Is Adjuvant radiotherapy needed if PSA is 0.04?

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Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3739
   Posted 11/6/2009 6:58 AM (GMT -6)   
Hey Guys,

I just read Sonny's post and something there woke me up.
I went to the paper he posted and pulled out a couple of things.
http://www.jurology.com/article/S0022-5347%2808%2903059-0/fulltext

"Adjuvant radiotherapy within 18 weeks after radical prostatectomy in a man with pT3N0M0 prostate cancer significantly reduces the risk of PSA recurrence, metastasis and the need for hormonal therapy, and significantly increases survival."
"More than 20 years after the initiation of S8794 this report demonstrates that adjuvant radiotherapy at the relatively modest dose used in the late 1980s significantly reduces the risk of metastasis in a man with pathological evidence of extraprostatic disease after radical prostatectomy. This significant reduction was realized despite the application of salvage radiotherapy, perhaps the most commonly used approach to these patients today, in a third of the patients in the observation group. Additionally, this reduction in metastases and improvement in survival occurred despite an almost doubled use of hormonal therapy in the observation group. It is important to place this outcome in perspective. The median 1.7-year survival benefit may apply to more than 30,000 men per year in the United States. In the realm of advanced prostate cancer docetaxel, the only treatment proven to improve survival, improves survival by only 1.9 to 2.3 months."

In addition to the most important outcomes of prostate cancer (metastases and survival), all other measures of disease recurrence were improved with adjuvant radiotherapy. For those men with an undetectable PSA postoperatively the median delay in time to PSA recurrence was substantial at more than 7 years."

My PSA was 23 pre-surgery, and 0.04 at 13 weeks. I took that to mean I was ok - or as ok as can be expected.
However, I did have an Extraprostatic extension and there was extensive perineural invasion
My Pathology stage was pT3aN0MX

At my 3 month check up with my surgeon, I asked if I should do anything else, and the answer was "No. We will monitor it. See you in 3 months" I did not seek another opinion. Being the cynic that I am, I figured if I went to a Rad Onc he'd recommend Rad, etc. The system is geared to pay for services.

This makes my worrying about pee pad and pen*s performance seem trivial. (I'm not called Worried Guy for nothing.)
So, is 0.04 undetectable or not? Should I rush out and find a doc as the 18 weeks is fast approaching?
What do guys with similar stats do?

Thanks,
Jeff
DX Age 56. First routine PSA test on April 8th: 17.8.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 10/31 3 months, Still no activity, nada, zip
Incontinence - 8/20 4 full pads per day
. 9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea. I know.)
9/17 2 months: Still 3 pads per day.
10/31 14 weeks: Still 3 pads per day. At this rate I'll be fine in 2012.
Post Surgery PSA - 9/3 6 weeks- 0.05, 10/13 3 months- 0.04 undetectable.


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 11/6/2009 7:04 AM (GMT -6)   
My every psa results each 3 months for 2 years have been .04. It's zero, undetectable, zilch. You got a post surgery baseline established. Just keep testing.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, Bimix .3ml PRN or Trimix .15ml PRN


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 11/6/2009 7:46 AM (GMT -6)   
Jeff,
Our stats are somewhat similar apart from the pre-biopsy PSA. Your pathology report reads much the same as mine. Separate tumour in each side, the larger in the right 2cmx2cm. Extensive perineural invasion, focal extra-prostatic extension. Doctor said before surgery he would not make a decision on nerves when he got in there........his judgment then was it too risky to do. As I learned more about the disease over the next six months, I like you, began to have some doubts (despite PSA being consistently <0.01) so I made an appointment with a radiation oncologist and a medical oncologist. Their separate opinions were the same...........PSA test results were good so don't at that stage risk possible radiation complications and save ADT till it's needed. So far they have proved to be right (2 year mark) although I'm due for another PSA test in the next couple of weeks. Because of the circumstances I elected to be tested each 3 months for the first 2 years and I will have it done each 4 months this coming year. You are essentially undetectable.......yippee!!! I remember reading that very low PSA can occur because of nerve sparing.......small amounts of benign prostate tissue still attached to the nerves and all that. My full story is here, I believe i may have even mentioned the study of which you wrote-------great minds think alike Jeff

www.yananow.net/Mentors/BillM2.htm

Bill

P.S.
I'd encourage all you fellas to put your stories on www.yananow.net/Links.html another great site helping those with PCa.
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01

Post Edited (BillyMac) : 11/6/2009 8:05:15 AM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 11/6/2009 8:37 AM (GMT -6)   
Dont worry! You are still pulling a strong zero. When and if it rises, then watch. If it rises 3 times, then worry and start to plan for your next step. Enjoy this period of zero's. Not a time to worry.

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 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 11/6/2009 9:26 AM (GMT -6)   
Jeff....I maybe wrong in this statement...but I thought I read somewhere that radiation after surgery can slow or even stop the recovery with incontinence and ED. So unless there was a strong reason to start adjunctive radiation I wouldn't recommend it. Maybe it would be better to wait with your numbers where they are right now and allow more time for healing. But follow the advise of your doctors.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 11/6/2009 3:05 PM (GMT -6)   
I read the article and it seems like a solid long-term study. The important thing to realize is that when they say “significant” they do NOT mean “big” or “important” they mean what statisticians mean “not likely to have occurred by chance” Thus in studies of large populations a difference which is “significant” can still be small in real terms.

This study does show that, for people with moderately bad pathology reports, going directly to radiation does carry a modest gain in ten year survival rate over waiting and monitoring PSA levels. As someone with a moderately bad report I have had to weigh going to radiation immediately and waiting. This with the knowledge that, in either case, the survival odds are pretty good. I have chosen to wait rather than undertake the stress and side effects of radiation.

As with all long term studies, this is based on the radiation available ten years ago. My bet is that improvements in radiation have reduced the risk of waiting. But that is my choice of what to bet on.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3739
   Posted 11/6/2009 3:36 PM (GMT -6)   
Guys,
You don't know how much your opinions mean to me. (I know, I know, you're not Docs. You haven't stuck anything up my rear end. You only have the data I supplied.) I was leaning the same way and will no longer second guess myself.
That paper was a few years old and was from patients that had their surgeries in the mid 80s.
I am going to make a few assumptions and live with the results. I assume that:
1) Medical/surgical science has come a long way since 1985 and better imaging during the procedure increased the chance of getting as much as possible.
2) The PSA test is more sensitive and precise since the mid to late 80's.
3) I am in significantly better shape than the average 67 year old in the study.
4) I will stay on top of my PSA like a fly on poop and monitor it faithfully.

So, there you go. I'm letting the arrow fly and it will land where it will land. Done.

Thanks for your help.
Jeff
DX Age 56. First routine PSA test on April 8th: 17.8.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 10/31 3 months, Still no activity, nada, zip
Incontinence - 8/20 4 full pads per day
. 9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea. I know.)
9/17 2 months: Still 3 pads per day.
10/31 14 weeks: Still 3 pads per day. At this rate I'll be fine in 2012.
Post Surgery PSA - 9/3 6 weeks- 0.05, 10/13 3 months- 0.04 undetectable.

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