My Diagnosis, Tests, and Second Opinions
I was minding my own business; went for a routine check-up in September 2006. Everything was normal but the blood test came back with PSA of 4.2 ng/ml, slightly elevated. My doctor said that it's probably nothing but I should have a biopsy, just to be sure. I put it off; I had "better things to do." I had no symptoms to indicate that I might have prostate cancer. I finally got the biopsy done by a local urologist in January 2007.
When my urologist called with the results, I almost fell off my chair when I heard the "C" word. It turned my world upside down. Psychologically, that initial week or two after diagnosis was the worst period. As time went on and I learned about prostate cancer and the various treatment options, I realized that prostate cancer was not the end of the world. As I had early stage cancer, it was probably curable. If all went well, my life expectancy will not be affected, and the quality of life impacts will be minor, in the long run.
From the moment of diagnosis, I spent hours every day learning about my options. I read five books (by Walsh, Scardino, Strum, Pilgrim, and the Prostate Cancer Foundation), studied websites devoted to prostate cancer, and I joined on-line discussion groups. I learned the most from Walsh's book (2nd edition, June 2007). The on-line groups, especially, PPML, were extremely helpful. Any time I posted a question to PPML, I would have the answer - often within minutes - and often, I would have multiple responses, including references to journal articles.
My urologist was also helpful. I spent about an hour with him during the post-diagnosis visit. He explained the pros and cons of different options; didn't try to push any one option. (He does do brachytherapy.) He advised against active surveillance. As Scardino (who is a surgeon) points out, on p. 216 of his book, "Despite the best of intentions, doctors tend to be biased in favor of what they do." So, I appreciated my urologist's objectivity.
I eventually got second and third opinions about my biopsy slides; the second at Memorial Sloan-Kettering Cancer Center (MSKCC), and the third at the hospital where I had my surgery, Mount Sinai Hospital, both in NYC. The three Gleason scores agreed: 6 (3 + 3).
My PSA doubling time was 6.5 years, as of the PSA result that led to the biopsy. This was based on four PSA tests between January 1996, when my PSA was 1.4, and October 2006, when my PSA was 4.2. (The two others were 1.6 in Sept 1998 and 2.9 in April 2003.)
I also had MRIs of the pelvis (with ER coil) and abdomen, and a whole body bone scan. All three were consistent with localized prostate cancer; these tests provided little new information.
I tried to get a second opinion from one of the best (or, at least, most famous) medical oncologists, Dr. Howard I. Scher, MSKCC. He was not taking new patients at the time. I was offered an appointment with another MSKCC medical oncologist, Dr. Lewis J. Kampel.
Dr. Kampel reviewed my records, explained my options (which I already knew by then). I didn't learn much new from him, but he did answer all my questions. He advised against active surveillance; recommended surgery. He added that, if I chose open surgery, he could set me up with Dr. Scardino. When I told him that I was leaning towards robotic surgery and Dr. Samadi, he didn't try to recommend a MSKCC surgeon instead. He did mention a couple of MSKCC surgeons who do laparoscopic surgery, but, he didn't try to change my mind about Dr. Samadi.
My Considerations About Treatment Options
Having a Ph.D. in physics, I know a bit about ionizing radiation, the damage it can cause, and that it is impossible to destroy the whole prostate without also damaging the urethra inside the prostate and tissues outside the prostate. I had considered radioactive seeds (brachytherapy), IMRT, the other ..RTs, the CyberKnife, and proton beam therapy. These procedures use tens of Greys (Gy), some as high as 100 Gy, of ionizing radiation.
To put the tens of Gy of radiation into perspective, five Gy is sufficient to kill a person! As stated at, e.g., in one reference, "The lethal dose for 50% of the exposed population to die within 30 days of exposure is about 4.5 Gy for whole body exposure…" While I recognize that radiation treatment is NOT the same as whole body exposure, no radiation treatment is perfect. Some healthy tissues outside the prostate are always exposed, even if by only a small part of the total radiation. A small part of 70 to 100 Gy can still be a lot of radiation. So, radiation treatment was not for me!
An important disadvantage of radiation vs. RP is that RP gives the patient some early, definitive answers. With radiation, on the other hand, there is no specimen to evaluate. The patient can only wait and hope for the best. After RP, the pathologist can tell if the cancer had been organ confined, and whether or not there had been capsular penetration with negative margins. The Gleason score can be revised based on an examination of the whole prostate (rather than just the tiny portions that were used in the needle biopsy). The post-surgical Gleason score can predict the probability of recurrence.
Another factor was that, whereas with surgery, the post-surgery side effects (incontinence, impotence) are usually instant but get better with time, with radiation, the side effects upon treatment are minimal but get worse with time. With early stage prostate cancer and surgery, the probability of becoming continent and sexually potent after the surgery is high. I would rather look forward to an improving situation and a full cure than to a worsening situation and uncertainty about whether or not I was cured.
HIFU and Cryoablation
I had also considered thermal ablation, especially high-intensity focused ultrasound (HIFU), and cryoablation (cryosurgery). My physics background helped me eliminate those too. Heating or cooling 100% of the prostate to temperatures that destroy the prostate while maintaining the urethra that goes through the prostate at near normal body temperature is physically impossible. There must be a transition zone next to the urethra where the temperature is in-between the urethra temperature and the temperature of the rest of the prostate. If there are cancer cells in this zone, then not all the cancer is destroyed.
Per Walsh's 2007 edition, p. 317, a Mayo study had shown that 17% of prostate cancers touched the urethra, and 45% were within one millimeter. This says that, in 17% of cases, HIFU and cryo will fail to kill all the cancer cells, and in another 28% of cases, it will be highly unlikely that they will kill all the cancer cells. So, unless someone can guarantee that there are no cancer cells near the urethra, why take a chance? No HIFU or cryo for me!
With the help of scholar.google.com, I found the Mayo study to which Walsh refers. It is based on 1991-93 data, which is pre-PSA era, when, on the average, men were diagnosed with more advanced cancer than they are today. So, the percentages of cases where cancer cells are next to the urethra would probably be lower today, but, nevertheless, why take a chance?
In the end, I narrowed the choices to active surveillance (AS) and surgery. I read everything I could find about AS. It seemed like an attractive option, BUT, the "window of opportunity" for treatment is a fuzzy one. Nobody knows where the edges of that window are.
Even if the window were to be correctly identified, I would probably have to have treatment sooner or later, because...
I'm 65, so, my life expectancy according to the actuarial tables is about 16 yrs. My blood pressure is 128/78, my weight is normal, and my cholesterol is 170 (in US units). Except for a few allergies, I have no other health issues. So, I expect to live longer than 16 yrs. (There can be too many PSA doublings in, say, 20-25 years.) AS vs. treatment comparisons have shown that there is little difference during the first few years, but, in the long term, the mortality was higher for the AS groups.
Another factor was that, if the surveillance showed that I needed surgery in, say, five years or later, by then, the cancer may NOT be confined to the prostate, and the recovery from incontinence and impotence, being age dependent, would be longer. As Walsh says, p. 301, "Men over age seventy have more problems recovering perfect urinary control than do younger men." I also didn't like the idea of living with cancer when the alternative was to be cured; yes, cured - if the cancer was truly prostate confined, which was likely in my case.
As I saw it, either way, it was a gamble. I liked the odds of treatment better than I liked the odds of AS. I'm in good health now, so, I'd rather get it over with now, then "fohgetaboutit." I recognize that others see the odds differently.
My local urologist advised surgery. Dr. Kampel, medical oncologist at MSKCC advised surgery; my gut instinct, and my brain, also told me that surgery was the logical choice for me. So, I decided to go for the possible cure and then, hopefully, look forward to a healthy, long life! With active surveillance, this disease would be hanging over me for the rest of my life, and my future health status would always be uncertain.
The Surgery and Surgeon Options
After looking at information on the different surgery options, open, laparoscopic and robotically assisted laparoscopic, for me, robotic was the clear choice.
Some who practice open surgery bad-mouth robotic surgery, claiming that the "tactile sensation" is missing. To that, my surgeon, Dr. Samadi, answers that tactile sensation is important for a blind man. In robotic surgery, the surgeon has a clearer, 3D, magnified view, unobstructed by blood. The surgeon can do everything an open surgeon can do, and do it with far greater precision. The hand tremors, for example, are not transmitted by the robot, and the robotic surgeon has an excellent view of the prostate, from all angles, rather than just from above.
Selecting a Surgeon
It is too bad that there is no "Consumer Reports" for surgeons. The information one gets in on-line discussion groups is usually one man's opinion about one surgeon. It is hearsay or anecdotal evidence. The information one gets from hospital and doctor websites, the popular press, and from journal articles, is often not very useful because there are no standard definitions, no apple to apple comparisons, and the data are often incomplete.
For example, just before my initial visit to Dr. Samadi, a press release appeared by another NYC hospital/robotic surgeon in which high success rates for his patients' regaining continence after surgery was claimed. Dr. Samadi's comment was that it was mostly hype. Without, e.g., the age distribution of those patients, the statistics are meaningless. Young patients regain continence sooner than old ones. Moreover, there is no standard definition for "continence."
The same point is made in a very informative article on post-RP ED by Dr. John P. Mulhall; "…the incidence of post-prostatectomy ED is unclear; it varies from center to center, from surgeon to surgeon, and from definition to definition." He points out that the post-surgery ED statistics, for example, often neglect to mention whether or not medications such as Viagra were used.
After researching the information available on many different robotic surgeons, and I didn't find much information of value, I chose Dr. David Samadi, at Mt. Sinai Hospital, in NYC. (My wife and I had previous, favorable experiences at Mt Sinai.) At about that time, Mt. Sinai hired Samadi to be its Chief of Robotics and Minimal Invasive Surgery. Previously, Samadi was at another excellent NYC hospital, Columbia Presbyterian Medical Center. (Samadi took his whole team with him when he transferred; he started at Mt. Sinai on May 1, 2007.)
Samadi has done about 1,000 such surgeries (as of Aug 2007); he typically does about 16 robotic RPs a week. He's trained in all three forms of RP: open, laparoscopic, and robotically assisted laparoscopic.
On my initial (and only) visit prior to the surgery, I found Dr. Samadi to be a regular, friendly guy. He answered my (numerous) questions patiently, and I felt, competently, with no BS. As my wife and I were leaving his office, he volunteered his cell phone number! He also answers his own e-mail, often within minutes.
The Surgery and the After-effects
My surgery took place on August 4, 2007. The actual surgery (not counting preparation and close-up times) took about an hour, according to Dr. Samadi. The Operative Report says that "the operation was 100 minutes." Fascinating procedure! Dr. Samadi controlled the (DaVinci) robot from a corner of the OR, about 15 ft from the operating table. He did everything remotely, through tiny incisions. I lost only about 20 cc of blood (one tablespoon = 15 cc). The abdomen is pressurized during the surgery; the blood vessels are compressed, so, the surgeon has a view that's unobstructed by bleeding. Because of the high pressure, a lung machine assists the patient's breathing.
When I awoke, I felt no pain! A couple of hours later, Arianna and I took a long walk, from the West wing of Mt. Sinai to the East wing and back. I felt great. I had difficulty believing that I just had major surgery, a few hours earlier. At one point, the walkway overlooked an atrium, and when I looked up, I could see a beautiful blue sky. For some reason, Louis Armstrong's "What a Wonderful World" popped into my head, and I got tears in my eyes (after-effect of the anesthesia, perhaps?).
Both nerves were spared, and the sphincter is OK according to Dr. Samadi. After spending one night in the hospital, I went home. As we live in New Jersey, a little more than two hours away, door-to-door, I was concerned about the trip home, especially about the catheter. Everything went well, however. The catheter was not a problem.
On day 2, I still had no pain. The only discomfort I had experienced during the first week was while trying to sit on a hard surface. The perineum (the region between the anus and the penis) was very pressure sensitive. Simple solution: don't sit on hard surfaces for a while. (I eventually purchased a doughnut pillow at a local drug store, for $8.82.) I'd asked Dr. Samadi if the sensitivity was normal, and if it was temporary. He replied yes, and yes.
In the hospital, I had a nice private suite, on the 11th floor of Mt. Sinai (11W, room 102), with a great view of Central Park. (It was Dr. Samadi's suggestion that I get a private room. I decided to splurge. It is an unreimbursed expense, but, what's money for if not for that!?) I could see the NYC half-marathon from my window, a hawk was riding the air currents not too far from my window, and a kite, flying well above my floor, the 11th, was being maneuvered by some really good kite flyer on the ground.
The worst after-effect was that I couldn't sleep the night after the surgery. They put pneumatic socks on me. It kept squeezing my left leg and then the right, left, right… . I was told it was necessary to help with the circulation and to prevent blood clots. Oh well; it was a small price to pay.
The best surprise of all had been that I had no pain, whatsoever, at any time after the surgery. I didn't have to take any pain killer. Nor have I had any bladder spasms, nor did I feel "sick" at any time. I sent e-mail to Dr. Samadi asking whether I am just lucky, or, is what I'm experiencing typical of his other patients. He replied that it is typical!
Another surprise was that I was not nervous or fearful, at any time. The reason, I believe, was that I was fully informed, read everything I could get my hands on; joined on-line discussion groups, PPML, RP.... I knew what to expect. (When I saw the robot in the OR, as a physicist, I felt like asking questions about it, but, within a short time, the anesthetic put me out.)
The Catheter and Urinary Control
On the fifth day after the surgery, the catheter was removed by Dr. Samadi's nurse, Adrianna. The procedure was quick, and not painful. She deflated the balloon that anchored the catheter in place, told me to cough, and, as I did, she pulled out the catheter. I felt something like a momentary pinch. She then back-filled my bladder with about 120 cc of water and told me to urinate. As I did, I tried to stop the flow (that was my idea, not hers), and I was able to do so. The sphincter was working! Yippee! (No pun intended.) I had done Kegel exercises during the weeks preceding the surgery, and continued doing them after the catheter was removed.
According to Walsh, p. 302, on urinary control, "Most likely, it will take some time for your control of urine to come back completely. For most men, this process happens in three distinct stages: Phase one is when a man can remain dry when lying down. In phase two, you're dry when you're walking around. If you can walk to the bathroom and not urinate until you get there, that's a great sign - it means that the sphincter is intact. And in phase three, you are dry when you stand up (using muscles that put pressure on the sphincter) after sitting."
Well, according to these definitions, I was past phases one and two about two days after catheter removal. The standing up part, after sitting, is still a slight problem three weeks after the surgery. From a sanitary point of view, a drop or two is not a problem because urine produced freshly by the kidneys is sterile (unless the individual has a urinary tract infection). It is harmless. The pads promise to neutralize the odors, and, they do.
On the 6th day after catheter removal, I had a scare during the night. I woke up with a full bladder; I couldn't start the urination. After what seemed like a long time, probably about 10 minutes, the flow started, in dribs and drabs, and continued that way until the bladder was emptied. The difficulty with starting recurred a couple of times but not to the extent of the first scare. There were no more such problems after about a week past catheter removal.
I had read Dr. John P. Mulhall's article about the benefits of taking Viagra (sildenafil) following radical prostatectomy. There is evidence that oxygenating the tissues helps to repair the damage caused by the surgery, and it prevents additional damage later on, such as venous leakage. (ED drugs do more than just treat ED. For example, Viagra is being used as a treatment of pulmonary hypertension.)
So, prior to the surgery, I had e-mailed the Mulhall article's URL to Dr. Samadi and asked if it was OK for me to follow Mulhall's advice, including the taking of an ED drug as soon as the catheter is removed. He replied that it was OK; it couldn't do any harm.
On the evening of the day the catheter was removed, just before going to sleep, I took a 25 mg (1/4 of a 100 mg tablet) of Viagra (sildenafil), and have continued taking it every night. I increased the dose to 50 mg after a couple of weeks. On day 18 after the surgery, I woke up at 2:30 AM with clear evidence that the Viagra I had taken three hours earlier was working! ;-)
Post-Surgery Pathology Report
The "Surgical Pathology Report" contained good news and bad news. The good news is that I had clean surgical margins. The bad news is that my Gleason score was stepped up from 3+3 = 6 before the surgery, to 3+4 = 7, and that the cancer had extended into the capsule, but not beyond.
The Report (from Mt. Sinai School of Medicine, NYC) is, as follows:
The sample weighed 46.0 gm.
"A. Radical prostatectomy specimen extensively involved bilaterally with prostatic adenocarcinoma (Gleason pattern 3+4, total score 7). The tumor extends into but not beyond the prostatic pseudocapsule. Intraprostatic perineural infiltration with tumor is identified. Foci of high grade PIN are present. The apical, base, pseudocapsule and soft tissue resection margins and seminal vesicles are negative for tumor.
B. Fragment of fibrous and adipose tissue, negative for tumor.
Pamela Unger, M.D.
So, what does this mean? According to both the Han tables, the CAPRA score, and the MSKCC Post-Radical Prostatectomy nomogram, the prognosis for no recurrence within 10 years is excellent.
However, none of these differentiate between capsular penetration and no capsular penetration. According to Walsh, p. 373, capsular penetration DOES make a significant difference, even with clean margins. He says:
"Gleason score of 7. Organ confined disease: an 86 percent chance of having an undetectable PSA level in 10 years; capsular penetration with negative surgical margins: a 62% chance..."
Negative margins but with capsular penetration means that my cancer was "specimen confined" (but not "organ confined"), per Walsh, p. 366. There was no "extracapsular extension (ECE)," i.e., no cancer was found outside the capsule (the membraneous covering of the prostate).
About "perineural infiltration," perineural means surrounding a nerve. Walsh, p. 187, says, "Thus it is not uncommon to find prostate cancer in the spaces around the nerves; this is called perineural invasion. Because the nerves are most common close to the surface of the prostate, the finding of perneural invasion on a biopsy suggests that the cancer is close to the edge of the prostate…"
My post surgery pathology report was quite a bit different from the pre-surgery report based on the needle biopsy. This illustrates the imperfection of needle biopsies. As Walsh points out, p. 179, "Each needle biopsy samples only one-thousandth of the prostate…" According to Scardino's book, p. 166, "…in 30 percent of cases, the tumor will turn out to be higher grade than it appeared to be in the biopsy, and 5 percent of the time, the grade will be lower."
My pre-surgery tests indicated that I had early-stage, indolent prostate cancer. Some had told me that I was a good candidate for active surveillance. The post-surgery pathology report found that my cancer was quite a bit more extensive than the initial results had indicated.
Conclusions - Three Weeks After the Surgery
Knowing what I know now, I have no regrets. I feel confident that I made the right decisions - about having robotic surgery, about the surgeon, and about the hospital.
I waited six months between the diagnosis and the surgery. Given the post-surgery pathology report, I am glad that I didn't wait any longer; I am glad that I did not opt for active surveillance.
Today is three months after my surgery. The best news is that the first post-op PSA result was "<0.05" ng/mL. The blood sample was collected during my first post-op visit with Dr. Samadi, on September 7, about five weeks after the surgery. (The PSA declines gradually after the surgery; the PSA half-life is "two to three days.")
During my post-op visit, I asked Dr. Samadi why the pathology report contains so little information. For example, Dr. Peter Scardino in his book advises that, if Gleason 4 was found, "you should ask about their size and extent." Dr. Samadi advised me to speak to the pathologist - which I did. She told me that my Gleason 4 was about 10% and the cancer was "confined to the gland." In view of the PSA < 0.05, my prognosis was excellent. "You're cured!" said she. I asked about the possibility of further pathology tests; she said that no further tests were necessary.
The incontinence and impotence have both been improving, gradually. I have had no leaks at night, ever, not even the night after the catheter came out. During the day, I have had slight leaks, usually upon physical exertion. I have never needed more than one pad during the day. My wife and I are avid ballroom dancers. During one night of heavy dancing, during certain steps, I felt that I had leaked. It seemed like that day was a particularly bad one, so, I weighed the pad at the end of the day and I compared it with the weight of an unused pad. The difference was 0.1 oz. I used an electronic (postage meter) scale which has a 0.1 oz resolution. So, I could have leaked anywhere from 0.05 to 0.15 oz; i.e., very little.
I have continued taking 50 mg of Viagra every night. Erections, although getting better, are still nowhere near what they were prior to surgery. Today, on the 3 month anniversary since surgery, I was finally able to have an erection sufficient for intercourse. From what I have read, my progress (at age 65 and three months past surgery) is pretty good.
I'd been reading more and more (especially on PPML) about the importance of maintaining a proper vitamin D level. So, I finally had the Vitamin D, 25 hydroxy test, for the first time in my life. The result was 15.7 ng/mL; so, I'm quite deficient. The proper range is 32 to 100 ng/mL. The LabCorp report includes the following note: "Recent studies consider the lower limit of 32 ng/mL to be a threshold for optimal health. Hollis BW, J Nutr. 2005 Feb;135(2):317-22." So, based on advice from several "experts" on PPML, I have started taking 4,000 IU of Vit. D a day. Up to at least 10,000 IU per day is supposed to be safe (people who sunbathe for an hour or more in the summer receive much more than 10,000 IU of vit. D.)
My next post-op visit with Dr. Samadi is in December. I plan to have both my PSA and vit D level tested. (Meanwhile, Dr. Samadi is well past his 1,000th robotic surgery. He is doing about 15 a week. He and his team are so proficient that it takes them only about 1 to 1-1/2 hours per surgery.)
It is now one year since my prostatectomy. Each of the four PSA test results since my surgery have been undetectable, i.e., <0.05 ng/ml.
The incontinence is 99.9% gone. I have been putting panty liners into my shorts every morning for the past few months, just for insurance. There has been no evidence of leakage, even though, occasionally, e.g., when I get up from having sat on a hard surface for a long time, or when coughing, it feels like a drop has been released. (The drop probably stays in the urethra because there is no evidence of the drop on the panty liner.)
The ED is much better too, although, erections are not what they were when I was younger. They are, however, good enough for intercourse, and the pleasure is no less than before the surgery. I have continued to take 50 mg Viagra every night (split 100 mg tablets). About a month ago, after reading Munhall's review article's last section, "The Structure of Rehabilitation: An Example of a Program," I take the full 100 mg, two days a week, and 50 mg each night the rest of the week.
My vitamin D, 25-hydroxy level is back to normal (after taking 4000 IU per day since 1 November 2007). As of the last test, on 15 April 2008, the level was 39.9 ng/ml.
In January, I caught a cold, which went to my chest and became bronchitis. I coughed hard, which was probably the reason for the ventral (also called incisional) hernia I developed. I noticed a bulge above my belly-button, at the approximately 1 inch long incision where the prostate was removed during the prostatectomy (the other incisions of robotic surgery are smaller).
I had hernia repair surgery in May. The surgeon inserted a polypropylene mesh and closed up the opening. The surgery took about an hour. I went into the hospital in the morning and was home by lunch time. There was no significant pain except when the abdomen was stressed - when it hurt like hell for the first few days. The pain due to getting in and out of bed, and coughing, was really bad. I used a hiking stick for the 1st few days, and wore a binder (about 8" wide elastic belt) for several days. The surgeon gave me a schedule of time after the surgery vs. the weight I was allowed to lift. It took six weeks before the surgeon lifted all weight lifting restrictions.
It is now one year and seven months after my surgery.
I just received the latest (ultrasensitive) PSA result: "<0.01 ng/mL," and the previous one, last September, was the same.
The Vitamin D, 25-Hydroxy result is 41.6 ng/mL. (I have continued to take 4000 IU per day, since November 2007.)
The incontinence is just about gone, and sex is as pleasurable as it was before the surgery.
After a general checkup in September, 2008, because of the Vitamin D deficiency I had up to September, 2007, I requested a bone density test. The results (DEXA) showed osteopenia, with T-scores of -1.0. -2.2 [Femoral Neck (Left)], and -2.0. The 10-yr probability of hip fracture = 3.3% according to the Frax® site. So, I have been taking 1.2 grams of calcium citrate daily, with an occasional extra 1 gm.
The year since my last update, in March 2009, has been unremarkable. Life is good!
My PSA is still undetectable, i.e., <0.01 ng/mL via the ultra-sensitive PSA test.
The latest "vitamin D, 25-Hydroxy" test result is 48.0 ng/mL; in the normal range. I have been taking a daily total of 5,300 IU of vitamin D (4,000 IU from vitamin D pills, 800 IU from the 1200 mg of calcium pills, and 500 IU from a multivitamin pill). Annual checkup, in January, went well; BP = 132/78, cholesterol = 170, LDL cholesterol = 105 (a bit on the high side), C-reactive protein = 0.28, etc., so, the doctor recommended no treatment of any kind.
My PSA is still undetectable, <0.01 ng/ml, as measured by the Ultrasensitive PSA test method on 24 March 2011.
I also had my testosterone level measured on the same day, for the first time in my life.
Total testosterone level: 323 ng/dL, below the "reference range" of 350 - 1030.
"% Free Testosterone (Dialysis)," 1.6%, within the reference range of 1.5 - 3.2 %.
"Free Testosterone, Serum," 52 pg/mL, on the borderline of the reference range of 52 - 280 pg/mL.
What prompted me to have my testosterone level tested was a discussion on PPML in which an article Testosterone replacement therapy after prostate cancer was cited, according to which "there is now evidence that testosterone replacement is safe in men who have been successfully treated for prostate cancer."
Testosterone deficiency is associated with several problems, including osteoporosis. (Yes, men too get osteoporosis.) Two years ago, I was diagnosed with osteopenia, possibly as a result of long term vitamin D deficiency, and, this year, a DEXA bone density test showed that one of the three T-scores, the one for the Femoral Neck, was -3.0 which indicates osteoporosis. My doctor has prescribed Boniva.
Since my April 2011 update...My PSA is still undetectable, <0.01 ng/ml, as measured by the ultra-sensitive PSA test method on 22 February 2012.
In my April 2011 update, I had mentioned that my doctor had prescribed Boniva. However, subsequently, I consulted a specialist who determined that the DEXA bone density test was done incorrectly. As a consequence, I did not start to take the Boniva or anything else.
As I approach my 70th birthday, life is still good!
Nearly six years after my surgery (in August 2007), my PSA is still undetectable - as measured on 5 June 2013 by means of the "PSA Ultra-sensitive W/Serial Monitor" test at LabCorp. The test result is shown as "PSA, Ultra-sensitive <0.015." No units are given but, in the past, it has always been ng/mL.
Life is good!
As of 21 April 2014, my PSA is <0.015 ng/mL (undetectable), per LabCorp Ultra-sensitive test with "Roche ECLIA methodology."
My PSA is still undetectable, i.e., <0.015 ng/ml (using the ultra-sensitive PSA test, done by LabCorp). Life is good!
My PSA is still undetectable. It will be 9 years next week since my surgery.
John's e-mail address is: firstname.lastname@example.org