Pathology report is in post RALP; waiting 90 days for PSA test normal?

Posted by thig350 @thig350, Jul 18 7:06pm

Hello! I had nerve sparing RALP nearly 3 weeks ago and had meeting with surgical urologist two weeks post surgery. I have attached the key information below from my pathology report.

Doctor said we wait 3 months from surgery date then take blood test to check PSA levels. if results are detectable then we go salvage radiation and hormone therapy. Doctor said that current practice is to not automatically go into radiation and hormone therapy because the real possibility exists that I may be undetectable so don't want to unnecessarily go that route without detectable PSA level.

At first I was fine with his recommendation but now after some additional thought I am wondering if he is perhaps not being proactive enough. I have done some research and have seen some cases waiting 3 months for PSA test and some cases where follow up treatment is initiated asap.

Can anyone on here offer some perspective on my dilemma? I want to trust my doctor but frankly I feel like the alarm bells should be sounding. Thank you!

Note: Pre surgery MRI and PET scan did not show spread.

Pathology report:
Gleason 3+5 = 8
Cribriform glands: present
Extraprostatic Extension (EPE):
Not identified
Urinary Bladder Neck Invasion:
Not identified
Seminal Vesicle Invasion:
Not identified
Lymphatic and / or Vascular Invasion:
Present
Perineural Invasion:
Present
MARGINS
Margin Status:
Invasive carcinoma present at margin
Linear Length of Margin(s) Involved by Carcinoma:
Greater than or equal to 3 mm (non-limited)
Focality of Margin Involvement:
Multifocal
Margin(s) Involved by Invasive Carcinoma:
Right anterior
Right base of prostate
REGIONAL LYMPH NODES
Regional Lymph Node Status:
All regional lymph nodes negative for tumor

pTNM CLASSIFICATION (AJCC 8th Edition)
pT Category:
pT2

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adoptedtomato | @adoptedtomato | Jul 28 10:00pm

In reply to @surftohealth88 "@adoptedtomato Every 3 days, cording to my husband's RO" + (show)

@surftohealth88 thanks. My PSA was 11 pre surgery - and it went down to = 0.1 right per that half life - then went down to <0.006

susanocl | @susanocl | Jul 29 6:29pm

@thig350 Hi Thig… my husband had similar findings pre, and post, surgery except his was graded T3a with conflicting info either 8 or 9 for Gleason depending on report. Pre surgery PET and MRI showed no metastasis and surgical margins clean. Vascular invasion. 1 LN (it’s all they could get due to past hernia surgery) on left and 5 right all negative. Previous PSA was 19, 35, then 24 the week before surgery. I WISH we had his first post surgery PSA done sooner than the ‘standard of care’ 3 months. At 12 weeks PSA was at 1.5, 14 weeks at 1.9, and 2.0 at 15.5 weeks when he started 38 salvage radiation treatments. Many studies show that high of a PSA post surgery (over .5) is not a great sign. I wish we’d tested at 6 weeks, then again at 8 to ensure it was headed down - right direction. That would have saved us a whole month of micro metastasis happening (the week before radiation, still nothing showing on PET MRI so RO deemed it micro metastasis). If you doctor won’t order it, PSA tests are relatively inexpensive at Quest and you can test 2 weeks apart to ensure headed in the down direction. That’s just our story and feelings.