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Newly detectable, 9 years post-op

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Posted 10/4/2024 6:38 PM (GMT -5)
I got some bad lab results today.
My prostatectomy was in 2015. Original 3+4=7 Gleeson was downgraded by the path report to 3+3=6. That was good news. The not-so-good news was I had margins.
But from 2015 through 2023 I was undetectable according to the older < 0.10 method.
As of 2023, my Uro changed the scale to one of a higher precision. My result was given in 2023 as < 0.04.
Since I got a "less than" and not a number, I was still technically undetectable.

Tonight my new result is 0.05, given as an actual number, not a "less than"....which to me means "detectable" under the higher precision method.
I have not yet had a chance to discuss results with the Uros but I wanted to check in with the gang here to see if anyone has had a similar borderline-hugging result after 9 years. I do not want salvage radiation. The prostatectomy I had was nerve sparing, and I have had a pretty good post-op life in terms of peeing and sex.

My profile needs updating: I am now 66 years old. Prostatectomy was September 11, 2015.
I'm considering taking no action if the PSA doesn't leap dramatically.

Does a 0.05 PSA after 9 years constitute a true and present danger?
Has salvage radiation gotten any better? As of 10 years ago, it seemed dicey in terms of Quality of life.
Posted 10/4/2024 8:32 PM (GMT -5)
At first glance, the PSA change isn’t YITBsignificant and certainly on its own does not signal a recurrence. And if you were a true G6 and all your prostate was removed, you should have nothing to worry about as G6 does not metastasize.

Today, the next step would be to have one of the more sensitive scans to detect any PCa activity in the prostate bed, or elsewhere. But, these scans only become dependable when your PSA is in the 0.50 vicinity. So you are a long way off. And by the time you get there, the chances that cancer would be limited to the SRT field would be less likely. In the best of circumstances, SRT is only curative in some 50% of situations and usually very proximate to the surgery.

So what to do? Keep testing, perhaps quarterly, to see what, if any, upward trend develops. If it does, then determine what actions to pursue. As to SRT, it is improving. The real problem is that without a prostate to absorb some 95% of the radiation, as is the case with primary treatment, SRT instead radiates them bladder and bowel looking for tiny specs of cancer that may or may not be there. Thus, the more significant negative treatment induced side effects

.
Posted 10/4/2024 8:44 PM (GMT -5)
Hello - There seems to have been a few similar threads lately so you may want to go down the list of posts and check some out that sound similar.

Obviously, any measurable PSA after surgery always raises questions and the more sensitive testing just alarms men earlier as nothing will be considered until >0.10. Sort of like a sign saying road construction 10 miles ahead, clear and present danger? Not quite yet.

The current thinking is PSA > 0.20 is where recurrence is defined after surgery. There are the PSMA pet scans now that can detect prostate cancer at low PSA levels but they are not very reliable at 0.20 but can still be considered.

I think you will find that salvage radiation is not nearly as bad as it was years ago. I had adjuvant radiation shortly after surgery (2019) and I did not have any unexpected side effects. There is always some risk but it seems less now with modern technology and more experience.
Posted 10/4/2024 10:42 PM (GMT -5)
I miss my GP. He was a cool guy and I liked him a lot because he just had a way of calming me down no matter the reason for my being there. He was soooo cool about all of my concerns. He seemed to really know his stuff and I know that he was a “student of medicine” until he retired. He never failed to allay fears. Not once in 25 years did I ever leave his office not feeling better about my “situation”. I called him “Dr. Cool”. 😎

But, I’ll never forget that one time I went into to see “Mr. Cool” for some reason or another. And when he walked into that examination room, his eyes were the size of silver dollars. He was sweating and began pacing back and forth while rubbing his hands through his hair. So I asked him, “Are you OK Doc?” And he told me (and I will remember this with fondness as long as I live)…He said, “No. I’m NOT OK. I had to start high blood pressure medication and I don’t know what I’m going to do about it”. That whole visit was nothing but a therapy session for him. I’d even forgotten what I went in for.

One thing he did say that always made me laugh and never failed to put things into perspective for me. He’d always say to me, “Dave, you just need to accept the fact that it’s only going to get worse from here”. lol. It may sound depressing, but…when accepted, things suddenly don’t seem so bad. I think it helps me because it brings me back into today. And, at least for tonight, I’m “OK”. 😊. (Except for this PSA test I have coming up. They always seem to evoke what I like to refer to as “acute” anxiety. lol)
Posted 10/4/2024 10:46 PM (GMT -5)
Good luck with your uros.
Posted 10/5/2024 9:36 AM (GMT -5)
Native,
You’ve had a very good run so far, and no matter where the current path takes you, I would predict that you still have a very long ways to go.

Island Time said,
*** “Dave, you just need to accept the fact that it’s only going to get worse from here”. lol. It may sound depressing, but…when accepted, things suddenly don’t seem so bad. I think it helps me because it brings me back into today. And, at least for tonight, I’m “OK” •••

Very well said my friend. I find myself reminiscing for the good old days of “only” having to worry about the state of my prostate cancer. Yeah, things only get worse, but the health crap going on after I passed 60 is a real cluster ••••.

Nevertheless, when I bed down at night I usually say, well I made it through another day and I’ll probably still be here tomorrow and the day after that. Things don’t seem all that bad.

I’m sure I would have liked your GP too.

Take care
Posted 10/5/2024 3:32 PM (GMT -5)
The good news is--your uptick is barely an uptick. There probably isn't anything there that a scan could find.

The bad news is--you've had an uptick. It might or might not mean anything.

Solution to both the good news and the bad news? Get another PSA in 3 months. Then, another one 3 months after that. Watch and see.

You've got to be a LOT higher-->0.2 or more before a scan can see it.
Posted 10/6/2024 6:10 PM (GMT -5)
Thank you all, my friends!
Your support means the world to me.
Posted 10/6/2024 10:42 PM (GMT -5)
Native, sorry for the uptick. I had prostatectomy in 2007. You can see my numbers in my signature. In 2015 my Psa was .06 and my urologist said it was time for SRT. I know that is early. I had 35 treatments with no side effects. I rang the bell and my RO said “David I think you are done”. God has been gracious and I am still <.006 in October 2024.
Posted 10/7/2024 10:47 AM (GMT -5)

island time said...


One thing he did say that always made me laugh and never failed to put things into perspective for me. He’d always say to me, “Dave, you just need to accept the fact that it’s only going to get worse from here”. lol. It may sound depressing, but…when accepted, things suddenly don’t seem so bad. I think it helps me because it brings me back into today. And, at least for tonight, I’m “OK”. 😊. (Except for this PSA test I have coming up. They always seem to evoke what I like to refer to as “acute” anxiety. lol)

Dave, I feel you on this. I realized a while ago, hey, something bad is gonna happen at some point in the future, and at age 73, probably not the too distant future. So just deal with it, accept it. Not gonna say I don't get nervous around test time (I have a ct scan coming up Thursday, repeat Urogram to check a large cyst on my kidney that was found a year ago as an incidental finding, and I have butterflies), but it becomes easier to deal with stuff, when you just accept the fact that your getting older and sh!t is gonna happen.

Maybe we will finally meet up in Florida this year? (if there is a Florida)
Posted 10/7/2024 10:53 AM (GMT -5)
Native.... I also had surgery in 2015. I lost the < after 2 years, went from <.02 to .02. I was g7(3+4). I increased testing to every 3 months and at 3 years with a steady rise, I was at .08. At that point I was advised by 2 prominent RO's (my surgeon disagreed) to take action. I did, and so far, 5 years later, I am still undetectable <knock wood>.
As with Mumbo, I feel the side effects of salvage radiation are much less of an issue with today's technology. I actually researched facilities before making a plan, speaking to the chief technologist at MSKCC Long Island about the machines they used and how new and current they and the software was.

I had very few side effects, to this day. I had more side effects (albeit temporary) from the hormone therapy. But today as a g6 or g7(3+4) you probably won't be recommended for hormone therapy.

For now I would just continue to retest, but I wouldn't wait until the traditional .2, to define recurrence.by then it may be out of the prostate bed. Look for a clear and discernible trend, and when you see it, act.
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