Results post surgery

Hi EJ

Sorry to hear about your dad's situation.

Psa of .03 is obviously very encouraging and makes it a somewhat surprising that they are indicating that there could be some cells left in the bladder.

If that is the case though then there are some good treatments for bladder cancer these days.

Trying to look on the bright side though, it might not be cancer, what are they planning to do now in relation to further tests?

Best wishes

Steve

Hi Steve,

thank you for your kind message. If I’m honest I don’t think my dad is sure if the doctor said 0.3 or 0.03. I imagine it might mean two different things! 

the next steps are that my dad has another PSA test mid February and then if it’s not down then they mentioned giving him some radiotherapy. They also suspect that the size of what is there is approx 3mm but I’m not sure exactly what’s going on...I don’t really understand it/sorry!

I think what’s most upsetting is that we can’t get our head around whats going on. In a sense that firstly the cancer wasn’t there and it was benign, then a little later it was there following the turp procedure. Then the doctor quite rightly gave dad 6 months breather and they did another PSA just before the operation and said it’s contained. And now I’m not sure... it’s very strange and very up and down. Just feel bad for my dad because he only retired just before this all started poor guy haha! No rest for the wicked...

HI EJ

Yes you are right, in terms of psa after prostate removal ,   .3 and .03 , quite a big difference.

Not sure how they would know the size of a bladder tumour without a scan , could be worth pushing for a Mri or CT scan at some stage to see what is going on.

I know that its' easy for me to say but try not to worry too much at this stage, bladder cancer is fairly easy to treat these days if that is what it is.

Steve

#Ej21m

I'm a bit confused about what's going on here myself.  It doesn't appear as if you're being given coherent information.

It's not really possible to say there's still cancer cells there from a PSA of 0.03.  If it were 0.3 however then it is likely.

You must therefore clarify, is it 0.03 or 0.3?

Secondly, even if there are still cancer cells there, it isn't possible to say WHERE they are.

This might be partially indicated by the post operative histology report.  After surgery the removed tissue is examined in path lab.  The report should say if the cancer cells have grown through the prostate wall or not, positive or negative "margins".  You should have been told this.  If you weren't told I suggest you ask.

If margins were positive then it's more likely that cells have been left behind.

If there are cells left behind then it is likely they're at the bladder neck, but you can't really say where they are unless detected by a scan. This would NOT be bladder cancer.    Unfortunately, with a PSA of 0.03 any tumour will be small and a scan can't detect anything less than 5mm in. size.  Probably no point in a scan at this stage.

If any tumour can't be detected and you can't say where it is, then radiation can't be directed at it, so you can't say how successful it would be.

I think that what's currently being done is right.  PSA should be repeated at short intervals to see if it's rising and not rising then falling again.  If it rises on 3 consecutive tests, then this is significant, how high it's rising is too.

If your dad's PSA had fallen to zero, then had reappeared, 0.2 is the level at which it"s classed as a biochemical recurrence.  However, since your dad's PSA doesn't seem.to have fallen to zero, it's known as "persistent".

At this point, if the figure of 0.03 is a bit worrying but not greatly.  0.3 would be worrying.

To put this in perspective.  My PSA after surgery was undetectable for a year, then reappeared, it subsequently rose and fell, rose and fell.  Twice it rose to 0.1, the last time in May 2019, in July it was 0.07.  I had a  CT scan, MRI and bone scan.  No prostate cancer was found.  I am 8 years post operative.

Hi all,

Many thanks for your patience on this. Basically, it's taken me a long time to find out the details gently from my dad.

The PSA result in January was 0.03. And it is a positive margin (3mm).

He will have another test soon, to see what trend there is.

Has anyone had any experience of positive margins? Im unsure exactly what it means. Although I read online if you imagine an orange peel as the prostate capsule that should have no cancer cells on the outside after removal and in this case, there were.

Any advice would be gratefully received 

Thank you!

Mine wasn’t clear post surgery due to diathermy (the tools they used burnt the edges so margin couldn’t be determined).  I suspect the psa was 0.3,  I had a scan which showed where it had spread to.  It is still prostrate cancer even if it’s in the bladder.  Depending on your fathers general health, if of concern then might be offered chemo (I’m 50 and just finished 6 cycles) or possibly might just be given hormone therapy.  The stampede trial shows the benefit of early chemo, but age and health do come into the decision/ choice.

if localised then radiotherapy might also be an option.

Hello

thats a good post.

You also have done your research .

May I ask you when you say undetectable straight after surgery  ,you really mean undetectable on an ultrasensitive test or under 0.1.

I realise you subsequently had ultrasensitive but it seems this can also vary.

I just did a post on biocemical recurrence because I had 0.09 after 6 weeks and now on  May 25th  0.08.

Two urologists are worried,two are "happy".

I have read the Munson book.

Its in the end ones own choice if and when  one does radiotherapy 

May I ask your Gleason score before surgery?

I will see another urologist tomorrow to see his tohoughts.

Hi all,

thank you for all your responses it’s very helpful to understand this more and sorry if it’s been confusing.

Just to be clear the doctor did not feel it was certain that further treatment would be necessary and would do this on the basis of a rising PSA level. 

The results post operation were a positive margin 5mm (not 3mm like I said before- apologies). there were complications at the bladder neck due to a previous turp operation my dad had because they initially diagnosed him with benign prostate enlargement. I believe that’s partly the cause of the confusion but also I believe the cancer had increased and resulted in the positive base margin. 

My dad received his blood test taken in May, which would be a 6 months post surgery.

Just to note, so far his PSA result previous to this: 0.03 Initially and then it was 0.03 again.

Last week he rang the surgery following his most recent blood test (which would be his second one since the operation in November) and the receptionist informed him his PSA result was 0.01. 
 

he rang twice To make sure he heard correctly. 

so now he’s happy and I’m confused and happy...

My initial Gleason score after biopsy was 6, this was uplifted to 7 post prostratectomy,  my psa was 1.1 post surgery with psma pet scan showing mets to ribs.

the ultra accurate tests I’m undecided about, they can concern too soon but can also show acceleration of cancer better than less accurate.

there are at least two different types of pet scans used with psma being more sensitive and accurate. I’m not sure whether I’ll receive another pet psma scan as it seemed reserved for initial diagnosis rather than spread.

anything below 0.1 is low and most consultants well those at my hospital would be satisfied with

all the best for you and your father