PSA. after surgery.

I'm not sure if it was Covid related ? In terms of a delay in the timeline , or whether the surgeon  felt that when performing the operation he commented I was clear of any potential spread to the lymph area around the  prostate>

I also assumed that he'd had the biopsy back before I had my six month PSA and was reassured that this confirmed the cancer was contained and had not spread out of the prostate ? 

I will post the question to him though on my next visit.

Thank you so much. Its complicated stuff this. Here's my pathology report:

MICROSCOPY
This radical prostatectomy specimen shows acinar adenocarcinoma, Gleason score 3+4=7 (approximately 90% Gleason pattern 3).
The tumour is present as bilateral nodules, with a dominant nodule estimated to measure 20mm in maximum diameter, located in the right posterior quadrant. The focus on the left is minimal, much less than 1mm in diameter.
Estimated tumour volume: 1.25cc (5% of prostate volume).
No extraprostatic spread is seen.
No bladder neck invasion is seen.
No invasion of the seminal vesicles is seen.
No lymphovascular invasion is seen.
Margins: The apical and base margins are clear. The circumferential margin, where sampled for frozen section, showed a 4mm positive front, right posterior, towards the base, as reported at the time. The tumour also abuts the diathermied circumferential margin immediately anterior to the frozen section site, right posterior, over a 4mm area (slide A12).

The separately submitted proximal right neurovascular bundle sample shows no involvement by prostatic carcinoma and the true surgical margin at this location is therefore regarded as clear.

DIAGNOSIS
Prostate, radical prostatectomy:
Acinar adenocarcinoma, Gleason score 3+4=7
Margins: Apical and base margins clear. Circumferential margin positive over a 4mm area within frozen section (but right neurovascular bundle negative) and a 4mm area adjacent to frozen section site (right side, tumour showing diathermy
artefact)
Staging (TNM 8th ed.): pT2

So, I have a 4 mm margin, but it looks like this is mostly 90% Gleason pattern 3, which I guess is positive news.
I also know its a good thing the the positive margin was diathermied (cut with a hot knife killing many cells in the process and this is likely to have killed off any cancer cells at that site)
My decimal points are all correct! ;-)

During the operation they performed a 'frozen section' and they thought, at that time, I had a positive margin on this part they did a frozen section on. So they did a 'reselection' at this site (went back to take some tissue away).  Only turns out this wasn't a positive margin at all but there was a positive margin right next to it! So the re-selection at that site was unnecessary and they missed the positive margin that was there.

I guess once I've had a good number of PSA blood tests and they don't show much of an increase I'll start to rest a bit more. Its on my mind a lot, too much it feels like.
I've had a chat with one of the specialist nurses and they are truly great. Perhaps I should have another conversation to mull it over.

thank you so much for your replies.
Matthew

Edited by member 17 Feb 2022 at 20:07  | Reason: update

Thank you so much Soren. 

Yes, my PSA blood tests are all conducted by the same lab each time. I ask my local GP surgery for a digital copy of the blood result so there's no misunderstanding about the number.

I'm keeping my figures crossed that the readings stay low. 

Thank you again for your help. 

Matthew 

well...  Just over 1 year after my original post ..

As suspected I did have recurrence..  

So Radiotherapy in December... and HRT  at same time...

Today I had a good call.... 1st PSA test result at Less than 0.1  

So seems to be under control.  HRT for another 1 year and 1/2. and PSA every 3 months.

Feeling good today... will open a beer (or 2) this evening .

I'm awaiting my 6-week post RP Ultra Sensitive PSA results (uPSA), so at after about 200+ hours of research prior to my treatment decision, I find myself taking a deep dive into yet another aspect of this disease - post surgery PSA.  This thread came up in my search results and I'd like help clear things up as it appears this is a subject not easily understood.  Probably due to the varied degrees that Urologists keep up with the latest data, which for the most part is easily accessible to us patients.

There are variances depending on your data source, but the general consensus in the Urologic Medical Community is that Biochemical Recurrence is defined as a reading of => 0.2 followed by a consecutive reading of > 0.2 post surgery.  (For post Radiaton, it's 2.0 above your lowest reading - which can take 2+ years to reach your low.)

The problem is, while studies have shown adjuvant radiotherapy (getting radiation after surgery because you had high Gleason and/or T3 disease, no matter how low your PSA is) does not provide a significant benefit over early salvage radiation therapy. Further recent studies are showing that earlier is better for salvage radiation to maximize the chance it will be curative. This is one of many studies that discuss it if you want to educate yourself as it shows the different Hazard Ratio multipliers for all the different prognostic factors.  Only the Gleason Score higher than 6 has a higher HR than the pre-salvage RT PSA.

https://ascopubs.org/doi/10.1200/JCO.2016.67.9647 (if you're not in the mood to read a long article, check out the second link I reference)

In my opinion, in the context of determining the need and timing for salvage radiation therapy, any Oncologist that wants to still "wait and see" when you've hit 0.1 is not up to date on the latest research. 

There's tons of recent data out there.  This article best sums it up in the Risk Factor Score Chart.  As you can see, if you get your salvage RT super early, at 0.05, you only add 2.5 to the score. O.1 is only 2.5 more points.  But as you go up to 0.2, now you are adding 5 points and have quadrupled from the 0.05 level. If you wait until your PSA reaches 1 to get your salvage radiation, you add a whopping 50 points to the score.

https://prostatecancerinfolink.net/2016/08/25/probability-of-remaining-recurrence-free-after-salvage-radiation/

In many cases you could go from a 0.05 to 0.1 or 0.2 in between PSA tests and then there will be a lead time before you can actually get treatment.  So it turns out, predicting very early on with high confidence if you are going to very likely have a recurrence can be critical to maximize the chance your salvage radiation will be curative.

"...first post-op uPSA ≥0.03, Gleason grade, and T-stage independently predicted cBCR. First post-op uPSA ≥0.03 conferred the highest risk (HR 8.5, p<0.0001)... Defining failure at uPSA ≥0.03 yielded a median lead-time advantage of 18 months (mean 24 months) over the conventional PSA ≥0.2 definition... "

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527538/

"In men with a PSA <0.1 ng/mL following RP, a ten-fold lower cutoff (0.01 ng/mL) stratified BCR-free survival and was a significant independent predictor of BCR as were pathological features."

https://www.practiceupdate.com/content/ultrasensitive-psa-measurements-may-predict-long-term-biochemical-recurrence-free-survival-following-radical-prostatectomy/29264

And as you can see from this study, the number of patients that were free from biochemical recurrence at 4 years was ZERO if their initial uPSA reading was => 0.02!  In both high-risk and low/intermediate NCCN risks groups.

https://academic.oup.com/jjco/article/47/1/74/2527621

So from the data, we know, that if you have an initial uPSA after surgery of 0.02 you have a very high chance of biochemical recurrence - not for sure, but likely.  If your uPSA is up to double that and goes up to 0.04 from there, you pretty much plan on a recurrence.  Combine that with knowing your chances of salvage therapy being curative starts to significantly decline if you get your salvage therapy when your PSA has gone over 0.2.  If your doubling times are long, then you have plenty of time to watch it creep up and get your salvage radiation scheduled before you hit a PSA of 0.2 but if your double times are short, then you probably want to be calling your Radiotherapy Oncologist when your PSA has hit => 0.04.

Waiting to make treatment decisions until you've hit an "old school" number of 0.2 defining "official" biochemical recurrence is not best practice these days based on the latest data.  That is, if you want to maximize the chance you can still be cured.

Edited by member 15 Jul 2022 at 22:58  | Reason: Not specified

Jaz, take a breath and relax, you PSA is what it is. I had the two decimal point test, it gave me a good indication that my PSA was slowly rising, I had a poor histology.  At some hospitals my PSA would have been classified as undetectable for 23 months, at 26 months I would have told , sorry your cancer is probably coming back.

Two vials of blood taken at the same time and tested at the same time in the same lab came back with a difference of 0.01.

Relax look after yourself and don't worry about things you can't influence. Are you in the USA, there are differences in how different countries operate.

Hope you recovery goes well .

Thanks Chris 

Upshot is going before 0.1 in most cases has no benefit.