PSA rising after Prostectomy

[joylangan]

My husband was dx with Prostate Ca in Dec.05., age 51. He had radical robotic prostectomy in June 06. The Cancer was found to be growing outside of his prostrate during surgery.  All biopsies were neg and his PSA went to 0.0.   Twelve months post surgery his PSA was 0.3.  His last PSA 3 months later is now 0.4.  He is otherwise in good health, no symptoms of any kind.  Eats healthy and exercises routinely.  His doctor said to follow-up in 3-4months with another PSA test.  I am so upset.  Is it normal to have and elevated PSA at all.  I would think this is clearly a sign of Sytemic Prostate Cancer.  Should we be seeing someone else for an opinion.  Do you start any treatment now.  Is there anything we could be doing rather than just wait?
Thank you

[Fernando Roque, MD]

Hi. I would first like to clarify something about the PSA values you posted before I make any comments: what was the unit of measurement given for the PSA value? Nanograms/milliliter (ng/ml) or micrograms/milliliter (ug/ml)?  PSA is usually measured as ng/ml, and the normal value is less than 4.  If your husband’s PSA values were measured as ng/ml, then 0.03 and 0.04 ng/ml are below the ceiling for normal (4 ng/ml) and should not be cause for alarm.  If the values were measured as ug/ml, then the values when converted to ng/ml would be 30 and 40, which are well above normal.

Now a comment on PSA:  No absolute value of PSA will tell you for certain whether your husband’s cancer is spreading or not.  If your husband had a PSA of 30 ng/ml a year after surgery, it does not necessarily mean that his disease is progressing, particularly if he does NOT have any overt symptoms pointing to disease activity (example: hip and back pains, weight loss, disturbance in urinating).  A more useful measurement for detecting disease progression is the rate of PSA increase over time (called PSA Velocity).  He needs at least three PSA measurements to compute this value.  That may be the reason why your doctor wants him to come back after 3-4 months for another PSA test.  

I understand the anxiety that you must be going through. You have a perception that your doctor has not given any treatment after the surgery in spite of the increasing PSA values your husband has been getting.  My advise is to sit down with your doctor and talk openly about your misgivings.  I’m sure he’ll be more than willing to discuss things with you.

[hope222]

my husband had his prostate removed march 2008.  gleason score was 8 and psa was 7.  his psa came back today at 1. and his doctor told him the next time would probably be a 2.  should he wait until his next appt. in february or go see an oncologist now.
thanks

[jackson1945]

I find some confusion in some of the PSA values cited above.  BEFORE joylangen's husband had the radical prostatectomy, he likely had an elevated PSA.  Pre-surgery, 4.0 nanograms/milliliter (ng/ml) would indeed be the "ceiling for normal," though many researchers argue that 2.5 ng/ml might be a better cut-off number. When my PSA reached 4.2, I was dispatched to a urologist, who found a "Gleason 9" (4 +5) on biopsy. That was later reduced to a "Gleason 7 (4 + 3)," after RPP at Hopkins.  The statement above that .03 ng/ml and .04 "should not be cause for alarm" seems quite correct, if made in reference to post-surgery PSA scores. But "4.0" is NOT the "ceiling for normal" when in reference to POST-surgical PSA testing.
      To "hope222" I suggest: be sure your husband's physician did indeed say that your mate's PSA was "1.0," and not "0.1."  POST-SURGERY, there's a whole lot of difference between those two scores.  The surgeons at Johns Hopkins advocate a PSA score of "0.2" as an indication that your husband's body may still harbor some cancer cells, either in the pelvic bed (which might be the target of future radiation done with "curative intent") or metastized already to bone or elsewhere ("systemic" mets).  It's very important to write down the exact figure: if it's indeed "1.0," then the doctor will want to follow your husband closely to see if that score might go down soon (PSA's do fluctuate, some, even from day to day).  In other words, a "1.0" is substantially more a Big Threatening Booger than a "0.1" PSA, after surgery.  But even that "0.1" can be an alarm bell, if it does not go down with the next PSA test your husband has.  
     But don't trust me--I'm a "doctor," but I have a Ph.D. in *English*, and all I know how to cure is colons (for an extra charge, I can also work on your semi-colons).  Just stay in touch with your husband's physician--and, by the way, when you go to the Lab, if you will ask them to send you an actual copy of the PSA test results, they are now required to send those to you.  My lab last week told me that my latest PSA test results would be mailed to me two weeks later--but they showed up in my mailbox after only four days (my doctor at Johns Hopkins still does not have the results), and I nearly had a stroke when I realized what the envelope contained.  (Yes, I'm frightened and anxious about a recurrence, just like most men are.)  This was my third three-month PSA test after radical prostatectomy, and my PSA score is still <0.1, which Hopkins surgeons consider "undetectable."  For now, that's good.  
     All the mathematical figures are mystifying to me (that's why I said, stay in contact with your doctor, and question him or her about the *precise* PSA score, and where it stands on the spectrum between "potential centenarian" versus "you're kicking the bucket." PCa is a nasty disease. But I am working hard to convince myself that, even it the cancer is destined to kill me, I must not let it kill me NOW, by allowing it to cause me to live my remaining days in anxiety and terror.  (I preach that, so far, better than I am able to practice it.)   I hope this helps a little, and I wish all here ... the BEST.

[liberty413]

That was a very well done reponse from jackson1945.  That decimal point on the reading is very important.  My husband was diagnosed mid 2007 and had Radical Prostatectomy in June 2007.  His PSA was not so high - 4.3, but the concern was that it was increasing so rapidly over a very few months.  Gleason post surgery was 4+3=7

Pathology also was good with the tumor confined to the prostate with no invasion into the margins.  Due to previous surgery, the approach was such that lymph nodes could not be harvested so no report on lymph node involvement.

While initial post surgery PSA was good at .04, subsequent follow up tests at 3 month intervals saw the PSA continue to rise whereupon radiation therapy was administered for 8 weeks.  My oncologist said that they like to perform any adjuvant therapy before the PSA reaches 1.0.  (Again note the decimal point)  We are now a year out from the RT,  the PSA has continued to rise, albeit slowly, but the latest is most alarming when it went from .40 to .86 in only four months.

So we are in the same boat.  Just what does this portend as far as metastatic disease and/or mortality?  We are also very worried.

[jackson1945]

     In a separate 'comment' I'm sending, you'll find another post I made  recently, & it relates to the idea of SALVAGE RADIOTHERAPY for one who has prostatectomy & then shows PSAs above 0.2 that indicate that prostate cancer may still be present.  It may've microscopically spread to distant sites even before surgery, & in that state could be undetectable initially.  BUT, it may be simply that the surgeon missed some PCa that had escaped the prostate before surgery, & those cancerous cells are still hanging out in the pelvic area.  If CT & MRI & bone scan tests show NO DETECTABLE DISTANT METASTASES, the doc may suggest SALVAGE RADIOTHERAPY.  It's the only "curative" option left, and *can* be successful.
    Go to: Jackson1945 to Steeler409

[jackson1945]

My earlier post Jackson1945 to Steeler409:  In a separate 'comment' I'm sending, you'll find another post I made  recently, & it relates to the idea of SALVAGE RADIOTHERAPY for one who has prostatectomy & then shows PSAs above 0.2 that indicate that prostate cancer may still be present.  It may've microscopically spread to distant sites even before surgery, & in that state could be undetectable initially.  BUT, it may be simply that the surgeon missed some PCa that had escaped the prostate before surgery, & those cancerous cells are still hanging out in the pelvic area.  If CT & MRI & bone scan tests show NO DETECTABLE DISTANT METASTASES, the doc may suggest SALVAGE RADIOTHERAPY.  It's the only "curative" option left, and *can* be successful, or at the least improve the patient's health & add years to his life.  Something's gonna kill him, but it may as well NOT be PCa!  Best wishes......
  

[doofusthefirst]

Your husband's story is a little like mine. I was diagnosed at the age of 52 with a PSA of 42. My Gleason score was 7. After having my prostate gland removed, my PSA dropped to undetectable. Unfortunately, it began to rise about six months later. Five years later, my PSA was at 15 and accelerating in its rise. I was about to agree with my doctor and go on hormonal therapy when I discovered a Yahoo group dealing with alternate methods of dealing with prostate cancer. They were discussing their experience with a product called Prostasol and I gave it a try. My PS dropped from 15 to 0.3 in a two month span. That was four years ago. My last PSA reading was 0.1.

I am now approaching my 62nd birthday and am in reasonable good health. I still have recurrent prostate cancer but it is held in check.The side effects of the Prostasol are mild. I recommend that you look at alternate methods of dealing with this disease and let the doctor know you are doing it. Most doctors I know though, do not know much beyond what their rigorous training has prepared them.  Prostasol is the only product that I know of that actually works. I have tried about forty other items, Lycopene, aged garlic, tocopherols etc, and none have had any discernible effect.

Good luck

Mike S