A good story.

In 2008 when I was 44 I found out I had prostate cancer. The biopsy indicated Gleason 6 and my psa was 4.1
When they did the robotic surgery it turned out that I had Gleason 3 4 (7) and the cancer was about 1mm from escaping the capsule and they couldn't guarantee it hadn't. Initially I did the ultra sensitive psa's and every 3 months I would look at my score ranging from .023 to .049 and freak out about every slight rise in my score the next test it would often drop again. After 5 years of staying under .1 I decided to go with the standard PSA test and now I don't agonize about the numbers so much other than its been staying under .1 Anyway I'm 9 years out now and still cancer free. I worry like crazy each time I do my test but I just wanted to tell you that these surgeries are often successful and it has certainly worked for me. Best of luck to all of you.

Nice story, thanks for posting

Very cool. Congrats and thanks for sharing!

Jumpy_Wolf said...

JackH said...
That's a great story about what has repeatedly been labeled "PSA Anxiety," and the over-use of the ultra sensitive PSA test in men with both favorable-risk clinical cases and favorable post-surgery pathology. The ultra sensitive, 4th generation, PSA test has got benefit for men with at least one of the indicators for its appropriate useage, but is a bane to those whose surgeons take a one-size-fits-all approach and prescribe it irregardlessly. Sorry you had to go through that.

JackH-Out of curiosity, what would be an indicator to have an ultra sensitive? I'm about to have my first post-op PSA test(6 weeks), and of course I'm pretty anxious, primarily due to the +margins in my post operative pathology.

Either unfavorable-risk-of-recurrence clinically, and/or unfavorable post-surgical pathology, as I previously mentioned (the flip-side of what I wrote, above, now in red). Either one is an indicator. You've had (at least) one—unfavorable post-surgical pathology (I don't know about your clinical status, but it doesn't matter much now)...I believe your surgeon will likely (and should), therefore, prescribe the ultrasensitive PSA test for monitoring for you.

Unfortunately, the positive margin already burdens you with anxiety...going forward, you should monitor closely with the ultrasensitive PSA test. Not all cases are alike, however, and I believe (fortunately, most but not all good surgeons do, too) the one-size-fits-all approach to the ultrasensitive PSA test is inappropriate.

good luck



PS: Do you know if your positive surgical margin was an accidental cut by the surgeon? It happens. It seems like we've had in inordinate number of Dr T patients here with what's called an "iatrogenic positive surgical margin." He's got some unique surgical techniques which may generate these. He may or may not have told you it was accidental...if it was, your risk of progression is less than if the margin was caused by disease extension, but it is still greater than if that hadn't happened. The ultrasensitive PSA monitoring test is still appropriate.

Post Edited (JackH) : 2/12/2017 11:33:59 AM (GMT-7)

Happy for you!

Bobby Mac

That's an interesting combination of words: prostate margin positive, and final surgical margin negative. I'd be curious on an unambiguous clarification of exactly what each of these mean independently while used in combination in the report. Would you mind letting us know what you find out in your follow-up meeting?

Henry Ford Hospital only takes PSA to one decimal point. They say the ultra sensitive tests are a waste of money and can lead to unnecessary worry.

Good for you!! PSA anxiety is real and I'm for anything that reduces that.

Good luck,
Tom