Psa And The Numbers

Before a TURP husbands PSA was 1.37....no cancer suspected. After surgery dx with PC and a Gleason score of 3 + 3/6. Had a PSA weeks after surgery that was .6. Year after surgery PSA is .94. My concern is since his pre-surgery PSA was supposedly a good number (age 62) but was still dx with cancer, how much do you let the PSA climb before ending "watchful waiting"? The nurse that called with the report said she thought this was an excellent report. I read somewhere yesterday that someone said their Gleason 6 was in the high end. That was the first time I had seen anything discussing high or low end of a Gleason score. Is there any validity to that? Thanks for any suggestions.

So are you saying that the surgery was just a turp and not a prostatectomy? Is he on hormone therapy or any therapy? Assuming no HT, the PSA is still really low. Likewise the Gleason score is what I would consider low. E.g. my Gleason was 4/5 =9 or 10 and after 5 years I am doing very well. 8,9,or 10 is high. I am not a fan of watchful waiting, but given the low numbers you report (and assuming he is not on any treatment) I can understand the rationale in your husband's case. I would ask the doc when he would do something more besides watchful waiting. Certainly the time it takes the PSA to double is a consideration in when to initiate treatment, as well as just the PSA score per se.
Pat K

Your husbands numbers are and were, pretty good. Most people consider a PSA of 0-4 to be normal and generally not a concern until it is over 10. The PSA doubling rate is important and generally is a concern if it is < 1 year. Based on guidelines, his options include RT, RP or watchful waiting. If you do WW, be sure to get PSA levels every 3 months.

Yes, he just had the turp and no other surgery and is not on hormones. I am glad you are doing so well!
My problem with saying his PSA is low or good is that it was low and good before we found out he has prostate cancer and we know that the Gleason score is likely to go up to at least a 7 if he had the complete removal. I think the doubling time will probably be a better indicator for his particular case, don't you? That too is a concern: if the .6 doubled that would be 1.2, right? So he is only .26 away from that happening. We will definitely be getting it checked again in 3 months. Thanks for your thoughts.

I know everyone keeps saying his PSA is good; it was good when he was dx with the cancer. I guess my question is if he had cancer with a 1.37 how is a low PSA ever going to be an indicator for him? Also, do you think there is a difference in the sampling if a biopsy is done rather than what was collected from the TURP? I realize that the locations were not pinpointed as they would have been in a biopsy so do you think we can really count on his Gleason score being as reliable as if it had come from a biopsy? Thanks so much for your help. One other question: I have read that doing a DRE before blood is drawn for the PSA can cause the reading to be higher; if this is true then this would also cause the free PSA percentage to be higher, too, since it is a percentage of the total PSA, correct? Thanks again for your help.

People with normal PSA's have cancer and people with high PSA's do not, so the PSA is a rough guide to prostate health. Its used in conjuction with other things like DRE, biopsy, pt age, etc, to determine what is going on with the prostate. I think the fact that his PSA is so low would indicate his cancer was caught very early. Thats a good thing. Im not sure if the biopsy from the TURP would not be a good as from a TRUS. That a good question for your urologist. It is true that a DRE can elevate the PSA. I would also think that the free PSA to be higher. Thats another good question for your urologist.
Your husband is lucky to have you !