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Archive for September, 2010

OK, this is a little complicated, so I’ll do my best. First, much to everyone’s delight, Mark has no detectable PSA. In theory, this means there is nothing in him producing PSA, neither a prostate nor prostate cancer. Under normal circumstances we’d be dancing around and shouting, “Let the ten year countdown begin!” But this is where it gets a little complicated. Mark had positive margins. This means there was cancer all the way to the edge of the tissue that was removed during surgery. Positive margins mean either the surgeon cut right at the very edge of the tumor, or there were cancerous cells beyond where he cut. That’s why men with positive margins have such a high recurrance rate. Normally, detectable PSA is the indicator that there is still cancer present.

In Mark’s case, he had a very aggressive, very extensive tumor but a relatively low PSA. This tells us that his cancer wasn’t producing a lot of PSA to begin with. So for him, undetectable PSA is not necessarily a good early indicator that cancer is still present. It could be that there is cancer present, but not enough to produce enough PSA to be detected. Thus, we have a choice. Do we watch and wait to see if the PSA begins rising, or do we proceed with radiation treatment to be on the safe side. There are pros and cons on both sides. Radiation should never be treated lightly, and in Mark’s case the risk is higher because he’s on Coumadin. That might argue for at least waiting until he’s off the Coumadin, either in November or in February, and then testing the PSA again. On the other hand, because we know Mark’s cancer is not one that produces a lot of PSA, the chances are higher that by the time PSA is detectable (if cancer is present) it will have already gone distant and hence become terminal.

We will meet with a raditation oncologist within two weeks, after which Mark will make his decision. Prayers for wisdom would be greatly appreciated. 🙂

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