PSA rising 18 months after prostectomy

[judyumcer]

I husband had a robotic prostectomy 18 months ago. All post op PSA tests have been undectable until last week.  His PSA came back @ 0 .13    Of course, we are scared out of our wits. Never expected this. Digital exam felt nothing. His doctor at Mayo Clinic wants to retest him in  3 months.  What are we in for?  J & J

[Ash Tewari, MD, M.Ch.]

Thank you for your question. Your husband had radical prostatectomy about 18 months ago. Some questions to ask that would be relevant to your inquiry are 1) what was the final pathological stage and Gleason grading of the tumor 2) what was his PSA prior to the surgery 3) where there any positive surgical margins (tumor at the inked margin) reported on final surgical pathology?

The definition of biochemical recurrence is generally between 0.2 - 0.4 ng/mL.

The decision for a course of action after this single PSA test will be dependent on the answers to the questions above. For example, if your husband's final surgical pathology showed a Gleason 3+3, T2a (tumor confined to one lobe, less than 50%, negative surgical margin), laboratory contamination may come into play.

A followup schedule should be discussed with your urologist and possibly a medical oncologist.

Best,

Ash K. Tewari, MD

www.cornellroboticprostate.org

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[sugardown]

someday I should learn how to spell   "prostatectomy"   sorry

[sugardown]

Yup,  in  radical prosectomy by surgeon or robot , it isn't unusual.  The reading of
0.13 seems low to me.    I am sitting here with 5.1 which came way down and they tell me .  I am being checked every 6 mo. on PSA  here ;
it is non-agressive goin nowhere, so far, my urologist says.  You are under the best of care it sounds like.
Happy Day to you guys.

[judyumcer]

A new PSA score came back today.  It is now 0.2   Upon rectal exam; no masses felt.  It was smooth and nothing felt by digital exam.  What does this mean? Judy

[Ash Tewari, MD, M.Ch.]

Given the final histopathology, metastatic disease is unlikely. Although the chance of micrometastatic disease that wasn't picked up on an initial bone scan is possible. A Gleason 7 is not indolent disease. A retest should be performed in the coming weeks.

[judyumcer]

Thank you for answering.  His gleason is 7 on one lobe only (R)  PSA 7.1 one month before the surgery.  Tumor type was 2B on R lobe. L lobe was negative.  No cancer cells at the margin.

[judyumcer]

Thank you for your positive notes.  My husband feels find and certainly hasn't lost any weight!  His incontienence is finally subsiding.  After 18 months; no more diapers or pads. Occassional leakage rarely.  It all takes time and a good frame of mind.  God's Blessings!  Happy Thanksgiving! J & J

[judyumcer]

Where did you  read this?  Oh, we hope it is true!  Anybody else have any knowledge of this or experience???  Thanks, Judy

[sugardown]

I just read where that is normal.