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PSA still elevated - Post prostatectomy followed by radiation
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PSA still elevated - Post prostatectomy followed by radiation

My husband is 57 years old.  One year ago he had a PSA over over 12, and then down to 8.  Biospy was a Gleason 7.  He was found to have non-functional endocrine pancreatic mass at the same time.  So we opted for a radical prostatectomy  once the distal pancreatectomy was done and recovered for 3 months.   They found the prostate was adhered to the wall of the rectum during the procedure and "shaved" as much of prostate as they could without invading the rectum.  The lymphs were clear.  One month later we were informed that the procedure wasn't clean and intact; and recommended 39 treatements with radiation.  That was completed the end of June.  Mid- August a PSA was drawn and was 1.8.   Upon discussion with oncologist and radiation oncologist it was suggested that he start hormone therapy and the side effects were explained at length.     He just had another PSA done this week and the result was 1.6.   The comments from the radiation oncologist was that he expected that after the surgery and radiation he expected the PSA to around  0.0 to 0.2.
My question is "What should we expect the PSA to be at over 6 months post radical prostatectomy that was followed 6 weeks later by radation and is now at 3 months post radiation therapy? "  

Is it unreasonable to thing we should get a second opinion?

If hormone therapy is started what is the prognosis?  What about is he opts not to have hormone therapy?  

Toni
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242579_tn?1252114771
Could you define "lean and intact." What was your husband's final pathology and TNM staging?
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Avatar_m_tn
By "clean and intact", I mean that they were not able to remove the prostate whole and there was concern by the doctors that they left Prostate tissue adhering to the wall of the rectum.   Pathology reports reads: Right pelvic Lymph node- hyperplastic lymph node tissue - no tumor seen.  Left pelvice lymp node; two hyperplastic partly replaced by fat lymph nodes - no tumor seen;  Prostatic adenocarcinoma, Gleason score VII, predominately pattern IV, partly practice duct adenocarcinoa, areas of perineural invasion present.  Tunor is present on both right and left sides of prostate is is extensively involvinig both right and left lateral inked edges of the specimen.  Negative apical and basal margins of the specimen.  Tumor does not show extraprostatic extension in secions examined.  Neagive right and left seminal vesicles.  
  I don't know what TNM staging means, but the report says:  pT2c, pNO, pMX  
Prostate:  Adenocarcinoma and Prosttic duct adenocarcinoa   Specimens A-C
Primary Pattern Grade 4, Secondary Pattern Grade 3,  Gleason Score 7
Tumor right and left lobe.
Proportion of prostate involved by Tumor = 30%
Margins involved by invasive carcinoma
  Focaility of Margin involvement by Tumor = Multifocal
  Location of Margin involvement by Tumor: Right lateral and Left lateral
Extent of Involvement:  Extraprostatic Extension and Seminal Vesical Invasion- Not identified
Lymph Node Summary - Number Examined = 3
Numbe involved = 0
Perineural Invasion - present
Lymphatic/Vascular Invasion: not identified
Pathology Staging: Primary Tunor: pT2c
Regional lymph Nodes pNO
Weight of prostate 35 grams, 4.5x4x3.8 cm
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