PSA results confirm recurrence

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Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/29/2009 12:34 PM (GMT -6)   
Ok. So I got another set of PSA results. It is now 0.20. This puts my doubling time at 3.8 months. I dont know why, but it shook me again. The good news in this is that the doubling time is a bit slower than the las time (it was 3.4).
 
I have appointments with two different radiation oncologists next week and the week after. Will decide then and off to the treatment...
 
ANy sugestions on how to decide between the two? What should I ask?
 
Greg

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 6/16/2008

Gleason downgraded 4+3=7, T2c N0MX, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/25/2009

0.17

 


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/29/2009 5:03 PM (GMT -6)   
Thanks, Ohio,

I don't think I am panicing, just upset. I am not sure what I expected to see on the test results - I guess I was hoping for a lab error. I am having hard time to even predict how I will react to any news anymore. I have done some work up of the numbers, given the doubling times, and based on my trend, I mathematically predicted 0.2. But when I saw it in black and white on the lab results, I was shoked. I think I am pretty much over this, a few hours and a drink with my wife later. So, now I have to get the best treatment plan charted. I know that, based on nomograms, my chances of cure after radiation are still pretty high (in 60%+ range). And if that does not work I have many weapons that can last a long time. And time is what this is all about. So many treatments are being created now that it is possible we will all see breakthroughs in the fight against PC.

My Memorial Sloan Kettering Onc - Susan Slovin, a great lady - has ordered a PAP test, along with PSA. I did not know what this was, but it looks like an independent predictor of recurrence. (See http://www.cancernetwork.com/display/article/10165/59708). PAP was 1.3, which makes odds of local recurrence more likely, according to the article. So, given my positive margine and favorable PAP result, I am tempted to assume the local recurrence.(I have an MRI scheduled a week from Monday to try to proof/dis-proof this).

My Duke Onc - another great doc, Phil Febbo - is of the opinion that Photons, not Protons is a way to go. As I mentioned, I have two appointments scheduled. But I have a poor betting average when it comes to selecting docs. My original Uro, who presided over my going from PSA 3.8 to 28 and did nothing other than an occasional byopsy was my pick from a few alternatives.

Is going with Sloan Kettering a safe alternative vs. a local doc? Logistically it is more complicated, but doable. How do I tell a good doc from a not so good one? I am also told that it is a Physicist who is as much if not more important. You don't even meet these guys, right? So, any advice here is greatly appreciated.

On the balance, I feel truly blessed. I have a great wife and kids. I am going to be a grand father in August! I have great friends. I live in the great country. We have one of the best, if not the best healthcare systems in the world. I feel great - am generally in good health, my incontinence is almost gone, my ED is getting better. I cannot ask for more than I have! Just more time...

Greg

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 6/16/2008

Gleason downgraded 4+3=7, T2c N0MX, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/25/2009

0.17

 


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 5/29/2009 9:10 PM (GMT -6)   
Hi Geebra,
I am in a similar situation as you can see by my Bio. I am starting IMRT June 10th. My wife and I were very devastated when I got my last PSA. Your feelings will subside in time and you will lose some of your anxiety once you make a decision to move on to the next step. People on the forum will guide you along every step of the way in your journey. Always be positive. You are in my prayers.

"Never give up, never give in"
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
05/13/09   PSA .18 (ouch)
Start IMRT June 3, 2009


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/29/2009 9:26 PM (GMT -6)   
Thank you, guys. You are the best.

Bootheel,

Best of luck in your treatment. How did you find your doc?

Anybody knows good radiation oncologist in Central New Jersey or in Manhattan?

Previous 5 biopsies over 4 years negative

PSA going from 3.8 to 28

Father died from PCa @ 78 - normal PSA and DRE

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 RRP at Duke (Dr. Moul) on 6/16/2008

Gleason downgraded 4+3=7, T2c N0MX, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/26/2009

0.17

5/22/2009

0.20


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 5/30/2009 6:14 AM (GMT -6)   

Sorry to hear about the .2....when mine hit .24 post-surg, my Uro summed it up best "that sucks..."  And yes, its very upsetting.

But....it took you 8 months to get there, that's not all bad.  PSA doubling at these low levels might not mean too much, plus you had a positive margin.  That actually increases you chances there is just residual disease in the prostate bed...and will be cured with radiation.

Salvage radiation isn't all that bad.  I had mine done at a local rad. oncologist --- I looked into photon and world class centers, but really didn't see too much advantage.  I had 36 sessions, and it only took 10 minutes to get there each day.

The main thing I'd ask about is if the docs recommend doing hormone therapy in addition to the radiation...and if so, how long?   I did 2 zoladex shots, three months apart.   THe effects of HT lasted about a year....my results are in my signature.

I was your age when I had this going on....it really sucks to be dealing with this so young, but the up side is you can tolerate the treatment a lot better.

This is a curable condition, and by acting this early, you really increase your odds of a durable response.  You seem to be willing to throw everything you can at this thing --- keep it up---you're going to win!


Sterd82
Age 49 - pre-surgery PSA 39 (at age 45)
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
PSA as of November 25, 2008 undetectable
PSA as of May 22, 2009 undetectable


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 5/30/2009 4:29 PM (GMT -6)   
Looks like you got some great responses from some of the best minds on PCa on the internet. The only thing I can ad is to maintain your spiritual and emotional health as you go forth with your decisions. Whatever you decide will be right and effective. Please know I will be thinking about you and hopefully you will keep us informed.

peace and love
dale
My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
 


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 6/1/2009 7:22 PM (GMT -6)   
Visited a local radiation oncologist. More choices to ponder now... Turns out you have a choice of equipment, not just docs. And all equipment is not created equal. There are regular IMRT machines that are roughly the same from a handful of manufacturers, but then there is TomoTherapy - a helix delivery system that allows x-rays to enter from 360 degrees around you, presumably minimising the damage. It is also CT scan guided for better targetting (IGRT). The local doc has both types, but recomends the TomoTherapy for my situation. I read up on it, but was not able to find a lot. One study said it improves GI (rectum?) side-effect at the expense of worse GU (urinary?). The other article says the distribution of the dose across the target volume is a bit more uneven. Third article says it is the future of radiation technology. The rest of the stuff are PR from the manufacturer.

Any experience out there with TomoTherapy? Why would one choose it over regular IMRT?

Previous 5 biopsies over 4 years negative

PSA going from 3.8 to 28

Father died from PCa @ 78 - normal PSA and DRE

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 RRP at Duke (Dr. Moul) on 6/16/2008

Gleason downgraded 4+3=7, T2c N0MX, one small positive margin

PSA undetectable for 8 months, then

2/6/2009

0.10

4/26/2009

0.17

5/22/2009

0.20

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