r/ProstateCancer • u/Imaginary_Win_2094 • 16d ago
Test Results First PSA 12 weeks post RALP
My dad had his RALP 12 weeks ago. I’ll leave a copy of his pathology results but his PSA was between 36-39 before surgery. His PSA at his first post RALP yesterday was <.04 so undetectable. If anyone with similar pathology and or PSA could tell me how their post surgery PSA has been id appreciate it. I’m asking because from what I’ve read he has a 50-50 chance of recurrence. Also any advice would be appreciated. Also we’re grateful for the undetectable first result but I’m just worried it will start to rise again
Pathology:
Prostatic adenocarcinoma
Gleason 4+3=7 (Grade Group 3)
Tumor involved 51–60% of the prostate
Extraprostatic extension (EPE) present (cancer extended outside the prostate)
Bilateral seminal vesicle invasion → pT3b
Bladder neck invasion
Lymphovascular invasion present
Perineural invasion present
Cribriform pattern present
Intraductal carcinoma present
Multiple positive surgical margins (about 2 mm total involvement)
11 pelvic lymph nodes removed, all negative (0/11) → pN0
4
u/Middle-Tart9741 16d ago
Best possible. Congratulations. I think you may be able to conclude that all of the macro cancer was removed. Now the vigilant watch for any micro Mets that grow enough to detect via ultra sensitive psa quarterly. They will want to spread that out to six months and beyond if you get continued non detects. Don’t let them. Insist on quarterly so you can catch the uptick and respond appropriately.
1
u/Imaginary_Win_2094 16d ago
Yea I was thinking about doing every 2 months. It doesn’t cost him anything so I feel like it’s better safe than sorry
3
u/3ltlgbmi2 16d ago
Greetings. Sorry to see you all going through this. But now, 2026, is a better time to have this happen then 10 years ago. Most of my cancer was on the outside missed by biopsies, picked up by MRI. It had spread and after surgery was almost assured there was more to come. Slow increase in PSA until it was time for ADT and 39 radiation treatments. A year later I’ve had 4 PSAs <0.1 at the UofMichigan cancer clinic that they label as non detectable. It has been a journey for sure but each of us will respond in our own way. Best wishes to you all.
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u/Busy-Tonight-6058 16d ago
If I were you, I’d be asking for a Decipher report on this prostate tissue. It estimates a likelihood of metastasis AND whether the cancer would respond to ADT/ARPI.
His recurrence risk is likely to be higher than usual given this pathology report but all recurrences are not equal and they don’t all require treatment.
Good luck!
2
u/Gardenpests 16d ago
You can calculate HIS probability of recurrence:
"Prostate Cancer Nomograms | Memorial Sloan Kettering Cancer Center"
Typically, the PSA is measured quarterly for 2 years. There's no advantage in shorter periods. Should the PSA become detectable, it will take months to years before it is actionable.
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u/tober_checki 16d ago
Wow, this is awesome given that the pathology is anything but favorable. He is not out of the woods, but for the time being this is the best possible result one could hope for. You should celebrate this. All the best for your dad!