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    Prostate Cancer Follow Up
    An_245055 posted:
    My dad is 71 years old and was diagnosed with prostate cancer in early March. He opted for the Divinci robotic surgery to remove the prostate. The pathology results came back and the surgeon advised us that the cancer was more aggressive than originally thought. It received a Gleason Score of 7 and he said that there was an area about a millimeter in size where the cancer had 'reached the edge of the prostate'.

    He said the next steps were to check PSA levels in six weeks and then again in 3 months to determine if follow up radiation would be needed.

    I don't like the term aggressive used with cancer and the plan to sit back and wait three months to see if levels rise.

    I'm trying to find out what the PSA levels should be and how to interpret them post surgery. I've read/heard that they PSA goes down by 1/2 every week post surgery, so that by the sixth week it should be zero. What I want to know is could we get a '0' reading at six weeks even if some cancer cells got out? If so, would you recommend waiting 3 months to see if the readings go up at all (or would you suggest more frequent checks - since it's considered aggressive).

    I really want to be optimistic and positive for dad, but I also want to be realistic and make sure we are doing everything possible to prevent any further invasion of cancer cells into his body.

    billh99 responded:
    more aggressive

    I think that important word is MORE and not aggressive.

    Was the Gleason a 3 4 or 4 3?

    What was the per-surgery PSA?

    there was an area about a millimeter in size where the cancer had 'reached the edge of the prostate'.

    He needs to get a copy of the actual pathology report.

    That reached the edge could mean that it reached the capsule, but had not penetrated it.

    This basically what happened to me. Gleason 3 3 before surgery.

    Afterwards the pathology report showed 3 4 with the pc reached the edge of the capsule, but had not penetrated it. And no vascular or seminal vessels involvement.

    And the margins where clear.

    Those are the details that you need from the report.

    I had mine in Jan 2011 and the PSA reports have been undetectable and gone to a 6 month follow.
    Basir U Tareen, MD responded:
    I think your urologist has taken a very reasonable approach. There is still great debate regarding adjuvant radiation vs. salvage radiation in urology about high risk disease and positive margins. In lay man's terms, here's the big question:

    "Should you radiate all men such as your father (adjuvant RT) to get the maximum chance of cure at the expense of treating a large percentage of men unnecessarily" (Radiation, like any treatment, can have side effects)

    Another approach is to treat with radiation after surgery after the first signs of PSA rise.

    I typically prefer to check a PSA intially and only treat if the PSA is detectable. (anything detectable on an ultrasensitive PSA).

    If the initial Psa at the 6 week followup is zero, I think it is reasonable to wait until the 3 month followup to check a 2nd PSA.

    Best of luck to your father.

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