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PSA two years after robotic prostatectomy
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PSA two years after robotic prostatectomy

My husband had surgery 2 years ago with a Gleason score of 7 (4/3).  A recent report he obtained said it was 8 (5/3), though this was not mentioned to him.  The cancer cells were outside the margin and he was originally told he may need to follow up with radiation if his PSA got to .2, that research indicated it was not beneficial or necessary before that reading. He faithfully checks his PSA each month. It has been 0.00, 0.02, 0.04, 0.07, 0.02, up and down until the last reading of 1.1.  My first question is why can the PSA go up and down?  Is this reading still 'undetectable'? This word is thrown around, but it seems to me that undetectable means 0.00.  The doctors seem to disagree about the need for radiation at this time. It is very disconcerting to have respected doctors have differing opinions and to try to make an educated decision about what to do.  
Secondly, a side-effect of the surgery was that a staple punctured the urethra and caused a stone, which was finally removed a year later.  Almost six months after this stone and staple removal, the symptoms appeared again and my husband had to have a second surgery.  This last one (about 5 weeks ago) was less successful in that the stone was removed but no staple.  Is it possible to have a stone form without a staple?  The doctor said there was no staple seen during the surgery.  Now symptoms of urinary frequency associated with lesser flow are beginning again.  The doctor said that just having the procedure may have initially helped his urinary flow.  He is unsure of how best to handle this newest onset of symptoms as it is very painful.  Do you have suggestions?
Thank you.
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Thank you for your question. In addressing your first question, "why can PSA go up or down?" is the result of several factors. PSA variation can be due to lab variation (going to a different lab or mishandling of the specimen after collection), positive surgical margins after surgery could also be a factor.

Secondly, the term undetectable is limited by the sensitivity of the test. That is the ability of the test to detect a certain level of PSA in the blood. For example, if you have a thermometer that only outputs whole numbers (75 degrees let's say), it would be impossible for you to determine if it was 75.9 degrees or 75.0 degrees outside. Likewise if a PSA test is sensitive only to the 0.01 level, values less than that would be considered "undetectable." There is published literature suggesting the benefit of ultrasensitive PSA testing for patients at risk for PSA recurrence after curative therapy.

With respect to your third question, it is not surprising that stones would form because of the obstruction. A cystoscopy may be warranted to better diagnose what is going on, as details of an X-ray may not paint the entire picture.

Sincerely,

Ashutosh (Ash) Tewari, MD

http://www.cornellroboticprostate.org

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