Post RARP PSA level

Morning David.

Only yesterday, I was wondering how you were doing.

I've only been on this forum for a few months but can't recall anyone reporting a similar issue. Like you I'd have expected an extremely low or preferably undetectable PSA reading.

What was you PSA, cancer staging and Gleason pre op?

Hopefully your imminent consultation will shed some light on what's occurred.

Hi Adrian ,  my first PSA test was 4.7 , the GP then ordered another which was 4.9 … everything then kicked off as a result of that second test.   I don’t know what to make of it …. I guess the consultant will shed some light on it all next week.   

Hello all.  Update on my unusual PSA level post-op.  After I saw my surgeon he ordered another blood test which came back as 3.73.  Down a little bit from 4.06 but still not at the undetectable level we were hoping for.   I had a PSMA PET CT scan on 29/4 which is a highly accurate scan which detects the location of a PSA source.   I have since  been sent an appointment to speak to the surgeon about the results of that scan. It’s on 16/5 and will be over the phone.   The fact that in just less than 2 weeks and over the phone I see as a positive sign … I think that if there was an urgent issue about the findings from the scan I would have been summoned in person ASAP. 

Hi Adrian,

The surgeon went through the histology with me in my post op consultation, I can’t remember the details but he didn’t seem overly concerned with the results.   His main concern was the 4.06 PSA level which he couldn’t explain so he ordered me the PET scan.  He said in all the operations he’d done he’d never come across this before.  (Typical, nothing is ever just straightforward!). 
I’ll have another read of the letter the surgeon wrote to my GP post op ( I have a copy on MyChart) and see if he mentions anything untoward .  
I would really want the results of the scan ASAP but as there’s a bit of a wait I see that as there’s no nasty news to pass on.   If there’s a problem I would expect to be seen in person in a shorter time scale.  
Regarding side effects, I’m still urinary incontinent which is getting me down a bit as I’m doing everything I was told, pelvic floor exercises, walking, no alcohol, reduced caffeine etc etc but little improvement.   Nothing to be done apart from waiting.   A friend of mine took 3 years to get right.  Apart from that, everything else is ok thanks.  How are you getting on?

Edited by member 05 May 2024 at 12:26  | Reason: Addition to text

Thank you. I’ve recently had  PSMA PET CT scan to see if the source of the PSA level can be identified.  I’m due to discuss the results on a phone appointment with the consultant surgeon next week so I’m hoping for some answers.  

Thankyou Adrian56,

Trawling the net I haven’t encountered the distinction being drawn between “prostatectomy failure “ and BCR. It makes sense as you said some cancerous area left behind after surgery would still be transmitting PSA. Hence the short post surgery time to detection of a relatively high initial PSA rather than a smaller initial PSA that ramped up due to microscopic growth. Ironically if this is the case then it is somewhat comforting in that may be my aggressive cancer isn’t ramping up as fast as the initial 3 month reading made it look…. if that makes sense. My surgeon was surprised at my this PSA test since the pathology during surgery did not show lymph node and bladder neck spread and I had a clear surgical margin. When asked to guess he said it might be a spread through the seminal vesicle since I had seminal vesicle invasion.
My feverish mind has an additional theory…. maybe outlandish. The original PSMA scan showed PC confined to the prostate but it is a “Skull to Thigh” limited scan, what if with my Gleason 9 “very aggressive” diagnosis had already started working on my legs below the thigh but was not also picked up by a prior bone scan due to lack of scan sensitivity? I guess all of this is speculation and may not change the radiation plan. One question I will ask the radiation oncologist in our meeting this week is whether it is advisable to wait till I have a .5 PSA in order to get PSMA directed radiation.

Thanks for listening!

Clinton, I asked about including a troublesome knee in my scans,but was told that was down to the radiographer. The radiographer did include the knees. My onco said he had only seen spread to the knee on three occasions, I did say I could be number 4, I wasn't. My second and third recurrences were in pelvic lymph nodes.

Thanks Chris