I’m not seeking medical advice as such here, but trying to understand what’s going on with a friend. I’ll give as much detail as I have, and thank you in advance for reading it.
Friend had a radical prostatectomy twelve months ago. After the operation, pathology showed that the margins and lymph nodes were clear of cancer. Three and six months after the operation, PSA levels were undetectable. At nine months PSA levels were detectable at 0.04. The specialist nurse said that sometimes cancer cells escape the prostate before it’s removed. When asked if it was possible that benign prostate tissue had been left behind, she said it was possible but very rare.
Today, at twelve months, PSA was at 0.05 and the research fellow said that it was likely to be benign tissue left behind. When asked if it was possible that some cancer cells had escaped the prostate, he said it was possible but not likely. So, two apparently conflicting opinions. Which one should he believe? What might happen next? And how worried should we be about our friend?
I would tell your friend to follow his doctor’s advice.
However, when my dad’s PSA started increasing after his prostate was removed, as you describe here, he was started on a regimen of chemotherapy and radiation treatment until the PSA was no longer detectable.
My father’s PSA was elevated a few months after his prostate was removed. He’s been on hormone therapy every since, and it’s kept the numbers down. If that starts to fail, the plan is for him to do radiation therapy.
I’m not sure what conflict you’re seeing:
Both say it’s possible. The only difference is one said it was rare. The thing about rare things is that they are only rare in the abstract. They are real for the rare person it happens to.
I’d follow up with the medical staff treating him on what action they think is appropriate.
Thanks, both of you. The conflict I saw was that one said that benign tissue remainders were possible but less likely than escaped cancer cells, and the other said that escaped cancer cells were possible but less likely than benign tissue remainders. It seems like one would be more worth worrying about, no? Or maybe it wouldn’t. Maybe I just really don’t know anything about this. Ugh.
Here’s my take. One of the possibilities is pretty harmless. The other is potentially deadly.
Your friend can gamble on having the harmless one, or follow up to try to understand the deadly one. Your friend shouldn’t have to think “I heard conflicting stories, so I’m not sure what to think.”
Some people don’t want to know. Personally, I’d be delving into the issue as deep as possible to understand my risks.
-D/a
Yeah, it’s not so much that I want to offer advice to him, it’s that I want to know which is ACTUALLY the more likely reason for the elevated PSA (if it’s possible to know that) for my own information. Our friend has decent doctors and will do as they advise him, I’m sure. I just want to know how worried I should be!
keep checking the PSA-those levels are very low, and I’m not sure that the amount of difference is statistically significant. See if they can freeze some of the serum, and recheck old and new serum at the same time to see if there is really a difference or if it is just a variation between batches.
Obviously, if PSA going up, further evaluation is needed.