PSA INCREASE POST RP

Thanx Barney for my post’s only forum contribution. While the 0.01>0.03 over the three recent PSA tests was not that alarming to me the GP action was. She had, I thought, got it from somewhere. Today I attended my Urologist/Surgeon referral. Until this my 5 and a half years post-Open Radical Prostatectomy PSAs had all been 0.01 but for one out of character 0.02 in the middle. The 0.30 to7.5 range still on the latest pathology and your forum post left me with an impression this referral was likely an overreaction. Google indicated less than 0.05 was “undetectable”. That further PSAs should follow and if results continue to rise referral, C/T, Bone or PET scans could be involved and that could possibly lead to radiation or hormone therapy. My waste of a day and expense of a urology consultation turned out to be a social get together with my former surgeon. He said anything under 0.2 was very OK. Bone, C/T and PET scans are old hat and if PSAs continue to rise a new PSMA, specific to Prostates, is currently the next step. He almost guaranteed me that going from age 72 to 78 post-surgery to where I am today I was very statistically going to die from something else before significant PCa would return. It’s a shame GPs don’t have access to information sources that prevent this initial stress and waste of effort.

I believed from my scant pre-op knowledge that surgery removing the gland that had not spread it’s malignancy would be the end of it. Learning post-op that the incontinence would go on forever and a prospect the PCa could still re-emerge in bones or other organs and ongoing PSAs in that regard were concerning. With all I have learnt from this forum and my post-op life I still would have gone down the surgery path. I would have resisted the Dutasteride and possibly the Alpha blockers. I should have waited for the robot. That’s a difficult one for I thought that was where I was. I definitely should have done a lot more research. Not so much Google but definitely a lot more use of Forums like this. Anyhow so long and hopefully no more contributions to the “Prostate Cancer” or “Prostate Problems” discussions.

Barrie H

By sheer luck I am online just after your recent post.

Your urological surgeon's claim that "anything under 0.2 was very OK. Bone, C/T and PET scans are old hat and if PSAs continue to rise a new PSMA" is correct for RT patients.

The well oiled "undetectable" hoped-for result is sometimes achieved for surgery patients soon after surgery, but not for RT patients.

If the PSA over time rises, the issue is HOW concerning is the rise? A rise per se is not the be all and end all. And I agree that if there is a rise then a PSMA PET CT is the way to go. I am in Australia and had a few of these at $1,000 a go. Not covered by Medicare or insurance. BUT it is wonderful as it has ONE JOB ONLY - to detect the existence and spread of prostate cancer.

Regardless of cost, if the PSA is not moving up, there is no need for such a scan. In fact my PSA is undetectable and since it has been that way I decided to save money by not seeing the urologic surgeon. After all, what can he possibly tell me other than "good work, keep it up". I have better things to do with a lazy $300 for a consult.

Let me correct one of your assumptions: robot assisted radical prostatectomy does not of itself guarantee a better outcome than open surgery. In fact I know this to be the case from speaking to a general surgeon who at 70 had open surgery because he could find no article claiming the results would be better by virtue solely of using a robot.

The KEY to a good outcome or as I say, "the best possible outcome given what the patient can control", is the skill of the surgeon. For instance, a surgeon who has done 500 open prostate surgeries should expect a better outcome from an open surgery than a surgeon who has done 20 robot surgeries and is preparing for another robotic surgery.

Thanx again. I appreciate your view on open vs robot assistance. I have only my experience against the outcome of others I have conversed with. It's chalk and cheese on that comparison. I will always feel I should have investigated better and at least postponed for the robot. Like many things with Prostates there are so many options and choices. When your outcome is the worst you naturally think the input was not that great. Thanks again BarrieH

You wrote: When your outcome is the worst you naturally think the input was not that great.

This is not strictly true.

I had brain surgery a few years ago.

Researched it very much.

Flew overseas for it.

Had a great surgeon (by reputation, skill and feedback).

The tumor was removed.

But the surgical team cut an artery. I had a major bleed in the brain.

A couple of years later, all was good.

Moral of the story: one can research until the cows come home etc. But one cannot allow for matters over which one has no control. In my case, the bad judgement of one of the trainees in the operating room who cut the artery. I mean, who knew there would be a trainee? Who know that trainee's name when the surgery was booked?