It appears you have not yet Signed Up with our community. To Sign Up for free, please click here....



Cancer: Prostate Message Board

  • Doubled PSA post Radical Prostatectomy

  • Post New Thread   Reply Reply
    Thread Tools Search this Thread
    Old 03-14-2021, 11:44 AM   #1
    CI212
     
    CI212's Avatar
     
    Join Date: Mar 2021
    Posts: 2
    CI212 HB User
    Doubled PSA post Radical Prostatectomy

    My Dad is 75 and was diagnosed with adenocarcinoma prostate ca with a Gleason score of 8 in Nov 2019. His original PSA was 24. He underwent a Radical Prostatectomy in February 2020. At the time of his surgery, his surrounding tissue and lymph nodes were tested and found negative for ca.

    Over the last 5 months his PSA has increased from .4 to .9. Everything I’m reading is telling me he has mets.

    Has anyone been through or witnessed a similar situation? What was the outcome?

    Any suggestions on what he should ask/request of the dr at his next appointment?

    Thanks,
    Tina

     
    Reply With Quote
    Sponsors Lightbulb
       
    Old 03-14-2021, 02:43 PM   #2
    Terry G
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Location: Butler PA
    Posts: 177
    Terry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB User
    Re: Doubled PSA post Radical Prostatectomy

    Tina, Welcome to the forum and I’m glad you’re here advocating for you Dad. I’m a radiation guy and I’m sure some of the surgery guys will be along to comment on Dad’s recent PSA’s. Undoubtedly they will ask for more information in order to be able to respond. Things like what was Dad’s PSA history, the size of his prostate, did he have BPH, what were his biopsy results prior to surgery, did Dad have only surgery as a monotherapy, and his overall health are all important regarding making comments on his current situation. This forum is most helpful when as much information as possible is shared.

    Some of this information may also be helpful in determining why Dad chose surgery vs. other treatment options. I have a feeling that Dad’s case is a little more complicated than a Gleason 8 choosing surgery. Thanks for advocating for Dad. It’s a blessing for our children to be offering input into our health situations.
    __________________
    Rising PSA:
    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
    Reduced ejaculate only side effect; everything works
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    PSA’s post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4

     
    Reply With Quote
    Old 03-14-2021, 08:12 PM   #3
    CI212
     
    CI212's Avatar
     
    Join Date: Mar 2021
    Posts: 2
    CI212 HB User
    Re: Doubled PSA post Radical Prostatectomy

    Thank you for Terry.

    My Dad’s PSA has been slowly increasing over the past 10-15 years, but he put off testing due to fear.

    He was never diagnosed with BPH. When he finally did have his colonoscopy in 2019, they found his prostate was about 3 times enlarged and positive for adenocarcinoma (reaching to the prostate wall). Hopefully that makes sense.
    He was given a choice between surgery and radiation, but felt pushed by the surgeon to have the surgery in order to give himself more choices for further treatment down the road.

    Other than his prostate ca, he also has hypertension, high cholesterol, hx of kidney stones, chronic knee pain (which started about 10 months ago) and he had renal failure, but that has improved since his surgery.

     
    Reply With Quote
    Old 03-14-2021, 08:50 PM   #4
    DjinTonic
    Senior Veteran
    (male)
     
    Join Date: Dec 2019
    Location: NC
    Posts: 574
    DjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB UserDjinTonic HB User
    Re: Doubled PSA post Radical Prostatectomy

    Hi Tina.

    If your dad's first PSA after surgery was 0.4 then he has persistent PSA (which is 0.1 or higher after surgery). It usually means that salvage therapy -- radiation and possibly hormone therapy -- is needed. It's time to meet with a radiation oncologist (RO). The same holds even if his PSA was undetectable after surgery and then rose to its current level. This would be BCR (biochemical recurrence), which also calls for salvage therapy.

    I assume his workup bone scan was negative.

    Your dad may or may not have mets -- it could just be tumor that grew out if the prostate locally even if not seen in the post-op path exam. Were there any positive margins?

    Speak to the RO about imaging to determine whether there are pelvic mets. That information can help determine whether to irradiate the whole pelvis or just the prostate bed. His PSA most likely indicates locally advanced PCa that can be successfully treated.

    Hope that helps,

    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, negative 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
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.023 (4 yr. 6 mo.)

     
    Reply With Quote
    Old 03-15-2021, 06:07 AM   #5
    Prostatefree
    Senior Veteran
    (male)
     
    Join Date: Dec 2019
    Posts: 617
    Prostatefree HB UserProstatefree HB UserProstatefree HB UserProstatefree HB UserProstatefree HB UserProstatefree HB UserProstatefree HB UserProstatefree HB UserProstatefree HB UserProstatefree HB UserProstatefree HB User
    Re: Doubled PSA post Radical Prostatectomy

    Move on to an RO (Radiation Oncologist) and/or MO (Medical Oncologist). The urologist/surgeon's job is done.

    The surgery failed unless its goal was simply to debulk the cancer and aid urine flow.

    I recommend a cancer center of excellence with experience with prostate cancer. They will be able to coordinate your father's medical needs going forward and provide a team approach to the treatment strategies.

    Did he recover his continence during the healing period? Radiation treatments going forward may stop any more healing recovery in his control.

     
    Reply With Quote
    Old 03-15-2021, 07:37 AM   #6
    Terry G
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Location: Butler PA
    Posts: 177
    Terry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB User
    Re: Doubled PSA post Radical Prostatectomy

    Tina, Sounds like Dad should be seeking out the help of the best Radiation Oncologist you can find. I always recommend finding the best and one who specializes in PCa. If you share your location possibly you’ll get some specific recommendations. A center of cancer excellence is always a good starting point. The combination of an oversized prostate and PCa always presents a more challenging initial treatment choice. In any event his prostate has been removed and your faced with salvage radiation and possibly ADT. The ADT can immediately stop progression and render any remaining cancer cells more sensitive to the radiation. As pointed out the surgeons job is done and new specialists are needed. Most likely additional imaging and testing in your future. As you search this forum you’ll find your Dad’s situation is very treatable and far from hopeless. Good luck and keep us posted. Hope we can offer some help.
    __________________
    Rising PSA:
    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
    Reduced ejaculate only side effect; everything works
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    PSA’s post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4

     
    Reply With Quote
    Old 03-15-2021, 07:44 AM   #7
    Terry G
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Location: Butler PA
    Posts: 177
    Terry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB UserTerry G HB User
    Re: Doubled PSA post Radical Prostatectomy

    Tina, Sounds like Dad should be seeking out the help of the best Radiation Oncologist you can find. I always recommend finding the best and one who specializes in PCa. If you share your location possibly you’ll get some specific recommendations. A center of cancer excellence is always a good starting point. The combination of an oversized prostate and PCa always presents a more challenging initial treatment choice. In any event his prostate has been removed and your faced with salvage radiation and possibly ADT. The ADT can immediately stop progression and render any remaining cancer cells more sensitive to the radiation. As pointed out the surgeons job is done and new specialists are needed. Most likely additional imaging and testing in your future. As you search this forum you’ll find your Dad’s situation is very treatable and far from hopeless. Good luck and keep us posted. Hope we can offer some help.
    __________________
    Rising PSA:
    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
    Reduced ejaculate only side effect; everything works
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    PSA’s post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3, 0.6, 0.8, 0.4

     
    Reply With Quote
    Old 03-15-2021, 08:40 AM   #8
    Insanus
    Senior Member
    (male)
     
    Join Date: Dec 2019
    Posts: 227
    Insanus HB UserInsanus HB UserInsanus HB UserInsanus HB UserInsanus HB UserInsanus HB User
    Re: Doubled PSA post Radical Prostatectomy

    Get Dad salvage RT.

     
    Reply With Quote
    Old 03-15-2021, 11:22 AM   #9
    IADT3since2000
    Senior Veteran
    (male)
     
    Join Date: Nov 2007
    Location: Fountain Valley, CA, USA
    Posts: 3,172
    IADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB UserIADT3since2000 HB User
    Re: Doubled PSA post Radical Prostatectomy

    Quote:
    Originally Posted by CI212 View Post
    My Dad is 75 and was diagnosed with adenocarcinoma prostate ca with a Gleason score of 8 in Nov 2019. His original PSA was 24. He underwent a Radical Prostatectomy in February 2020. At the time of his surgery, his surrounding tissue and lymph nodes were tested and found negative for ca.

    Over the last 5 months his PSA has increased from .4 to .9. Everything I’m reading is telling me he has mets....
    Hi Tina, and Ill add my welcome!


    Some key points have already been made, so I’ll mention other things to keep in mind for you, your dad and your loved ones.


    So much progress has been made in managing and treating prostate cancer in the US, and also elsewhere in the world, that prognosis in the US is outstanding for cases like your dad’s, even with its challenging characteristics. Overall, according to the American Cancer Society based on research, the chances for an American prostate cancer patient to live at least to fifteen years from the date of diagnosis are in the mid-90 percents. That is an average of all cases, from those with very mild prostate cancer to those with widespread distant metastases at the time of diagnosis. The latter usually have a very challenging course, but there is even progress for them. For all the rest, survival at ten years is virtually 100%, even for those with metastases in the general region of the prostate, and, having pulled out the small proportion of the widespread distant mets cases, survival for the rest of us at fifteen years is in the upper 90 percents. Gleason 8 cancer with an elevated PSA at the start makes the long-term outlook somewhat more challenging, but mainly in the extra effort area, with survival prospects excellent; I’m looking at a study from a highly respected center that indicates survival of 95.9% for men like your father at the fifteen year point: Gleason 8 and negative findings at surgery (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2897964/, Table 3). Even if your dad has metastases, as many of the men in that study for the “Gleason 8, negative findings” probably did, chances are at this point that they are not numerous and distant, which means that salvage and spot radiation (or spot surgery by an expert) have a good shot at eliminating them.


    Another point is that your dad is in good company with other Gleason 8 patients who have had initial surgery. That strategy involves a significantly better than even chance that the patient will have a recurrence within a few years, and, depending on the patient’s circumstances, that recurrence will often warrant salvage treatement, usually radiation. However, while your dad probably will need radiation, his initial choice of surgery for a Gleason 8, high PSA case gave him some advantages:

    - There was some chance that the surgery would be curative, about one in three at the five year point in the study I mentioned (Figure 1). For the fortunate ones, that would mean no added radiation plus added androgen deprivation therapy (ADT) for many months.

    - The odds for “high-risk” cases like your dad’s of a “cure” (or at least no recurrence for many years) for the surgery plus salvage approach added to the odds for curative surgery, though apparently not quite as good as modern, upfront radiation, are roughly in the same neighborhood, with a very substantial majority of the initial surgery patients being apparently “cured” and not needing further therapy.


    - Some patients and their loved ones gain comfort in the feeling that “the cancer is out of me and in a jar – problem solved.” While that is often not true with higher risk cancers, which have often pushed a bit beyond the prostate or have sent out micro, undetectable and viable metastases at the time of the surgery, it is a seductive feeling, and, while it lasts, is reassuring.


    - The patient does get the benefit of post-surgery pathology, which means he will have useful clues, especially the pathological Gleason score. Arguably, this is not as much of an advantage today because of modern imaging capabilities, but it can still help future treatment planning.


    - He gained a year and a half for prostate cancer technology to improve, which it is doing constantly and at a pretty fast clip. For instance, my recollection is that at least one new drug has been approved for advanced prostate cancer cases in the past year, and a very powerful form of imaging, G68 PSMA PET/CT, was just approved in the US in December (available earlier in Europe).


    - Unless the patient has a strong analytic bent and is comfortable holding his own with doctors, it is a lot easier for many patients to just follow the urologist’s guidance and not have to deal with weighing advice from competing specialists, especially radiation oncologists. Then, if the surgery is not curative, the urologist is usually more than happy for the patient to move on to radiation, and usually will assist in the process.


    All this is a long way of saying that your dad’s surgery offered some worthwhile features and he should dwell on regret about choosing it. Now it’s time to move forward, probably with salvage radiation.


    Medical research indicates notably greater success when salvage radiation (often with supportive androgen depriavation therapy) is done when the recurrent cancer is still likely small, as reflected in a PSA of about .5 or lower, but with .9, your dad’s current PSA being significantly better than with substantially higher PSA. ADT prior to the radiation will knock the PSA back as it knocks the cancer back.


    Good luck to you, your family and especially your dad.

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
    Reply With Quote
    Reply Reply

    Related Topics
    Thread Thread Starter Board Replies Last Post
    A question on nerve sparing for radical prostatectomy music4ever Cancer: Prostate 11 02-12-2021 12:49 PM
    Radical Prostatectomy OR Plant Based Diet? stephenwilliam Cancer: Prostate 28 12-31-2019 06:39 PM
    Post surgery PSA hmcg7 Cancer: Prostate 4 03-22-2018 04:13 PM
    Had a diVinci radical prostatectomy and regret it oldbeek Cancer: Prostate 1 08-21-2017 09:13 AM
    post radical retropubic prostatectomy urethral strictures feb2409 Cancer: Prostate 6 03-05-2011 05:05 PM

    Tags
    prostate cancer., psa level prostate cancer, psa test



    Thread Tools Search this Thread
    Search this Thread:

    Advanced Search

    Posting Rules
    You may not post new threads
    You may not post replies
    You may not post attachments
    You may not edit your posts

    BB code is On
    Smilies are On
    [IMG] code is Off
    HTML code is Off
    Trackbacks are Off
    Pingbacks are Off
    Refbacks are Off




    Sign Up Today!

    Ask our community of thousands of members your health questions, and learn from others experiences. Join the conversation!

    I want my free account

    All times are GMT -7. The time now is 02:18 PM.





    © 2022 MH Sub I, LLC dba Internet Brands. All rights reserved.
    Do not copy or redistribute in any form!