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Rapid rise in PSA only 4.5 months after Prostate surgery

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Posted 3/20/2021 8:05 PM (GMT -5)
Big John, I'm sorry about this recent turn and wish you great success with treatment!

There appears to be an error in your post-op pathology data. Perhaps you can check your signature against your copy of the report. Your signature states your final path staging as pT3a, which would be correct if there had been just extraprostatic extension. However, it states that seminal vesicle invasion was found. This puts your staging as pT3b. Is there a typo on your part or the pathologist's?

Djin
Posted 3/21/2021 7:51 AM (GMT -5)
Stage pT3a pN0 R0

Thanks for your help it’s very much appreciated
Posted 3/21/2021 8:19 AM (GMT -5)

Hello, Big John ~~~

Always good to share an update here.

Time to get the boxing gloves on and step back into the boxing ring.

I agree with others ---- make sure you have a proactive oncologist looking after you and your case.

I have been on continuous ADT since diagnosis, back in 2013.

Make certain that you are on a very regular PSA testing schedule. It's not always fun, but it's what many of us need to do to track PSA trends.

You mentioned stepping back from ADT for a year --- was PSA tested regularly during that time?

Also --- make certain you ask your doctor to place an order for a testosterone test, when you do PSA tests and labs. You need to make CERTAIN your form of ADT is adequately suppressing the testosterone level to a high degree, to help control the PSA levels.

In my case, my oncologist discovered that LUPRON was not fully suppressing my testosterone consistently. My urologist had failed to request testosterone tests --- a major oversight.

My oncologist discovered "spikes and flares" in testosterone --- which resulted in spikes in PSA.

In my case, a change in ADT was needed -- so FIRMAGON was tried, and then ZOLADEX.

In my case, ZOLADEX worked best --- proven by greatly lowered testosterone levels and more stable PSA levels. I found out that changing to different types of ADT --- if it is warranted --- was easy to do.

My lesson learned? Any fellow on ADT should request an occasional testosterone test --- it can easily be done along with one's usual labs. If your testosterone levels are consistently low, then your form of ADT is doing all it can.

Keep us posted --- let us know what your oncologist suggests, going forward.

Here's to new treatment success!
CYCLONE ~~~ # Iowa State University
Posted 3/21/2021 8:39 AM (GMT -5)

Big John said...
Stage pT3a pN0 R0

Thanks for your help it’s very much appreciated

I believe that may be incorrect: spread to even one seminal vesicle (SVI) would be pT3b and not pT3a. I would clarify this at your next visit. There are several points: (1) which is the actual error, the SVI finding or the 3a staging? (2)There is no "Present" or "Absent" after "Extraprostatic extention:" (3) Are there any other errors in the report?

(I assume the SVI is correct and the "3a" is wrong, since there is a slide reference for this finding. However, one shouldn't be making assumptions about a post-op path report, which is a crucial part of treatment decisions)

IMO the whole report should be reviewed for accuracy and corrected by the lab that issued it.

Djin
Posted 3/26/2021 7:01 PM (GMT -5)
Thank You for your encouragement ... they will have me doing PSA tests every 3 months and also checking my testosterone.
Posted 3/30/2021 2:18 PM (GMT -5)
BobbyMac & Steven S have both recommended the newest scans to see if you now have:
"Oligometastatic Prostate Cancer”.

A friend of mine has been able to have a couple of "hot spots" zapped on two different occasions over last
three years to keep things under control..."without ADT" so far.

I re-recommend that you check on this before starting up ADT again.
Mike
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