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How high can the PSA safely go post surgery before further action

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Posted 3/18/2009 12:34 PM (GMT -5)

My husband had a PSA of .07 four months after surgery. Four months later it had risen to .1; 3 months after that to .12. How high is it safe to go before further action such as radiation is taken? I have read that .2 is the cutoff point although doubling time is also looked at. Needless to say, we are concerned.

 Any shared personal experiences or Dr. opinions would be greatly appreciated!

Posted 3/18/2009 1:02 PM (GMT -5)
Hello and welcome here, Oceanwave. Glad you found us and now a part of us. What would help would be if you could post some of your husbands stats related to his Prostate Cancer, make a signature at the bottom of your post. What was his post surgery pathology report like? What was his final Gleason score and tumor designation?

Some doctors, after PC surgery, would use .1 as the point to consider a second treatment, but others would still watch and see if it went higher yet. Some more information here would help with the opinons.

David in SC
Posted 3/18/2009 5:38 PM (GMT -5)
I've read a couple of studies that indicated the sooner a 2nd treatment was started the better the outcome. I believe this was related to ADT3 and not radiation or another salvage method, but I think it would make sense for all secondary treatment options. You want to stop the cancer when it's at its weakest.
JohnT
Posted 3/18/2009 6:34 PM (GMT -5)

Dear Oceanwave:

I can understand your concern.  I understand that .2 is the "cutoff" but, as you say, doubling time is an essential issue.  I have posted a couple of links below that may be helpful as you examine your options:

http://www.communityoncology.net/journal/articles/0304191.pdf

http://www.phoenix5.org/Basics/psaPostSurgery.html

Tudpock

Posted 3/18/2009 7:40 PM (GMT -5)
My psa post RP has risen from less than 0.1 to 0.6 over the last 12 years. My Gleason was 2+1. (Lower than the average psa of 3+3) I have not had any further treatment so far. (advice from two urologists) A friend who had a rise post RP from 0.5 to 0.8 in 3 months (Gleason 3+4) after 5 years post RP just had a prostascint scan which indicated a nodule in the prostatic bed. He is now undergoing radiation treatments. Check the prostascint scan information with a web search. You will find out that the scan is more definitive when the psa is above 0.5. My friend felt relief that the cancer was identified in the prostatic bed.(Local recurrence) The scan did not show any other possible cancer sites in his body. Keeping a close watch by graphing the psa has help me deal with the recurrence.  Best wishes,Al
Posted 3/18/2009 7:57 PM (GMT -5)
Oceanwave

I started additional therapy 6 months after surgery, when my PSA had risen to .08.  Even before the rise, my surgeon and oncologist had suggested this, due to my positive margins.  As others have mentioned, looking at the pathology report is one key, and discussing this with your surgeon is another. 

Good luck

Posted 3/18/2009 9:31 PM (GMT -5)
Hi Oceanwave,
My psa stayed good, <0.04, until my 3 year point and then it was 0.07 and rose to 0.1 back in September. It was rising .01 every 3 months which comes out to a 15 month doubling time. My surgeon referred me to my Radiation Oncologist and he advised to start with salvage IGRT. He said, and I have read several studies that confirm, the earlier the better with the Radiation. I finished mine 1/14/09 with very little side effects. Now all I have to do is wait and see if it was successful! If I were in your place I would have a radiation consult. I know all of this is a crapshoot but I want to be in the game. Good luck to you and be proactive.

David
Posted 3/18/2009 10:12 PM (GMT -5)
Hi Oceanwave,

The magic number is usually determined by the individual physician. I am sure it is probably based on PSA level at time of diagnosis, post surgical Gleason scores, and the extent to which the cancer had spread, if any. Obviously, if the cancer seemed to be aggressive, you would want to start subsequent treatment as soon as possible. It is imperative to make sure you and your physician are on the same page so he will be as aggressive as you want to be.
Best Wishes,
Dave
Posted 3/25/2009 9:24 AM (GMT -5)
My uro said as long as PSA in < 0, not to worry.  Before you start kemo or radiation, get a second or third opinion.

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