← Return to Rising PSA immediately following RP

Discussion
bob65 avatar

Rising PSA immediately following RP

Prostate Cancer | Last Active: May 28 8:23am | Replies (32)

Comment receiving replies
Profile picture for rlpostrp @rlpostrp

1. Were your PSA tests performed by the same clinical laboratory? It is usually only very subtle differences that are seen when someone has their testing done by/at different labs. Your PSA value has essentially doubled and in a very short time. That would only happen if you have prostate tissue remaining in your body "somewhere."
2. I would ask to have you surgical pathology slides of your prostate tissue sent to Mayo Clinic or another reputable university-based teaching medical center where the best urologists, and more importantly "best pathologists" are who see tons of prostate cancer cases. PSA is only produced by prostate tissue.
You say that your "margins were clean" (no "surgical margins) and your disease was "contained" to the prostate, which means no Extraprostatic Extension (EPE) that could have seen prostate tissue left behind in your body. The only way that your PSA could be rising after your prostate was presumably 100%, entirely removed, is that prostate tissue WAS actually left behind...and that does not match your surgical pathology report. You need a fresh pair of HIGHLY skilled pathologist's eyes looking at your all of your prostate tissue slides again, to yield their own report. With a clear PET scan and MRI, that should mean that the disease was confined to the prostate, without any radiation detected in your lymph nodes or bones. This all does not make any sense. It is almost like your slides were mislabeled...your slides were labeled with another patient name, and your name was put on someone else's slides (this CAN happen in labs with poor procedural quality control, that are processing multiple patient samples at the same time). it is ULTRA rare, but it could have happened. Update us after you have your slides re-read. Good luck!

Jump to this post


Replies to "1. Were your PSA tests performed by the same clinical laboratory? It is usually only very..."

@rlpostrp

That is not true. Cancer in very small amounts can not be seen on scans, not even PSMA.

Cancer cells can escape prostate gland well before surgery via blood, lymphatic system, neural bundles etc. That way micro metastasis are established and can start growing on their own in proximity or in distant places.

There are many , many patients here with negative margins and intermediate, gleason 7 cancer that ended up with BCR. That is absolutely not an anomaly.

On the other side, there are patients with positive margins, EPE and gleason 9 who did not have BCR in many years post op.

With PC there are just NO rules and no certainty.

@rlpostrp I think it’s more the velocity, than the value in this case.
My urologist said that normal - even hyperplastic - Prostate tissue left behind does not have real fast doubling time. Best,
Phil