Eight years ago for the first time my PSA was elevated (PSA 5, my free PSA was 15% DRE have always been negative). That's when I had my first biopsy, 7 cores, they all came back negative. I then went to a top Urology group at a top Manhattan Hospital. The Urologist would check my PSA twice a year. For the most part it kept on rising (on a few occasions it dropped 10 to 20%) The PSA went from 5 up to 9 from 2005 until 2012. Over the next 7 years I had 4 saturation biopsy's done. (average 22-24 cores) all came back negative for cancer but on 3 of the biopsy's they found High Grade Pin.
In Feruary of 2013 I went to my doctor for a routine yearly check up. My previous PSA was around 8.5. The blood work came back showing a PSA of 12.5. Having had a few problems over the years with the labs results for other blood work I asked my doctor to re-take the PSA test. Two weeks later the results came back from the second PSA test it was 8.2. Is this variation in such a short time possible, or do you think lab error is more likely the case? I scheduled an appointment (March 2013) with the Urologist and brought my recent blood work with me. He gave me an examination (DRE normal) and took blood-work. The PSA came back at 10. At that office visit and the previous visit the Urologist took a PCA3 test (I hope I have the name of the test and percentages correct, It's from memory) the first one came back at 36% and the second one 93%. So we did another biopsy (22 cores) in April 2013. This time the results came back with a finding of prostatic adenocarcinoma, with a single focus in 1 tissue core, 0.7 mm in largest dimension, less than 5% of the biopsy, Gleason combined 6 (3+3). The Urologist and I discussed treatment but he said normally I would recommend waiting, but "there is a disconnect from the findings and your PSA levels" so he recommended surgery. I took all of my information and had it sent to another highly rated Urologist at another Hospital. That Doctor explained that he is a proponent of waiting and continued testing but he also felt the PSA level and biopsy findings didn't make sense, and since the PSA was 10 he recommended surgery. I had been doing my "homework" and that is the way I was leaning.
I had my robotic surgery done in August 2013 (Prostate and seminal vessels, prostatectomy) The Surgical Pathology report had the following findings,
Tumor Type Adenocarcarcinoma, Primary Gleason grade 3, Secondary Gleason grade 3, Tumor Location right posterior, small foci. Capsule tumor confined to prostate, Seminal vessels bladder neck not involved
From what the Urologists said before the surgery and from what I could read about PSA and prostate cancer a Gleason score of 6 and a small foci tumor doesn't really add up to my PSA score. Any input would be appreciated.
What is more confusing is in the last biopsy it shows adenocarcinoma in the left peripheral zone, but in the Surgical Pathology report it reads, Tumor location, involves right posterior small foci. It doesn't mention adenocarcinoma in the left peripheral where it was originally found in the biopsy. Anybody have anything like this happen to them? From my limited knowledge of Staging the pT2a doesn't seem correct for the Pathology report. Am I correct?
In 2 weeks I will finally get to sit down with the surgeon for the first time to ask him questions. I have been speaking to his nurse since the surgery and she tells me to ask him these questions. If anyone can think of other pertinent questions for me to ask please let me know. If in fact the pathology report is correct than I consider myself fortunate with the findings.Thanks for listening and you all have helped me every step of the way so far with your input on this board, thank You!!
I had robotic surgery at Sloan Kettering Hosp. around Sep. of 2013. My PSA was as high as 12.5. I have no side effects and all my follow up PSA tests so far have been undetectable. I chose surgery because to me it was the best way to go to survive long term regardless of side effects so I could be here to take care of my family. All things considered with my surgery and recovery, it was far less painful and the recovery was easier than I had imagined. If anyone out there is considering surgery (or any type of treatment), as it has been stated here many times, if at all possible, go to a major cancer center and try to get a doctor with as much experience as possible. If possible, I recommend you go to Sloan Kettering. The doctors and staff were excellent. Good luck and God Bless!
It has been about 2-1/2 years since my robotic surgery. My follow up PSA tests have all come back undetectable so far.
My sexual function is about 85% of what it was before surgery. The only side effects I have now is if I drink alcohol to excess I will leak otherwise no leakage. It's happened twice both times after parties that I drank much more than usual.
Overall recovery from the robotic surgery was better than I had anticipated. Surgery was for me the way to go. Make sure if you opt for robotic surgery, if possible do it at a major cancer center and insist on a experienced surgeon who is VERY experienced.
Paul's e-mail address is: firstname.lastname@example.org