PSA Persists After RP

Add a Comment

11 Comments

Comment by John Cochrane on June 17, 2008 at 10:00am

Bob:
If I were the patient I would be concerned. I am not the patient.
If the man is in his 70's the doctor may think there is sufficient time to address the disease without significant risk to the life span of the man. Perhaps the doctor is not concerned with the doubling time which appears to be 19 months +/- from first to last measure. This would suggest a few years before intervention if waiting is acceptable to the patient. Perhaps the doctor is the radiologist and he/she likes to wait as long as possible to declare failure for professional reasons, or others. Perhaps the doctor prefers to wait to recommend salvage treatment until some absolute value is reached, not shared with the patient. It is unlikely that the doctor is an oncologist, as I believe testing one or two times a year would not be good practice for such a specialist.
A further biopsy would likely determine his current condition and assist in showing which door to consider next. Any layperson's advice you take from here, including mine is worth what you have paid for it. Perhaps the patient himself should address this forum.

Comment by Bob Shiell on June 16, 2008 at 11:02am

A friend of mine sent the following: Comments from other members would be appreciated.
My wife's mom is concerned about her husbands PSA levels. His doctor does not seem concerned but it is causing them some anxiety. If you would feel comfortable voicing your opinion I would appreciate it. Here is the history.

After radiation PSA levels:
- 0.77 April 05
- 1.3 April 06
- 1.4 Sept 06
- 1.7 April 07
- 2.9 May 08

Comment by Oktay on May 20, 2008 at 12:29pm

how is your cut off value?
we prefer PSA examination six week after RP and if higher than 0.2 mg/dl firstly evaluating for local recurrence or methastasis after then if local recurrence have been ocuured, managing with maximal androgen blocage or RT, if methastasis have been occured managing with only antiandrogen therapy.

Comment by Steve J on May 10, 2008 at 12:54pm

From the Journal of Urology, Volume 179, Issue 5, Pages 1791-1796 (May
2008):

"Risk Stratification for Biochemical Recurrence in Men With Positive
Surgical Margins or Extracapsular Disease After Radical Prostatectomy:
Results From the SEARCH Database."

The study cohort of 902 men had positive surgical margins and/or
extracapsular disease without seminal vesicle invasion or lymph node
metastasis.

At a median of 3 years of followup 346 patients (39%) had biochemical
recurrence.

See, http://tinyurl.com/4at5l3

Comment by PaulC on May 9, 2008 at 9:20pm

A member of the group focused attention on the following paper published in Journal of Urology:
http://www.jurology.com/article/S0022-5347(08)00049-9/fulltext

Two things that jumped out at me from this paper:

• Methodology. I wonder exactly what the authors meant when they wrote, "We performed a retrospective analysis of the records of 902 men treated with radical prostatectomy [...]." I wonder what criteria were used to create the sample: Presumably, all men had no followup after RP went uncounted, possibly implying that the group that was followed was sicker. Also, the breakdown by race sums to 896 men, the breakdown by clinical Gleason sums to 871 men, and the breakdown by pathological Gleason sums to 874 men, so I wonder if different data sets were used for various retrospective analyses.
• Unremarked anomaly. There was an enormous percentage of men whose clinical Gleason sum (cGS) was adjusted upward at pathology (pGS):
  • cGS of <7 ..... 526 men (60%) pGS of <7 ..... 283 men (32%)
  • cGS of 3+4 .... 208 men (24%) pGS of 3+4 .... 384 men (44%)
  • cGS of 4+3 .... 69 men ( 8%) pGS of 4+3 .... 93 men (11%)
  • cGS of >7 ..... 68 men ( 8%) pGS of >7 ..... 114 men (13%)

Comment by PaulC on May 8, 2008 at 8:17pm

Biochemical recurrence, as I understand it, means inferred recurrence of cancer based on biochemistry alone. In other words: When all other tests return negative (imaging, symptoms, physical exams), but PSA is still detectable, there is a presumption that prostate cancer has returned. The presumption becomes stronger as PSA rises.

Comment by Burt on May 4, 2008 at 7:26pm

Dear Arnon and freinds,
I just read in the Rotary Magazine in an artricle to give an overview of options for prostate cancer that 35% of men treated surgically have what was called "biochemical recurrence". Could this be interpreted to mean that those of us sitting on very low numbers that pop up 3-4 years later like my 0.2 are coming from other sources? I had not seen this term before.

Comment by Burt on April 14, 2008 at 10:55pm

When do you recommend CTC test?

There is also a product in dentistry where you can stain what appear to be possible oral cancers and then place a special light that make any cancer leisons illluminate. Have you ever thought of trying a cell staining/finding technique to go in and find the remaining cells if they are there with a technique like this using Lap or DaVinci? Im sure you could find some guinea pigs in some of us faithful followers
Burt

Comment by Thomas Day on April 13, 2008 at 3:36pm

I did not know that test was available I had radiation and my psa was still elvating.

Comment by Arnon Krongrad, MD on March 30, 2008 at 11:13am

Paul,

Several reactions:

1) PIN is very common. It has meaning on biopsy (correlates with SV involvement) but less meaning on final path.

2) There are other sources of PSA. Check out The Major's PSA for some discussion.

3) If you know others who are in your situation please invite them to this PSA Persists After RP group. You're a small bunch and you might want to get to know each other.

• 1
• 2