PSA is dropping

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New Member

Date Joined Sep 2009
Total Posts : 15
   Posted 10/22/2009 8:10 PM (GMT -6)   
I've just scheduled brachytherapy today for 11/10/09 and having buyer's remorse. My PSA is dropping rapidly (appx. 11 in July to 4 in Oct.). One biopsy analysis showed 3+3 and another analysis of the same tissue showed 3+4. On the recommendation of my Dr (Brian Moran at Chicago Prostate) I sent the same tissue to and the test score is really low at 19 out of 100 which indicates only an 8% change of cancer returning in 10 years after surgery or BT. I know the bottom line is the fact that there is cancer but all indications is that it is extremely slow moving. Am I the perfect candidate for Watchful Waiting?

What's a guy to do
Age 56 - 6'0" 215lbs
Overall Heath Condition - Good
PSA - Feb '07-3.9, Feb '08-4.8, Feb '09-5.5, July '09-11.4, Sept. '09-6.1 Oct. '09 4.3
Biopsy - 12 core. 08/12/09 - 10 % of one core, Gleason (3+3)6,
Second analysis same biopsy - 14% of one core, Gleason (3+4)7
Aureon Score 19 out of 100

Volume 10/13/09 - 38 Grams

Considering options

Post Edited (Klaats) : 10/22/2009 8:21:00 PM (GMT-6)

Elite Member

Date Joined Oct 2008
Total Posts : 25355
   Posted 10/22/2009 8:24 PM (GMT -6)   
Wouldn't dream of telling you what to do ,but if the core was really 10% gleason 6, and with your psa at that level, it would seem all things considered that you might be a good candidate for AS.

On the other hand, if the reading of a Gleason 7 were really the case, I wouldn't want to gamble with the agressive nature of "4" cancer cells, they can be very unpredictable, as most of the guys with a Gleason 7 know.

You are still a good candidate for seeding if you still choose to go that route, with your stats and your prostate size.

I know its tough to be in that position, ultimately only you can make that choice.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.

Veteran Member

Date Joined Jul 2009
Total Posts : 1267
   Posted 10/22/2009 8:44 PM (GMT -6)   
Like you, Klaats, I was a 3 + 3 on my first read and a 3 +4 on my second read, and a PSA of 1.5

And, like you, I was looking at a non-surgical therapy. In my case HIFU. But when I thought about the possibility I might have "4" cells, not "3" as the second most common ones, I decided I wanted the prostate out, and I wanted the pathology of the whole thing. It wasn't a medical decision so much as it was one of knowing myself and what I'd be happy living with. You have a lot of choices open to you. The right one is the one you are happy with, and can live with.

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
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09  0.02
Oct 1st 09 -- dry at night, during day some stress issues, but better every week.    

O Buddy Boy
Regular Member

Date Joined Oct 2009
Total Posts : 106
   Posted 10/22/2009 9:08 PM (GMT -6)   
There are things that can elevate your PSA level that are not cancer.

I know. I had chronic prostatitis for 15 years, with a big flare up only weeks before my biopsy. My PSA at the time of diagnosis was only 3.5. Very odd.

Even more odd was that the tumor was like a spider attached to the inside of the prostate wall. The tumor was more interested in the capsule wall than that the soft glandular tissue. So while there wasn't much cancer in a lot if the cores, it was because the tumor was spread shallow along the wall. The tumor was more interested in getting out than doing time, growing slow and hanging around inside. Some of the low PSA cancers can be very aggressive and mine was.

Had I waited long, I think I would have been far worse off. But who knows.

55 yo
DRE: Susp
PSA: 3.5
Gleason: 3+4/7
6/12 Cores Positive; Sextants were 1%, 3%, 8%, 15%, 12%, 0%
RALP: 10/10/09
Margins: Clear
Lymph Nodes: Clear
Seminal Vesicles: Clear
Gleason: No increase from biopsy 3+4/7
Some perineural and capsule invasion.

Forum Moderator

Date Joined Sep 2008
Total Posts : 4045
   Posted 10/23/2009 12:54 PM (GMT -6)   

Dear Klaats:

This is a tough call.  with your stats, the BT should do the trick.  And, generally, active surveillance is only recommended for men over 60.  However, you need to be sure you are making the right choice.

If I were you, I would do a couple of things ASAP:

1.  Get a color doppler.

2.  Call a specilist in active survieillance.  One of the best is, Dr. Ballentine Carter at Johns Hopkins.  He is the director of the division of Adult Urology there and also runs the JH "Expectant Management" (aks AS) program.  I'm sure there are others good docs with AS experience, but you should find one to give you peace of mind.

Good luck.


Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4171
   Posted 10/23/2009 1:57 PM (GMT -6)   
I agree that your case is boderline for AS. A G7 puts you in an intermediate risk catagory. You would have to monitor your psa very carefully and be sure the doubling time exceeds 3 years. A targeted biopsy with a color doppler is an excellent idea. I would never start AS without a color doppler knowing what I do now.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.


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