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 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.
Ashutosh (Ash) Tewari, MD
This forum is for information only. The contents, such as graphics, images, text, quoted information and all other materials ("Content") are provided for reference only, do not claim to be complete or exhaustive or to be applicable to any particular individual's medical condition. Users should always consult with a qualified and licensed physician or other medical care provider. Users are warned to follow the advice of their physicians without delay regardless of anything read in this forum. The Weill Cornell Prostate Cancer Institute assumes no duty to correct or update the Content nor to resolve or clarify any inconsistent information which may be a part of the Content. Reliance on any Content is solely at the User's risk. This forum may contain health or medically related materials considered sexually explicit. Users are warned that if they may be offended by such Content, an alternate source of information should be found. Publication of information or reference in forum to specific sources such as specific products, procedures, physicians, treatments, or diagnoses are for information only and are not endorsements of the Weill Cornell Prostate Cancer Institute.
Copyright 1994-2018MedHelp.All rights reserved. MedHelp is a division of Vitals Consumer Services, LLC.
The Content on this Site is presented in a summary fashion, and is intended to be used for educational and entertainment purposes only. It is not intended to be and should not be interpreted as medical advice or a diagnosis of any health or fitness problem, condition or disease; or a recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action. MedHelp is not a medical or healthcare provider and your use of this Site does not create a doctor / patient relationship. We disclaim all responsibility for the professional qualifications and licensing of, and services provided by, any physician or other health providers posting on or otherwise referred to on this Site and/or any Third Party Site. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. We offer this Site AS IS and without any warranties. By using this Site you agree to the following Terms and Conditions. If you think you may have a medical emergency, call your physician or 911 immediately.