Friday, May 30, 2014

Cancer Treatment XXII – follow-up PSA test

Yes, Surgery was Jan. 28th, and back to the surgeon, May 6th, having had another PSA test.
next appointment: July 24. Another PSA test.

May 6 
-1:51 arrived at parking lot
-2:15  appointment
-2:58  taken into exam room
-3:35 Change in urination? No. Settled down. All is healing well.

Could pull remaining stitches, but only day for doing scopes in the operating room is Thursdays and his schedule is full. 

PSA test on Apr. 10th was 0.32 low but not as low as he'd like to see it. It was 5 prior to surgery.  Should be undetectable. Research says 0.2 accepted at that level. Had a high Gleason score: Gleason 8 is a warning sign. The PSA indicates that the cancer is somewhere in his system, lymph nodes, or bones, a possibility. Imaging all negative. Bone scan, the MRI, CAT scan indicated these were clear. Cancer cells escaped before they removed the prostate.

Given surgery in Jan., April is far enough that circulating PSA should be gone. It's been about 3 mos. since the prostatectomy. Maybe microscopic disease is there. Maybe it is  high from residual, benign glands, a possibility.
Come back for PSA in 3 months. If back to low, good. If not sign there is some cancer there.

What to do? If it is persistently elevated, more in keeping with distant disease; lymph nodes or bones. 
Systemic disease needs: medication  (hormones) to block hormones which will block the cancer. If it is in the lymph nodes it is not a cure.

Good news: can have up to a 10 year control. Can keep it in check for some time. 5 years for sure -10 years is reasonable. Hormonal therapy would not start now, there is no consensus on the best timing. May be time if the PSA gets to 4 or 5. At very low levels, there is no benefit from starting at low or 5. Rate of rise of PSA is important. Slower = later. 

Set up 3 mos. follow-up with this double check. 
Call if still has symptoms and arrange for cystoscopy again.
Our urologist, Dr. C., phoned on Wednesday, and the PSA was down to 0.24. This is still higher than it should be.

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