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From: skeptic on 6 Aug 2008 21:33
Can someone explain psa rise post surgery vs. psa rise pre surgery?
If a high psa, say 10-20 range before treatment is so bad, then why is
a tiny psa after surgery, say 0.2, a sign of doom, so to speak?
If the original (very high) psa is because of prostate cancer and the
prostate is removed, even if there are residual cancer cells left, why
are they regarded as so dangerous when there are no tumors present and
only a very very low psa (but not undetectable)?
Why isn't watchful waiting considered in that situation, instead of
continued agressive treatment?
Is it possible for mets/tumors to become aggressive with such a low
psa...assuming it stays fairly low but still considered high for post-
op?
(I hope this doesn't come across as total ignorance.....I'm fairly
well studied on this, as all of us are....it's just hard to phrase
correctly)
From: ron on 6 Aug 2008 21:59
On Aug 6, 7:33 pm, skeptic <ribr...(a)aol.com> wrote:
> Can someone explain psa rise post surgery vs. psa rise pre surgery?
> If a high psa, say 10-20 range before treatment is so bad, then why is
> a tiny psa after surgery, say 0.2, a sign of doom, so to speak?
> If the original (very high) psa is because of prostate cancer and the
> prostate is removed, even if there are residual cancer cells left, why
> are they regarded as so dangerous when there are no tumors present and
> only a very very low psa (but not undetectable)?
> Why isn't watchful waiting considered in that situation, instead of
> continued agressive treatment?
> Is it possible for mets/tumors to become aggressive with such a low
> psa...assuming it stays fairly low but still considered high for post-
> op?
> (I hope this doesn't come across as total ignorance.....I'm fairly
> well studied on this, as all of us are....it's just hard to phrase
> correctly)

If the surgeon really got it all, then post-op PSA should be <0.01 ng/
ml. Any detetctable PSA indicates that the surgeon didn't get it
all. In turn, that may mean that a) some tissue (cancerous, benign)
was left behind or b) the disease was not localized to begin with.
One detetctable PSA reading post-surgery tells little more than that,
it does not spell doom. What would be more meaningful would be a
series of post-op PSA values so that a doubling time can be
determined. A doubling time of 5-10 years suggests that benign tissue
was left behind and AS is an option followed by many/most in this
case. A doubling time of 3 years or less suggests more serious
consequences with intervention of some sort a likely option...ron
From: JimBob on 7 Aug 2008 09:13
skeptic wrote:
> Can someone explain psa rise post surgery vs. psa rise pre surgery?
> If a high psa, say 10-20 range before treatment is so bad, then why is
> a tiny psa after surgery, say 0.2, a sign of doom, so to speak?
> If the original (very high) psa is because of prostate cancer and the
> prostate is removed, even if there are residual cancer cells left, why
> are they regarded as so dangerous when there are no tumors present and
> only a very very low psa (but not undetectable)?
> Why isn't watchful waiting considered in that situation, instead of
> continued agressive treatment?
> Is it possible for mets/tumors to become aggressive with such a low
> psa...assuming it stays fairly low but still considered high for post-
> op?
> (I hope this doesn't come across as total ignorance.....I'm fairly
> well studied on this, as all of us are....it's just hard to phrase
> correctly)



Skeptic,

In my case I had my RRP in late 2003. PSA's were OK for a year or so
then started to creep up. My uro-doc told me that there might well have
been a small piece of missed tissue and if so hopefully it remained in
the prostate bed. He didn't see any necessity for immediate treatment
unless the PSA started to rise so "watchful waiting" was the suggested
TX at that time.

In late 2007 my PSA jumped to .6 from the previous .2 and thats when my
uro-doc decided to act. I had a ProstaScint scan that failed to find any
major localized "hot spots" so the assumption was a a small spot of
tissue left in the prostate bed. At that point I did RT and within 2
weeks of completing treatment my PSA was back down to <.2 and my last
test about a month ago was <.1 .

Actually my uro-doc and rad-onc were pretty much relaxed about the whole
thing and there never was a sense of urgency to do anything until my
physical situation dictated it. I guess what I'm trying to say that
contrary to your post it isn't always "doom and gloom" , it just seems
to get the most "press" ......


JimBob
"Master of the Sr. Moment"
From: rosbif on 7 Aug 2008 10:52
On Thu, 07 Aug 2008 09:13:40 -0400, JimBob
<JimBob(a)invalid.comcast.net> wrote:

>skeptic wrote:
>> Can someone explain psa rise post surgery vs. psa rise pre surgery?
>> If a high psa, say 10-20 range before treatment is so bad, then why is
>> a tiny psa after surgery, say 0.2, a sign of doom, so to speak?
>> If the original (very high) psa is because of prostate cancer and the
>> prostate is removed, even if there are residual cancer cells left, why
>> are they regarded as so dangerous when there are no tumors present and
>> only a very very low psa (but not undetectable)?
>> Why isn't watchful waiting considered in that situation, instead of
>> continued agressive treatment?
>> Is it possible for mets/tumors to become aggressive with such a low
>> psa...assuming it stays fairly low but still considered high for post-
>> op?
>> (I hope this doesn't come across as total ignorance.....I'm fairly
>> well studied on this, as all of us are....it's just hard to phrase
>> correctly)
>
Not at all, I think it's an excellent question and one that still
appears to confound everyone (please let him post who is not
confounded!). More generally, to what extent is the natural history
of PCa altered by the various treatments offered?

>
>Skeptic,
>
>In my case I had my RRP in late 2003. PSA's were OK for a year or so
>then started to creep up. My uro-doc told me that there might well have
>been a small piece of missed tissue and if so hopefully it remained in
>the prostate bed. He didn't see any necessity for immediate treatment
>unless the PSA started to rise so "watchful waiting" was the suggested
>TX at that time.
>
>In late 2007 my PSA jumped to .6 from the previous .2 and thats when my
>uro-doc decided to act. I had a ProstaScint scan that failed to find any
>major localized "hot spots" so the assumption was a a small spot of
>tissue left in the prostate bed. At that point I did RT and within 2
>weeks of completing treatment my PSA was back down to <.2 and my last
>test about a month ago was <.1 .
>
>Actually my uro-doc and rad-onc were pretty much relaxed about the whole
>thing and there never was a sense of urgency to do anything until my
>physical situation dictated it. I guess what I'm trying to say that
>contrary to your post it isn't always "doom and gloom" , it just seems
>to get the most "press" ......
>
>
>JimBob
>"Master of the Sr. Moment"


Thanks for posting this up JimBob. What interests me most is your
coming relatively late (4 years post RP?) to SRT and at a PSA level
(0.6) high enough to have made some shudder...whatever, it looks like
a really good result for you. Long may it continue.
From: JimBob on 7 Aug 2008 11:58

>
>> Skeptic,
>>
>> In my case I had my RRP in late 2003. PSA's were OK for a year or so
>> then started to creep up. My uro-doc told me that there might well have
>> been a small piece of missed tissue and if so hopefully it remained in
>> the prostate bed. He didn't see any necessity for immediate treatment
>> unless the PSA started to rise so "watchful waiting" was the suggested
>> TX at that time.
>>
>> In late 2007 my PSA jumped to .6 from the previous .2 and thats when my
>> uro-doc decided to act. I had a ProstaScint scan that failed to find any
>> major localized "hot spots" so the assumption was a a small spot of
>> tissue left in the prostate bed. At that point I did RT and within 2
>> weeks of completing treatment my PSA was back down to <.2 and my last
>> test about a month ago was <.1 .
>>
>> Actually my uro-doc and rad-onc were pretty much relaxed about the whole
>> thing and there never was a sense of urgency to do anything until my
>> physical situation dictated it. I guess what I'm trying to say that
>> contrary to your post it isn't always "doom and gloom" , it just seems
>> to get the most "press" ......
>>
>>
>> JimBob
>> "Master of the Sr. Moment"
>
>
> Thanks for posting this up JimBob. What interests me most is your
> coming relatively late (4 years post RP?) to SRT and at a PSA level
> (0.6) high enough to have made some shudder...whatever, it looks like
> a really good result for you. Long may it continue.


Well , like I said in my post my PSA had just been hanging in the .2
neighborhood for what seemed like "ever" and I was a little anxious at
times. My uro-doc ( also surgeon ) just kept telling me not to get
freaked out and that if it hit .3 then he would advise SRT.

What got the train moving was the 6 month jump from .2 to .6 , believe
me when I say that all was relatively ok at a steady .2 for 2 1/2 years
or so but the .6 surprised even my doc's. I just had to have faith in
what I was being told and trust the folks treating me. Ultimately it
appears that they were correct in my ongoing DX's and TX's .

I'm sure that there are cases somewhat like mine that end up killing
folks earlier than should be but I also believe that's where a lot of
the "doom and gloom" publicity comes from. Self study on this disease
is a necessity but you can't let yourself get overwhelmed by one side or
the other. In retrospect I probably was much to far on the optimistic
side in the beginning. The original DX didn't phase me much nor the
subsistent "flair-up" and SRT. I've seen writings both here and in some
"blogs" that suggested to me that "some" Pca patients were suffering far
more from perceived problems and an unknown future than from the disease
itself.


JimBob
"Master of the Sr. Moment"


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