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PSA "undetectible" for amost a year
The fourth consecutive PSA result came back at <0.02 ng/mL, nearly one year after surgery.
Four consecutive undetectable PSAs over nearly a year are certainly reassuring and indicate that there is currently no detectable biochemical recurrence. However, they do not mean it is “all clear.” They also do not erase my longer-term recurrence risk given my adverse pathology and biology: Gleason 3+4, pT3b with seminal-vesicle involvement, extracapsular extension, lymphovascular and perineural invasion, and a high Decipher score.
For now, I plan to continue with my current strategy of regular PSA monitoring and reserving salvage radiation for a confirmed rising PSA rather than automatically pursuing adjuvant radiation. Why subject myself to treatment and its potential side effects before I need it? If there is roughly a 50% chance that I will not experience a recurrence, why undergo treatment now that may ultimately never be necessary?
I’m encouraged by the continued undetectable PSA and, as always, I welcome any and all input from the group.
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@diverjer That’s pretty much what mine was…a ‘tiny’ break in the capsule, but surgical margins negative.
Needed SRT 5 yrs later anyway…
Phil
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1 Reaction@carbcounter
Your PSA numbers are pertinent to the type PSA test you are taking. I have the standard one every 3 months and mine is now undetectable. <0.1 You posted <0.02 so you are having the ultra sensitive test done. I have no experience even though I am aware of what they mean from A.I. so will not comment on the numbers from it.
But just know not all labs have the same undetectable range for ultra sensitive test versus a standard number when using standard.
From Co-Pilot A.I. it describes it much more accurately than I can. But same information was given to me by my PCP but it was verbal.
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A.I. Co-pilot:
"Professional guidelines (AUA, EAU, NCCN) keep the universal definition at <0.1 ng/mL:"
"Different institutions define “undetectable” differently because their ultrasensitive PSA machines have different detection limits. Standard PSA tests use <0.1 ng/mL, while ultrasensitive labs may use <0.03, <0.02, or even <0.01 depending on the assay."
Hope this helps. Always talk to your urologist or medical provider who is ordering your test of what type test is being done and what they mean for you. Not what someone gives you on MCC as you are an individual and it depends on what type test is being done the specific lab doing it.
@heavyphil
It's all confusing to me because up further in report it says:
Margin Status: Invasive carcinoma present at margin
Linear Length of Margin(s) Involved by Carcinoma: Less than 3 mm (limited)
So what margin are they talking about? One place says Margin Involvement by Invasive Carcinoma in Area of Extraprostatic Extension (EPE): Not identified then another says- Invasive carcinoma present at margin.
My guess is they took out fatty tissue around prostate, cancer had went through prostate in one spot <3mm into fatty tissue. However at the outside of that fatty tissue cut there wasn't anything? Maybe I can get some answers in next couple weeks, it's only been about 4 months, wouldn't want to rush them!
@diverjer You are quite right in that it does sound confusing. It seems as if there was no carcinoma in the area of the EPE, where it might have been expected.
However, there was carcinoma present in another part of the surgical margin, where it wasn’t.
I think it is extremely important for you to get some clarity on this because it will give you insight as to what to expect going forward with your every three month PSA tests.
Ask your surgeon to explain to you in plain English what the report is saying: is there suspected cancer left behind or not?
I got rid of my surgeon, even though he was a renowned man in the field because he wouldn’t give me straight answers and treated me like he knew best, and I that I shouldn’t care, ask or worry about anything….
But we are not children and we must refuse to be treated as if we are.
If you can’t get a simple YES or NO from your doctor, that man/woman is in the wrong profession: they should be in Congress…
Phil
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5 Reactions@diverjer
When a pathology report states "Invasive carcinoma present at margin" after a prostatectomy, it means the surgical margin is positive. Cancer cells are touching the outer edge (the inked border) of the tissue removed during the surgery. This indicates that microscopic cancer cells may have been left behind in the body, though it does not guarantee the cancer will return.
Many patients that have this report, never have the cancer come back.
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3 Reactions@jeffmarc
Then why do they say: Margin Involvement by Invasive Carcinoma in Area of Extraprostatic Extension (EPE): Not identified ( I think in my pea brain that is fatty tissue around prostate that was removed)
But then say Invasive carcinoma present at margin Linear Length of Margin(s) Involved by Carcinoma: Less than 3 mm (limited). Could this be a margin that was just prostate and not EPE.
It almost like they have 2 margins checked. It got past prostate into Fatty EPE, but not clear past the outside of EPE? Hopefully I can get answers tomorrow from surgeon who is not that good of a communicator (suppose to be good at surgery) or on 25th with oncologist which I only met once.