Continuing high PSA after prostatectomy

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I am having a devastating experience following prostatectomy 3 months ago for Gleason 8 PCa.  My first PSA test, repeated twice shows a PSA around 4ng.  I know that a level >0.1 ng is biochemical failure.  I have been sent for PSMA PET, a molecular imaging scan.  A level of 4ng is what clinicians might see 5 years out with rising PSA and metastatic disease. To have it now strongly suggests not future but present metastases as far as I can evaluate as a non medical person. And hence the prospect of only a few years to live. Has anyone else experience of PSA persistence  of this type or seen it clinically. What was the prognosis?

  • Sorry to hear about your PSA after prostatectomy PatBe.

    It is not easy to deal with. 

    What was your post op histology? e.g. positive margins, negative margins, seminal vesicle involvement, staging.

    Ido4

  • Hi PatBe

    Sorry to hear about the PSA level, but it sounds as though your team are following up with further tests. Try not to worry too much as you can still have hormone treatment and salvage radiotherapy.

    Yesterday is history, tomorrow is a mystery and today is a gift.
    Seamus
    (See my profile for more)
  • Thanks for replying ido4.  It was; negative surgical margins, negative seminal vesicles and negative local lymph nodes, Stage T1c, no extracapsular extension, T1, N0, M0.  But it seems the staging was incorrect now.

  • Thanks for replying Seamus47. I will have a look at your profile 

  • Hi PB

    Sorry to hear of your situation but your comments of only a few years to live is probably not correct.

    There are still plenty of different treatments out there , hopefully you will be stating on hormone therapy follwed by Radiotherapy soon.

    Must have been a few rogue cells left behind during surgery but no reason to presume that it has metasised.

    What was the Psa just before surgery?

    Best wishes

    Steve

  • That’s a hard one to deal with. The PSMA PET scan will hopefully clear up what’s going on.

    It is the most sensitive PET scan for prostate cancer. I had an F18 choline PET scan at the end of 2016, nowhere near as sensitive but it still picked up things.

    Are you in the UK? If so I would recommend having a chat at a Maggie’s centre if there are any near you.

    They were very helpful at putting things into perspective for me and giving me coping techniques.

    We’re all here to help. When is your scan scheduled?

    Ido4

  • Hi Grundo thanks for that.

    it was 17ng before surgery. So I guess only 13 of that was as a result of the normal and prostate cancer in the organ

  • Fingers crossed that the PSMA doesn't shown anything sinister, with a still lowish psa hopefully it's still in the prostate bed area although I know histology doesn't show that.

    Steve

  • Hi Ido4 thanks very much for your helpful words. I am not based in the UK so cannot use one of those centres.  My scan is on 2 April.  One major concern I have is the effect on my work. I was onsick leave for 6 weeks only recently. 

    Did you have radiotherapy and were you able to continue working through it?  Also has anyone else worked during radiotherapy?

  • Thanks Steve. Yes it is mysterious that I showed negative surgical margins and no local lymph node involvement - unless of course it is located in my bones. Whether you can have metastases without any local spread is something I have not been able to find any information on.