Well, it was a little over 4 months ago that I had the Da Vinci surgery and today was the meeting with the Doctors for the first follow-up. Saw three different Doctors and the consensus was that everything looked fine and I was doing well above the average (of course I am younger than the average so that helps a lot).
Mayo (at least this doctor at Mayo here) only checks PSA every 4 months after the Da Vinci surgery, presuming you have clear margins, no vesicle involvement and the like for the first year. Then they do every 6 months for two years and then yearly. At least that is what they said now. Obviously that could change in the future.
Regarding the PSA, they only use the regular sensitivity PSA instead of the ultra-sensitive because they seemed to think that they would not do anything if it hit 0.2 (hopefully never). This is the only area where I disagree with Mayo Clinic. According to this study (From NYUMC) and this one (PubMed) they are useful in predicting biochemical recurrence at least in the 3-5 year range, and perhaps longer. They didn’t have the time frame to do a long study at that time. But the sensitive tests consequently could provide “18 months” lead time for salvage therapy.
However, the Doctors that I saw at Mayo do not make treatment decisions until the PSA level is 0.2 or higher. This is why Doctors often say “there is no clinical significance of the ultra-sensitive PSA test.” What it means is, nothing will get done anyway until the levels are reached. This represents a difference of opinion between some Doctors and others where some will treat the area earlier than others. In many people’s opinion (including mine) early treatment is best because you have a better chance of knocking out recurrent prostate cancer.
What I would prefer is a third generation PSA test at Mayo to show “< 0.01″ instead of the “< 0.1″. But since they do not do it right now, I will keep asking and order the laboratory work on my own. The LabCorp tests have showed “< 0.01″. I actually may print out a few research papers on it for my doctor and see if I can sway him.
They said that sometimes it seems as if “anything can cause anything” when I asked about losing the taste for PB&Js. One said they had a guy who had a kidney blockage and they cleared it and within a month he no longer needed his reading glasses he’d been using for years. So, the consensus was essentially, strange things can occur and no one yet knows why.
All in all, good news, but I didn’t get the sense of relief I did after the surgery when they said that it was clear of margins, no involvement etc. Perhaps it will come in time. Years maybe. You hear the statistics, but it is not enough comfort yet.
p.s. After I posted this, I remembered I wanted to say that the Doctors at Mayo said that E.D. and continence continue to improve for at least 18 months. Mine is doing well. Continence good except during sit-ups you get drops. ED is pretty good, especially with Viagra. BUT if you are reading this and at 4 months or 6 months or even 12 months do not give up! It will still keep improving. Try not to be discouraged – I know it is easy to be discouraged. Those first 3-5 weeks were very discouraging because it is hard to see the light at the end of the tunnel.
Studies such as this one (from 14 years ago) (Schild SE, Buskirk SJ, Wong WW, Halyard MY, Swanson SK, Novicki DE, et al. The use of radiotherapy for patients with isolated elevation of serum prostate specific antigen following radical prostatectomy. J Urol 1996;156:1725-9.) have shown that early radiotherapy saves lives.