatment), or never. When needed after a RP, this treatment is usually radiation, especially in the case of positive margins. I strongly suggest your dad's PSA be followed with a test that reports at least two decimal places, not one.

    IF your dad's PSA is on the rise and adjuvant radiation is advised, a consult with a radiation oncologist would be the next step-- the question would then become how much recovery time should allowed before the start of treatment. This consult can be done with a rising PSA even before further treatment has been decided, just to have a plan in place.

    Your dad's pre-RP PSA >10, SM+, and (possibly) G7 (4+3) -- which would put him in the intermediate unfavorable Gleason Grade Group for risk stratification -- do not mean further treatment is unavoidable, but do mean mean careful PSA monitoring, probably every 3 months for a few years, is essential.

    It's not a bad idea to keep an updated copy of your signature text somewhere, in case you accidentally delete it online, or your entire Forum gets deleted

    Best of luck to your dad!

    Djin
    Thanks for the reply Djin. You may not remember my name from the old forum, but you were an amazing wealth of knowledge during a tremendously tough time last year - I can't thank you enough.

    I'm catching up with mum and dad on Thursday after the appointment so I will get all the details again. I had a break from the old forum and didn't realise it had disappeared!

     
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    Old 01-22-2020, 07:54 PM   #4
    rizzoaus
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    Re: Second blood test post - RP

    Little update ... Second undetectable blood test for day post RP. Super happy with the result ... Let's hope it continues.

     
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