Radiation Inevitable with 0.07 PSA?

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NewspaperLover
Regular Member


Date Joined Sep 2009
Total Posts : 220
   Posted 7/11/2011 9:52 AM (GMT -7)   
Just when you think the bear has gone to sleep.  Had robotic surgery in  November '09.  Very quick recovery.  No incontinence at all. Felt great.  Went diving off the coast of Vietname three months after surgery.  Margins clean, first three post operative PSA tests "undetectable at < 0.05" until two months ago.  In late May, a fourth test/check-up scored a .1.  My surgeon  said to wait six months before testing again. Waiting six months did not sit well.  After 4 calls, much hassle with his staff, convinced him to do a test number 5 which came in at 0.07.  (Tests four and five were at a different lab because the lab my surgeon had been using for the first three tests  was no longer in business, so that complicates matters.)  I  think 0.07 is still not any where near good enough.  My surgeon wants to wait to November to test again.   A physician friend of my wife's commented to her that at "0.07 radiation was inevitable, and the sooner the better."  So my immediate decision point is do I pursue matters with another physician/oncologist and push for radiation now?  Or do I let things ride with my surgeon?  I was wondering if posters have experience with a rising PSA a few years out from surgery, and at what level did you pursue radiation, if you did?  Any experience or insight appreciated.  Thanks...
 
NewsPaper Lover:  Age 67. Radical Prostatectomy DaVinci Nov. '09.  Margins "clean."
PSA tests Feb '10, May '10, Nov '10 all reported by my surgeon  "undetecable at < 0.05."
PSA May '11  "0.1".
PSA June '11  "0.07"
 
 
 
 
 
 

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 1841
   Posted 7/11/2011 10:00 AM (GMT -7)   
I would be seeing a very good medical oncologist, preferably one that does a lot of prostate cancer work. In my opinion the surgeon's work is done and the oncologist now does the testing and coordinating to determine whether you need RT and whether HT should be added.

Clearly any steady increase in PSA would indicate there is some cancer working. The oncologist will have a protocal in place to determine whether a recurrance is evident.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010
HDR Brachytherapy December 6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.
PSA <.1 on 4-7-2011
Second Eligard shot on 4-7-2011

dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 147
   Posted 7/11/2011 10:29 AM (GMT -7)   
Hi NewspaperLover,
Sorry to hear your numbers are on the rise. My surgeon told me that 3 consecutive rises or .1 he considered it a failure. I had both so off we went.

I am 6 yrs out with surgery now and @ 3 yrs I had recurrence.
I am now 3 yrs post SRT and am doing great with the numbers, <0.04, since 1st post SRT psa.

Hope this bit of info helps. I would just go with the Doc friends direction and figure sooner the better. That is what my surgeon and Rad Oncologist recommended also and it seems to have worked so far1

good luck!!

David
Age 55
Pre-op PSA 4.3
Surgery Feb. 17 2005
Post-op Path : Gleason 3+3=6
Right pelvic lymph nodes: negative for metastatic carcinoma
Left pelvic lymph nodes: negative for metastatic carcinoma
extent: right lobe 40% left lobe 10%
capsular penetration: Absent
Seminal vesicles and vasa differentia: Uninvolved
Prostate: 26 grams
Post-op PSA's <0.04 for 3 years
Feb. 08: 0.07, March 08: 0.08, June 08: 0.09 and Sept. 08: 0.1
IGRT scheduled.....November 17th....
FINISHED 01/14/09
05/14/09
1st PSA after SRT <0.04
12/03/09
2nd PSA after SRT <0.04
06/03/10
3rd PSA after SRT <0.04

Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1174
   Posted 7/11/2011 11:17 AM (GMT -7)   
Many members here will tell you to wait with SRT until you've had 3 consecutive increases above .1 in your PSA. However, my experience was more like David's (dsmc) experience. When my PSA, 2 years after open RRP, went from <.04 to .04 to .05 then .07, my medical team and I decided that I had a recurrence and I started preperations for SRT. By the time I started SRT the PSA was at .1. Now, after more then 30 month, I'm doing ok. There is some doubt as to exactly when to start SRT, but waiting too long could make SRT less effective.
Wishing you well in your battle.
Mag

Born 1936
PSA 7.9, Gleason Score 3+4=7, 2 of 8 positive
open RP Nov 06, T3a, Gleasons 3+4=7, Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; at SRT Start=0.1,
Salvage RT completed (33 days-66Gy) 19 Dec 08
PSA: in Jan 09 =.05, all tests to date (June 11) <.04

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4137
   Posted 7/11/2011 12:34 PM (GMT -7)   
I'd get another test at the end of July... Or find a third lab and do a test now and then again in a month.

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5969
   Posted 7/11/2011 12:42 PM (GMT -7)   
My uro/surgeon also uses the "multiple rises over .1" scheme. It did delay things a little bit for me, as I was seeing the .0x rises 6 months earlier.
 
Since I did RT as adjuvant due to other indicators, I can't speak to your case, other than to say that ultrasensitive tests are not used by all of our uros, although I wonder if the "anxiety" tradeoff is a valid justification.
DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2191
   Posted 7/11/2011 12:53 PM (GMT -7)   
Been wondering how you are doing, haven't heard from you in a while.

You have some very good recommendations already; try to find a good PCa Onco and test again.

I had surgery just before you and never reached undetectable. Had SRT just 3 months after surgery and still have a climbing PSA. But had it not been for that I would have not jumped on the SRT table so quick.

It is not talked about here much, but there are possible side effects, both immediate and future that can accompany SRT. Sounds to me like you have healed well from your surgery and are enjoying life.

Just my opinion, but I would take the tests again, monitor closely and find an Onco that I am comfortable with. Just like you did when you decided on surgery, gather the facts and make an informed decision as to what is best for you and your circumstances. As you know, there are no iron-clad rules when it comes to PCa.

For what it's worth,

Sonny
60 years old - PSA 11/07 3.0 PSA 5/09 6.4
da Vinci 9/17/09 Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5% positive margin, extra-prostatic extension
PSA .6 IMRT completed 1/15/10 35 treatments- 70Gy
2/23/10 Post IMRT PSA 1.0
3/22/10 PSA 1.5
4/19/10 PSA 1.2
5/22/10 PSA 1.3
8/9/10 Radiation for MET
9/7/10 PSA 2.2
1/5/11 PSA 3.9
3/7/11 PSA 4.2
4/10/11 PSA 3.8
5/19/11 PSA 4.9

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24403
   Posted 7/11/2011 1:06 PM (GMT -7)   
I would definiitely wait and have a re-test.

At .07, even that is proven correct, I would still not jump to do SRT.

My medical team here all agreed on 3 consecutive rises above .10 before calling it recourrance. There are those doctors that would want to wait till you hit .20, though I personaly don't agree with that thinking.

There are risks associated with SRT, I am the victim of such risks, and had I known I would be so damaged by SRT and ultimately having the SRT fail so fast, I would have never agreed to do it.

The radiation oncologists I spoke with first, also agreed that SRT is most effective if you hit it before reaching .50, you are a long, long way from that number. Other doctors feel that you can safely reach 1.0. I don't agree with the later number, myself.

I think you fully need to have recurrance declared in the normal sense, before pulling the trigger. Radiation is a much more serious endeavor than its seems on the surface, and once you start it, there is no going back or quitting midstream.

If your current quality of life is pretty decent, again, I wouldn't want be doing any kind of radiation without being fully justified with confirmed recurrance.

Good luck with whatever you decide

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81, 6/11 5.8
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 674
   Posted 7/11/2011 2:06 PM (GMT -7)   
My Rad Doc told me that if my psa goes up to0.09 we are headed in . Every one was elated at my psa of 0.08 from 48.9 at surgery. I guess we shall see.
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear
1st post op PSA-0.26-03/16/11
2nd PSA-05/09/11-0.08
Lots of ED

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 846
   Posted 7/11/2011 4:56 PM (GMT -7)   
0.07 was my first detectable PSA after a pair of <0.05 undetectables. And my PSA proceeded to double every 6-7 months from that point.

I did not have radiation as the risks outweighed the benefits. That leaves HT at some point in my future. What do I do while waiting? I have opted to try the diet/supplement route and my early results are promising. Not expecting a cure, just a slowing or halting of the PSA progression.

Opinions are divided as to when to start radiation or HT. Some say hit it early, but the other side says that these treatments have sometimes serious side effects, so best not to start until really sure you do have a progression.

Not an easy choice. Good luck with whatever you decide.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but then rose to 0.4, doubling time 7 months
Following diet change, PSA static at 0.4...

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2820
   Posted 7/11/2011 7:22 PM (GMT -7)   
I would wait and have another test - changing labs ( as we have seen on other postings here at HW) have caused a lots of stress and mis-information.
I am at 0.05 and my doctor and urologist/surgeon are not concerned - even with my positive margin...
.. also, having a doctor friend comment - is NOT the same as your own team of doctors knowing your stats, history and path report... disregard whatever he said to your wife ... he has nothing to lose with a off-the-cuff-diagnosis.

sincere hugs,
BRONSON

tigre
Regular Member


Date Joined Sep 2010
Total Posts : 69
   Posted 7/11/2011 8:19 PM (GMT -7)   
newspaperlover,
just a quick word about my experience, as it is not exactly like yours but somewhat.
i had rp in oct. 2009 and first psa following surgery was 0.02. Dr. said it was good but not what we were hoping for. we took another psa two months later and it was 0.05. Dr. said in his mind this confirmed that cancer was still present and the next week i was in the radiation oncologists office getting ready to start.  Uro and radiation onco. agreed that the sooner the better for me to get started. i believe studies show that success rates are better if post op radiation is started before .1.
keep in mind though, that i did have a positive margin going in to rp. my gleason was fortunately 3 and 3 (6) before and after surgery.  the hope in my case was that the cancer had not spread outside the "bed" area around where the prostate was. obviously, my hope is that with gleason 6 we did catch it in time. i was 45 when diagnosed. so far i've had three consecutive <0.1 results after radiation and am up for my next test in aug.  for me, i believe the right decisions were made all the way to this point. Good luck!
 

NewspaperLover
Regular Member


Date Joined Sep 2009
Total Posts : 220
   Posted 7/11/2011 9:19 PM (GMT -7)   
Thanks to you all for your detailed and thoughtful replies. Moved quickly today and was able to schedule an oncology appt for this Wednesday. I will let you know how that goes. Thanks again. You have given me valuable information. NewsPaperLover.

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1252
   Posted 7/12/2011 2:56 PM (GMT -7)   
Hi Newspaperlover, no medical advice but I did want to say hello. I sure do remember you, not least because I started my career as a newspaper reporter, and have loved the business ever since.

I'll look forward to the report from your Oncologist meeting.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 7/12/2011 3:33 PM (GMT -7)   
Just make sure you are treating a disease and not a number. Too many folks chase the PSA and not looking at the disease progression. Make sure of the trend before pulling the trigger on SRT. SRT is NOT benign and there is a chance of unpleasant side effects.

FYI I had SRT when PSA hit the .44 mark and because of the doubling time. I was going to wait until I was convinced otherwise due to the progression. Early treatment in my oncologist opinion was before 0.6 in reference to the earlier the better thinking for additional therapy.

Good luck at the drs visit tomorrow.
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44
PSA Doubling time approx. 6 months
Clinical Trial - Control Arm SRT begins 3/01/11
Post SRT PSA (6 weeks) 0.16
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