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Cancer: Prostate Message Board


Cancer: Prostate Board Index


[QUOTE=Brute290;3906704]I had a TURP June of 08 1 chip of 8 was 3+3=6. PSA was 2.4 . 6 months later PSA was 0.43 had a biopsy 1 of 12 cores was 3+3=6. Jan 30 had Da Vinci RP. 4 weeks after RP PSA is still 0.428. Did I take it too soon? Dr. says wait another month and re-take PSA . Pathology on prostate after RP found no cancer. Doc is perplexed , I,m perplexed.[/QUOTE]

Hi Bill,

I'm thinking with your doctor that you probably took the PSA too soon, but that level of 0.428 after 4 weeks and a starting point probably between 2.4 and 0.43 is puzzling. I am not familiar with the finer points of RP recovery, but I just checked Dr. Patrick Walsh's 2001 book, "Dr. Walsh's Guide to Surviving Prostate Cancer," pages 292 - 294, and found some pertinent observations. (It's in the section "How Successful Is Treatment".)

Dr. Walsh advises against having the PSA checked too soon, recommending 8 to 12 months after surgery - "when PSA should be at rock bottom." He states that "PSA has a lengthy half-life in the bloodstream (two or three days)-which means it takes quite a while for PSA levels to go down after a radical prostatectomy. For example, if your PSA before surgery was 10, it would take seven half-lives before the PSA fell into the undetectable range (less than 0.1)."

Daff, if you are seeing this, is that what he says in his more recent book?

It's clear that the understanding of PSA and its role for us has advanced a lot since 2001 :D when Dr. Walsh's book was published. For one thing, the reliable lower limit of practical, useful PSA results is now "<0.01," :D and with special procedures it is as low as 0.003 the last time I checked, perhaps now as low as 0.001 or <0.001. Thus, it is no longer correct to say that a score of "0.1" is undetectable. (Of course, it is correct to say that 0.1 is "undetectable" if the particular test can't reveal lower results, but we should add that that is only because the test is very limited in its capability. To me, that's a lousy test as a sentinel for recurrence. :( :()

Also, as of the 2001 book Dr. Walsh did not advise getting an ultrasensitive test, partly due to the fact that some ultrasensitive tests were apparently unreliable at that time, and partly because he did not see value in learning of recurrence before the PSA rose to about 0.2. The experts I follow now feel strongly that there is value in being forewarned much earlier :cool:; on the flip side, if our scores are very good as they should be and typically are, we can gain peace of mind much earlier :D :angel:. Repeated research studies have now scoped out how PSA should behave after surgery if there is not or is a recurrence. (By the way, the one I have been using most - the Immulite Third Generation ultrasensitive PSA test - has been reliable since before 2001. :cool:)

I hope this helps, and I hope you get that PSA result you hope for!

Jim





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