Elevating PSA after radical prostatectomy

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Elevating PSA after radical prostatectomy

by Lasheld on Sat Mar 31, 2007 12:00 AM

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My father, whom is 63,  had a radical prostatectomy March 2006 for treatment of prostate cancer.  His Gleason score after biopsy was 9/10.  Out of 14 lymph nodes removed and biopsied, none were found to have cancer.  The cancer was within margin on all sides with the exception of one side which we were told was very minimal.  His highest psa pre-op was 21.  Since his surgery, he has had four follow-up PSA checks, with the last four from earliest to latest being .03, .05, .05, and recently .06,(so an obvious increase in PSA).  His surgeon is stating that he will most likely need radiation therapy or hormone therapy, however would like to wait 3 months for the results of another PSA.  I am questioning the hesitance and waiting for 3 months to being any type of treatment.  Any thoughts?

Thank you,

Lori

RE: Elevating PSA after radical prostatectomy

by Witchdoctor on Sun Apr 01, 2007 12:00 AM

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He should be restaged with PeT , CT's and Bone scans.  Also an MRI should be obtained.  If the tumor appears to be localized , then he should get irradiation with LH/RH antagonist and Casodex for the first month.

With a gleason 9 he is lucky there was not gross tumor left post surgery.  High grade prostate with PSA above 20 IS NOT a surgical disease.  The results are better with irradiation and hormone deprivation for 2 years.

Radiation should be external beam and the lymphnodes should be treated as well.

RE: Elevating PSA after radical prostatectomy

by Oncrx on Mon Apr 02, 2007 12:00 AM

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On 3/31/2007 Lasheld wrote:

My father, whom is 63,  had a radical prostatectomy March 2006 for treatment of prostate cancer.  His Gleason score after biopsy was 9/10.  Out of 14 lymph nodes removed and biopsied, none were found to have cancer.  The cancer was within margin on all sides with the exception of one side which we were told was very minimal.  His highest psa pre-op was 21.  Since his surgery, he has had four follow-up PSA checks, with the last four from earliest to latest being .03, .05, .05, and recently .06,(so an obvious increase in PSA).  His surgeon is stating that he will most likely need radiation therapy or hormone therapy, however would like to wait 3 months for the results of another PSA.  I am questioning the hesitance and waiting for 3 months to being any type of treatment.  Any thoughts?

Thank you,

Lori

I would agree with WD that RT and HT are in order.  I dont see any problem with waiting 3 months for another PSA. 

 

RE: Elevating PSA after radical prostatectomy

by Lasheld on Mon Apr 02, 2007 12:00 AM

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On 4/2/2007 Oncrx wrote:

 

On 3/31/2007 Lasheld wrote:

My father, whom is 63,  had a radical prostatectomy March 2006 for treatment of prostate cancer.  His Gleason score after biopsy was 9/10.  Out of 14 lymph nodes removed and biopsied, none were found to have cancer.  The cancer was within margin on all sides with the exception of one side which we were told was very minimal.  His highest psa pre-op was 21.  Since his surgery, he has had four follow-up PSA checks, with the last four from earliest to latest being .03, .05, .05, and recently .06,(so an obvious increase in PSA).  His surgeon is stating that he will most likely need radiation therapy or hormone therapy, however would like to wait 3 months for the results of another PSA.  I am questioning the hesitance and waiting for 3 months to being any type of treatment.  Any thoughts?

Thank you,

Lori

I would agree with WD that RT and HT are in order.  I dont see any problem with waiting 3 months for another PSA. 

Is there any reason in particular you'd wait 3 months to start with the RT or HT?  I'm worred it will spread and this is only delaying treatment?  Am I over reacting?

Thx, Lori


 

RE: Elevating PSA after radical prostatectomy

by Oncrx on Tue Apr 03, 2007 12:00 AM

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Guidelines say that PSA failure is defined as 3 consecutive rises in PSA after a nadir.  So technically, you havent had that as two PSA's were the same.  If the next PSA is >.06 then technically, that would iniatite treatment.  That may be what you doc is thinking, but I would ask him that question.

RE: Elevating PSA after radical prostatectomy

by Witchdoctor on Tue Apr 03, 2007 12:00 AM

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Oncrx,

   The biochemical sign of failure is for radiation patients or other who have not had the prostate removed.  Post prostatectomy PSA of any kind is considered a failure up front since it is supposed to be zero.  It at least means there is prostate tissue left behind.  Given the initial PSA and the Gleason score in this case and the fact that salvage is much better when treatment is initiated with a low PSA (of course this is far below 2.5 upper limit) and the relatively young age of the patient I would approach it aggressively.  The diagnostic studies may also show something as well.

If this were a gleason 6 or below with low initial PSA in an older patient I would agree to wait.

RE: Elevating PSA after radical prostatectomy

by Oncrx on Tue Apr 03, 2007 12:00 AM

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On 4/3/2007 Witchdoctor wrote:

Oncrx,

   The biochemical sign of failure is for radiation patients or other who have not had the prostate removed.  Post prostatectomy PSA of any kind is considered a failure up front since it is supposed to be zero.  It at least means there is prostate tissue left behind.  Given the initial PSA and the Gleason score in this case and the fact that salvage is much better when treatment is initiated with a low PSA (of course this is far below 2.5 upper limit) and the relatively young age of the patient I would approach it aggressively.  The diagnostic studies may also show something as well.

If this were a gleason 6 or below with low initial PSA in an older patient I would agree to wait.

WD

I was trying to think of ideas of why her doc would wait on another PSA,  but I agree those recomendations were post RT.  What you are saying is you would begin treatment now based on the patients age.  Thanks for the clarification.

RE: Elevating PSA after radical prostatectomy

by Witchdoctor on Thu Apr 05, 2007 12:00 AM

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The aggressiveness of the tumor as well, not just age.

RE: Elevating PSA after radical prostatectomy

by Orionskye on Mon Apr 09, 2007 12:00 AM

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For what it's worth, PSA doubling time is an important measure to watch. I just read this article this morning but there are many others that have preceeded it and have had similar conclusions.

PSA doubling predicts prostate cancer recurrence

A detectable level of prostate-specific antigen (PSA) is the first indicator of recurrent prostate cancer after radical prostatectomy. In a new Mayo Clinic study, the concept of PSA doubling time (DT) is found to be a reliable tool to distinguish which patients have prolonged innocuous PSA levels after therapy from those who are at great risk for disease recurrence and death from prostate cancer. Doubling time is defined as the duration for PSA levels in the blood to increase by 100 percent.

Mayo’s study, published in the April issue of Mayo Clinic Proceedings, concludes that patients with a PSA doubling time of less than three months after therapy are at imminent risk of death from prostate cancer. Patients with a doubling time of three to 12 months are at a significant risk for the development of systematic disease and cancer-specific death.

According to the authors, the new findings should prompt physicians whose patients have doubling times of less than one year to treat them with systematic therapies. Patients with PSA doubling times of one to 10 years are more likely to have a local rather than systematic recurrence, and patients with a PSA doubling time of greater than 10 years are at a low risk of recurrence.

RE: Elevating PSA after radical prostatectomy

by allako on Tue Aug 05, 2008 12:00 AM

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On 4/1/2007 Witchdoctor wrote:

He should be restaged with PeT , CT's and Bone scans.  Also an MRI should be obtained.  If the tumor appears to be localized , then he should get irradiation with LH/RH antagonist and Casodex for the first month.

With a gleason 9 he is lucky there was not gross tumor left post surgery.  High grade prostate with PSA above 20 IS NOT a surgical disease.  The results are better with irradiation and hormone deprivation for 2 years.

Radiation should be external beam and the lymphnodes should be treated as well.


Hi, I would like your opinion on the case of my husband, who is 46years old. His PSA was 12 and Gleeson score 7. He had prostate removed in November 2007. First PSA test after that was 0.01, then 0.04 and yesterday's result 0.06. We will only see his surgeon in September.

What additional tests should he have in meantime and what do you think about his prognosis and further threatment. Thank you.

 

 

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