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Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/12/2009 7:06 PM (GMT -6)   
Hey - I am new to this board, but I found it very informative. Wanted to ask for an advice from the pros.
 
Here is my story. Just when I started to relax a bit about the results of the surgery, my PSA came back. It was undetectable 6 months after RP, then 0.1 at 8 months and 0.17 at 10 months.
 
I have followed with two oncologists - one from Duke where my clinical trial and surgery were done, the other at Sloan Kettering. The Duke guy says it is likely a recurrence, do another test in a month and then salvage radiation. The MSK says it is under 0.2, nothing to worry about, do a test in three months, then we'll talk.
 
Very hard to wait even a month... should I get the radiation docs lined up? What do you guys think?
 
 

Previous 5 biopsies over 4 years negative

Dx Nov 2007, age 46

PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke

6 rounds of chemo (Taxotere+Avastin)

1/8/2008

33.90

1/11/2008

29.50

1/31/2008

38.20

2/21/2008

32.00

3/13/2008

26.20

4/3/2008

26.60

4/24/2008

20.60

followed by surgery at Duke (Dr. Moul) on 6/15/2008

Gleason downgraded 4+3=7, T2b N0M0, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/25/2009

0.17

 


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 5/12/2009 8:12 PM (GMT -6)   
This is a tough call and I'm sorry that you are stuck with it. One way to see it is that this is a rise two times in a row and so it should be treated. The other alternative is that these are three low figures and the pattern may be just accident. In a perfect world we would know which view was right, but no one does.

So the issue comes down to which feels better to you -- acting or waiting?
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3 + 4 = 7
CAT scan 1/09 negative, Bone scan 1/09 negative

Robotic surgery 03/03/09 Catheter Removed 03/08/09
Post surgical pathology report. Lymph nodes negative, Seminal vesicles negative
Surgical margins positive, Capsular penetration extensive Gleason 4 + 3 = 7
At 6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 5/12/2009 9:36 PM (GMT -6)   
Hi Geebra,

Sorry that you have to be here, but welcome to this great site. As you can see by my signature, I also had a recurrence about 20 month after my open RP. When it reached 0.08, my Onc, my Uro and myself decided that it was probably a recurrence and that the best hope for a cure is probably early RT. It is my understanding that the earlier salvage radiation is started, the better the chances of success. By the time RT started my PSA had increased to 0.1. If I was you, I would keep a very close eye on my PSA and take the next step sooner rather than later.
All the best to you.

Magaboo
Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 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; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA on the 26 Jan., 09, =0.05. PSA tests now every 6 month


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 5/12/2009 9:50 PM (GMT -6)   
Sorry to hear your predicament.  I would start researching the radiation oncologists and go with a happy medium of retesting at 6 weeks if you want to wait.  You are pretty close to the MSK recommendation of .2 and from your past PSA trend, it seems like if your PSA is continues on the trend it is going that your PSA would be above .2 if you waited 3 months.  I'm not a doctor, and I have learned there seems to be no method to this PC madness, but I tend to lean on the aggressive side.  just my opinion, for whatever it is worth.  Good luck and keep us posted. 

Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/12/2009 10:05 PM (GMT -6)   
Sounds like a very familiar situation, one I am just starting to face myself. And there is no one easy answer for it, a lot of things to consider. Please keep us all posted.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 5/9 .10 doubled in 3 months, new test in six weeks, then possibly off for salvage radiation
 
 


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/13/2009 9:17 AM (GMT -6)   
Thank you all for your replies!

I have another question. It is very important to find the best surgeon to do your RP, as the results are strongly correlated with the surgeon's skills. Is it as important to find the best radiologist? My Oncologist at Duke thinks the most importnant part is the equipment they use. Thought? What is the best equipment?

Previous 5 biopsies over 4 years negative

Dx Nov 2007, age 46

PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke

6 rounds of chemo (Taxotere+Avastin)

1/8/2008

33.90

1/11/2008

29.50

1/31/2008

38.20

2/21/2008

32.00

3/13/2008

26.20

4/3/2008

26.60

4/24/2008

20.60

followed by surgery at Duke (Dr. Moul) on 6/15/2008

Gleason downgraded 4+3=7, T2b N0M0, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/25/2009

0.17

 


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4835
   Posted 5/13/2009 9:50 AM (GMT -6)   
Yes a good radiologist is important...If they miss - they could take off your leg or body parts of someone in the next room. Note that I'm making a slight Exaggeration here but you get the point...

Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
 
06/25/08 - Da Vinci robotic laparoscopy
Catheter in for five weeks.
Dry after 3 months.
 
10/03/08 - 1st Quarter PSA -> less then .01
01/16/09 - 2nd Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.
 


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 5/13/2009 11:22 AM (GMT -6)   

I am basically in the same situation possibly as you can see my rising PSA numbers on my profile.  I am awaiting a call for my most recent PSA results(15 mos.) as I write this post.  I like you had 1 positive margin.  I have already set up a consultation with a Rad oncologist and am considering IMRT if needed. One positive note: my research indicates that positive margins are a sign that the cancer may still be in the prostate bed which may give a better chance for cure with radiation. I would at least set up a consulatation.  It may relieve some of your stress.  Just a thought.


Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable
03/02/09- 1 yr. post-op PSA .09 Undetectable

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