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mgl
Regular Member


Date Joined Feb 2007
Total Posts : 122
   Posted 2/6/2010 11:43 AM (GMT -6)   
At what PSA level did your Dr start you on HT after you had surgery and radiation
50 years old
gleason 3+4=7 psa5.8 clinical stageT3a
Da vinci surgery April10 2007 Mayo clinic Rochester, Mn.
extraprostatic extension Gleason -same
pelvic lymph nodes -negative
Catheter out April 19
psa aug 2007 0.28
37 treatments IMRT ended 10/26/07
psa Jan 29 2008 0.10
psa april 30 0.14
psa aug 21, 0.16
psa dec 17 o8 , 0.16
psa apr 09, 0.21
psa aug 09, 0.26


turner
Regular Member


Date Joined Jan 2010
Total Posts : 119
   Posted 2/6/2010 12:54 PM (GMT -6)   
 I've wondered the same as iam faced with the same delima. From what i read here and on other fourms, this is becomming a very controversial subject.
 You might want to check this thread out
http://prostatecancerinfolink.ning.com/forum/topics/things-that-puzzle-me-about?xg_source=activity
 
 
 
 
 diag 2/09 @ 3 wks before 50th bday and 2nd wedding :(
 psa 4.5
 t2b
 5 of 6 cores pos....5,20,50,25,5 %
gleason 3+4
 N/S RALRP 4-20-09
 Path: lymph node -
          seminal ves -
          margins -
          EPE -
          preineural inv-
          gleason 3+4
          stage pt2c
          tumor vol 40
Continence- 99%- @3-4 months post op
ED-gradual work in progress w/meds
       psa 7/22/09  0.1
      10/23/09  0.3
       11/23/09 0.5
       01/05/10 1.1
 Met with raidioligst 12-28
 Meeting prostate oncologist @Uof M 1-11
 Not like'n where this heading.  Surgery was and still is a walk in the park compared to what lies ahead :(
 01/26/10 scans all clear.Met w/Onc. at U of M. She has convinced me to go with Radation only at this time starting Mon feb.1. at St.Marys in saginaw.68.4 Gys @38 days What have i got to lose?
 Let the games begin...again 
 
 
 


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 2/6/2010 1:53 PM (GMT -6)   
Can't speak for others but I started radiation and HT two weeks after surgery. Mine was not based on my PSA it was due to my cancer having spread outside the prostate. What information are you getting so far from your doctor?

peace to you
dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

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
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13

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%


mgl
Regular Member


Date Joined Feb 2007
Total Posts : 122
   Posted 2/8/2010 6:44 PM (GMT -6)   
my Dr is saying wait until the PSA number is higher than 5.0 Going back to the Mayo clinic to see what my Dr down there says

50 years old
gleason 3+4=7 psa5.8 clinical stageT3a
Da vinci surgery April10 2007 Mayo clinic Rochester, Mn.
extraprostatic extension Gleason -same
pelvic lymph nodes -negative
Catheter out April 19
psa aug 2007 0.28
37 treatments IMRT ended 10/26/07
psa Jan 29 2008 0.10
psa april 30 0.14
psa aug 21, 0.16
psa dec 17 o8 , 0.16
psa apr 09, 0.21
psa aug 09, 0.26


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/8/2010 6:51 PM (GMT -6)   
mgl,

you must mean .50 on the PSA, not 5.0, is this correct?
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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


Lucious
Regular Member


Date Joined Jan 2010
Total Posts : 23
   Posted 2/8/2010 7:49 PM (GMT -6)   
Hope this help;

pc diagnosed 10/08, age 58, psa 7.5, G 8, biopsy positive in 3/12 areas; imrt Jan-Mar 08,treatment at 6500 rad, lupron Ht- Dec/08 ongoing for over a year;current psa trends .20; T1c

mgl
Regular Member


Date Joined Feb 2007
Total Posts : 122
   Posted 2/9/2010 6:14 AM (GMT -6)   
The urologist said 5.0 and I have read at other sites of similiar responses

50 years old
gleason 3+4=7 psa5.8 clinical stageT3a
Da vinci surgery April10 2007 Mayo clinic Rochester, Mn.
extraprostatic extension Gleason -same
pelvic lymph nodes -negative
Catheter out April 19
psa aug 2007 0.28
37 treatments IMRT ended 10/26/07
psa Jan 29 2008 0.10
psa april 30 0.14
psa aug 21, 0.16
psa dec 17 o8 , 0.16
psa apr 09, 0.21
psa aug 09, 0.26


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 2/9/2010 11:11 AM (GMT -6)   
 
My doctors suggested salvage radaition before 0.5 that seemed to be the cut off for good results.  I never heard of waiting until 5.0 very interesting.  I was at 0.4 when I started treatment.
 
Jerry1
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 
12/28/09 PSA 0.5
Start radiation treatments ib January 18th. 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/9/2010 12:04 PM (GMT -6)   
That still has to be a mistake there somewhere. Never heard or read of waiting for a post surgical recurrance rate of PSA 5.0 before considering a salvage treatment. What am I missing here? .50 is a very common and traditional line in the sand. If one waited till it came back and hit PSA 5.0, I would think that any salvage treatment would be utterly hopeless. Am I missing something obvious here?

The radiation oncologists that I have spoken with were all of the .50 for max. effectiveness for salvage radiation, and 1.0 for the point of minimun return.

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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/9/2010 12:31 PM (GMT -6)   
David, The question was After surgery and SRT and then begin hormone therapy....what is the psa. I think the 5.0 for hormone therapy is correct...afterall this is now systemic disease and therefore a cure isn't possible.
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 


flippin out
Regular Member


Date Joined Mar 2006
Total Posts : 137
   Posted 2/9/2010 12:31 PM (GMT -6)   
If I might interject
I was thinking its the averages that are most looked upon or trend if you will an upward trend would suggest a presence of disease
therefore an action would be prudent when considering all the factors Age being a major one side FX s Etc. Etc. I was advised not to wait when one month apart a rise in PSA was observed after surgery. The question in my case. Was the disease being confined ,or as my Dr. had said it was quite close to the margin ( TOO close I guess ) after almost the same distance out from radiation as was surgery we seem to see a slight continuing rise again. It is an up hill battle against a formidable foe.
Fight on Gents!
54 Cancer Detected
PSA 8.0+ Gleason 7
55 DaVinci City Of Hope California
57 Cancer rise in successive PSA's
57 Proton Radiation Loma Linda Medical Center California
Oct. 09 0.07


mgl
Regular Member


Date Joined Feb 2007
Total Posts : 122
   Posted 2/9/2010 4:23 PM (GMT -6)   
I have already had radiation treatments , and the Psa did drop , but has started to climb. Like LV tex said  there is no cure at this point,and you have to weigh the pros and cons , like side effects

50 years old
gleason 3+4=7 psa5.8 clinical stageT3a
Da vinci surgery April10 2007 Mayo clinic Rochester, Mn.
extraprostatic extension Gleason -same
pelvic lymph nodes -negative
Catheter out April 19
psa aug 2007 0.28
37 treatments IMRT ended 10/26/07
psa Jan 29 2008 0.10
psa april 30 0.14
psa aug 21, 0.16
psa dec 17 o8 , 0.16
psa apr 09, 0.21
psa aug 09, 0.26


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/9/2010 4:30 PM (GMT -6)   
mgl,

i get it now. i thought you had only surgery, not surgery and salvage radiation both used. i apologize for misreading. wish you the best in what will be a tough decision to make. its the one that I am hoping not to have to face, though the jury is still out on my own salvage radiation.

good luck.

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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 2/9/2010 4:40 PM (GMT -6)   
 
Sorry I misunderstood thought you were talking about SRT.  There are a lot of different opinions on HT therapy even Dr Patrick Walsh feels there are few benefits starting HT early.  He recommends waiting until something is seen on a scan before starting treatment the outcomes seem to be the same and he is of the mindset that you have a better quality of life waiting because it could take many years before something is seen.  I met with a medical oncologist at the cancer Center that I go to and he said he has patients with extremely high PSA's and still nothing showing on scans and they are still playing golf everyday years later with with no symptoms.  He also agrees that there are no studies that show that HT therapy works any better if started early or after something shows up.  Of course, you need to watch it closely and have scans done every 6 months.  I know a lot of our brothers have done HT and are doing fine but if my radiation does not work I am going to wait until something shows up before I start any other kind of treatment.  I guess we all have to decide what is best for us.  You are also much younger than I am and have many more years to live.  The problem with HT is it is not a cure and only works for so long.   I am hoping a new treatment will come along withour the awful side effects. 
 
Jerry1
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 
12/28/09 PSA 0.5
Start radiation treatments ib January 18th. 


mgl
Regular Member


Date Joined Feb 2007
Total Posts : 122
   Posted 2/9/2010 6:21 PM (GMT -6)   
thank you for your comments, quite the club we are in

50 years old
gleason 3+4=7 psa5.8 clinical stageT3a
Da vinci surgery April10 2007 Mayo clinic Rochester, Mn.
extraprostatic extension Gleason -same
pelvic lymph nodes -negative
Catheter out April 19
psa aug 2007 0.28
37 treatments IMRT ended 10/26/07
psa Jan 29 2008 0.10
psa april 30 0.14
psa aug 21, 0.16
psa dec 17 o8 , 0.16
psa apr 09, 0.21
psa aug 09, 0.26


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 2/9/2010 6:46 PM (GMT -6)   

Jerry,

I think that most oncologists would disagree with your doctor. "Hit it hard and hit it early" is the mantra of most oncologists.

JT


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.

JohnT


Aprilsunny
New Member


Date Joined Jan 2010
Total Posts : 15
   Posted 2/9/2010 9:50 PM (GMT -6)   
Found the following quotation from Mayo Clinic Proceedings, February 2007, which supports Jerry1's post.


Ultimately, the decision to start androgen ablation therapy in the setting of biochemical failure is based on one of several trigger points used in the clinical setting, for example, a predetermined PSA level that will trigger the initiation of therapy, such as an arbitrary PSA level of approximately 10 ng/mL or a PSA doubling time of less than a year. The PSA doubling time enables an assessment of the likelihood of progression, which can be useful to discuss with patients in deciding when to initiate hormone therapy. There is an increased rate of metastatic disease when the interval between primary treatment and PSA failure is short (≤2 years) with a rapid PSA doubling time (<10 months).8 Unfortunately, no real data exist to aid in this decision-making process. Often, it is simpler to begin therapy, but caution regarding impact on quality of life and clinical benefit must be considered. Patients who opt for active surveillance will require ongoing discussions regarding the risks and benefits of deferred therapy. Clinical trials would be optimal to help address this dilemma. (My underlining.

Doesn't make the decision any easier, does it?

Best of luck!
AS
Brief History (Husband)

Age - 60

4th of 5 brothers. Brother 3 died at 65 of PCa, brother 2 is five-year survivor of PCa, (brother 1 died at 61 of heart attack). So far brother 5 is okay.

PSA - October 2009 - 6.4
Biopsy - November 17, 2009 - Gleason 4+3=7 DRE Normal Stage T1C
open RP - January 14, 2010


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/9/2010 10:00 PM (GMT -6)   
Good link with a good read, Thanks AS
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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days

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