Non dectable PSA post Robot RP

Posted by kepasa @kepasa, Oct 5 7:16pm

Hello, what resource path can a post Robotic RP patient that had negative bone scsn, cat scan and MRI ( no pet scan taken to evaluate Oligio Metastases post surgically ? PSA 3.2 pre surgical, .01 < , .14<. .02, .04<nn/ ml.
All different modalities of PSA evaluation.

Gleason 8 , ashkenazic Brach 2 genome.
Tumor 1.4mm max dimension, not penetrating lining of prostate nor fat facia, negative margin on path , all 10 lymph nodes unremarkable as well as seminal vesicle
22 months since surgery
10 % of prostate cancer patients approx harbor metasasis in spite of undetectable psa
Input appreciated

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My numbers looked a little like that. My path also showed Perineural and Lymphovascular invasion.

Those last two indicators in conjunction with my PSA doubling had the surgeon refer me off to a radiation oncologists. My belief at this time is it may have been a little premature. Looking back I'd have liked to have one more blood test to see if the psa continued it's course. I've been told by folks on here and the RO that rate of doubling isn't as big a deal in those low numbers. I'm fine with aggressive treatment too though.

A) What do the docs say regarding the PSA increase? Next steps?
B) I would definitely want to get apples to apples comparisons to look at. I'd go to the same lab as the last test or find a lab you're comfortable with and get two ultrasensitive tests back to back,

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PSA 5.3 radical prostatectomy G 9
Contained Edges, lymph’s, seminal vessels negative
30 day PSA<0.01
90 day PSA 0.2
PMSA PET SCAN negative
120 day post PSA 0.331
Started Lupron
Salvage Radiation 40tx starting 2months

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Is that correct? I had learned USPSA would show some elevation if the PCa had spread. TYIA.

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I gleaned the fact that 10 % of Mayo clinic prodtate patients had no Psa expression , Dr Eugene Kwon , head of urologic oncology, prostate cancer " do it uourself combat manual part 3 You Tube. Enlightening to say the least. No Psa but riddled w / metastatic prostate cancer.

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@darlynn

Is that correct? I had learned USPSA would show some elevation if the PCa had spread. TYIA.

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What is USPSA? Thanks in advance.

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@kepasa

What is USPSA? Thanks in advance.

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'Ultra Sensitive' PSA

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Thank you for defining acronym USPSA,
I would think that The University cancer center would utilize the method you hsve kindly referenced
Thanks

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Undetectable is not zero, but below a minimum to clarify, ,

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@kepasa

Undetectable is not zero, but below a minimum to clarify, ,

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What is that number? I've never heard anything definitive. There seems to be a lot of different opinions on it.

Also, has anyone heard of a clinical definition of Biochemical recurrence in terms of actual PSA numbers? This is more of a regulatory question regarding my employment (DOT physical) as opposed to a treatment question. The NIH just says a "rise in PSA", this must have been written before USPSA was common.

Steven J. DiBiase, Stephen C. Jacobs, in Prostate Cancer, 2003 say "
Clinicians should define biochemical recurrence as a detectable or rising PSA value after surgery that is 0.2 ng/mL or greater with a second confirmatory level of 0.2 ng/mL or greater."

Not really sure if that's a settled thing though.

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Here's an article laying out imaging – https://www.prostatecancer.news/2016/12/pet-scans-for-prostate-cancer.html

Given the clinical history in your message, you may want to continue what I call "active monitoring," which is to every 2-4 months, have labs and a consult with your medical team.

.01
.14
.02
.04.
With those labs, doubt that any imaging is going to show where any PCa might be. That's not saying there's micro-metastatic disease that is too small to detect, but I would consider continuing to actively monitor and just enjoy life for now.

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