thoughts on BIO-chemical recurrance vs, local recurrance.

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deer hunter
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Date Joined Jan 2010
Total Posts : 246
   Posted 3/29/2010 6:24 PM (GMT -6)   
I know local recurrance of Pc is easier to find than BIO-chemical  recurrance. Ouestion? then if you have BIO why do SRT on the prostate bed ? It would seem that BIO  could be making a home anywhere.  so does anyone else have an idea on this situation?
DEEHUNTERS WIFE
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. psa the last of 7/09was .55 onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see 3/10 psa.05


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 3/29/2010 7:13 PM (GMT -6)   

Hi DHWife,

I hope that I can add a little clarity.  I do not have direct experience in this detailed area of biochemical recurrence, but have read a lot about it.  If I say something wrong, I’m sure someone else with more direct experience will correct me so I don’t lead you off-base.

Firstly, biochemical recurrence (BCR) is the general term given to any rise in PSA after primary PC treatment with either surgery or radiation. 

The BCR may occur locally, in the prostate bed; most typically in tissue next to the prostate or in surrounding lymph nodes, or in the prostate itself if radiation was the primary therapy. 

Or, the BCR distantly in bones or other organs; this is also called metastasis.  Distant metastasis is usually (eventually) marked by bone pain, and later shows up on bone scans, but until symptoms show up the primary evidence available is the rising PSA results. 

The doctor can use some of one's individual case history to statistically predict whether BCR is due to local or distant recurrence, but when the only evidence is a rising PSA and no other symptoms exist, then it is really only a statistical guess. 

Post-surgery, the best secondary treatment for local BCR is radiation.  The best treatment for distant BCR is hormones.  In the absence of knowing exactly what is causing a rising PSA BCR, some doctors will take a dual approach and do both.

This is as I understand it.  Hope this helps…


deer hunter
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Date Joined Jan 2010
Total Posts : 246
   Posted 3/29/2010 7:36 PM (GMT -6)   
Case 59 thanks for the input I've read some on BCR but when no tumor or cancer cell can be found in the old , prostate bed you would think SRT would not work. And drs would not do SRT on patiences where PC cells can not be found. IT just puzzles me why SRT is used on BOC.
DEERHUNTERs WIFE
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. psa the last of 7/09was .55 onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see 3/10 psa.05


turner
Regular Member


Date Joined Jan 2010
Total Posts : 119
   Posted 3/29/2010 8:31 PM (GMT -6)   
 Casey, Its my understanding that ,for the most part theres no reliable way to"find it", at least at these very early stages.Prostascint are unreliable and VERY expensive.  . Ive had similar reservations in my situation. Its really a last ditch effort for a cure. Not good odds,but its all we have before the less than pleasant future therapys......turner
 
 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 
 
 
 


logoslidat
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Date Joined Sep 2009
Total Posts : 5818
   Posted 3/29/2010 10:43 PM (GMT -6)   
casy59's post needs to be reread. BCR is simply a recurrence of the cancer after what ever primary treatment the patient has had. It can happen right after treatment, with surgery, or happen 12 years out as with Merve Griffith. Its a little dicier with rad, as a nadir has to be determined, nother thread, Its called BCR, be cause it is such a small amount. Do not think EPE, etc or t3a is a BCR. It just increases your chances of BCR, that and I higher Gleason score. As casy59 said , the BCR can be local and curable with adjuvant or Salvation radiology, or metatastic, not curable, but treatable with HT
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
8 week psa 0,o

Hypocrisy is vice's homage to Virtue


English Alf
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Date Joined Oct 2009
Total Posts : 2215
   Posted 3/30/2010 8:13 AM (GMT -6)   
My uro and Radiotherapist both said that they can't be certain if my raised PSA (BCR) is due to something in the prostate bed or something distant. The problem is that volume of the prostate cells producing this small amount of PSA is too small to show up on a scan or similar.
BUT if you wait till the volume is big enough to show up on a scan then there is going to be too much tumour to treat it adequately with RT, and so much time will have passed by then that mets can be more likely too.

They are going to blast the prostate bed as, if the problem is there, then that should treat it, the proof being my PSA going down afterwards. If my PSA stays up however, then that will suggest the prostate cells were not in the prostate bed and they will have to try something else, eg Hormone Therapy (Which is why they said they don't want to use HT at the same time as RT)

Treating the prostate bed makes some sense as they said that as my staging was 3b there is a possibility that as well as having spread to the seminal vesicles the cancer might have spread to somewhere else close by, equally there was tumor in the bladder neck so there could be some close to that area as well.

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 3/30/2010 8:56 AM (GMT -6)   
You might want to look into joining the P2P internet thingy, Dr. Strum just replied to a patient on this type of thing and using certain parameters and nomograms and other stuff he is familar with, informed a patient on his case as to what those statistical percentages (odds) were for getting a probable success rate to base an assessment on if doing salvage radiation. (came out to be 40% favorable vs. 60% unfavorable on this patients history).

I don't have all the info, if you are really interested send me an email I will copy and save the total discussion for you or others and could email attached.


Youth is wasted on the Young-(W.C. Fields)


John T
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Date Joined Nov 2008
Total Posts : 4227
   Posted 3/30/2010 11:12 AM (GMT -6)   
Casey is absolutely correct. SRT is a shot in the dark where they are just assuming that the reoccurrance is local. The only way to really know is to do a biopsy and find the PC in left over prostate tissue or in the bed and this is difficult with a very low psa as the pc would be very small.
As Zufus pointed out there are various computer tools that by plugging in before and after data a probability of local or systemic reoccurrance can be determined. Again this is only an estimate, but is better than just a shot in the dark.
It may be helpful to discuss just what causes a local reocccurance:
In surgery 100% of the prostate tissue is never removed; good surgeons remove more than bad surgeons; but there is alwasys something left and these may contain cancer cells.
There may be a positive margin were the PC has leaked into the prostate bed and the surgical margin was not sufficient to get it all. 50% of all positive margins are in the APEX and are difficult to get in a surgical enviornment. Patients having large APEX tumors may do much better with radiation. Historically surgery has yeilded 30% positive margins. Today's surgery are more in the low 20% range.
In radiation failures there could be doe to an uneven dose that left dead spots or the dose was not high enough to kill all of the PC. Margins in radiation are usually not a problem in that the margins are usually 10-15 mm and should get most extra capsular extensions.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/30/2010 11:24 AM (GMT -6)   
I fully agree, SRT is at best, and educated shot in the dark. My own radiation oncologist acknowledge that part quite clearly. She did say, that in my case, having one known tiny positive margin could be a good thing, as it could mean that any remaining cancer cells were there in the prostate bed. But it doesnt stop other cancer cells from having leaked out, i.e. through PNI. So there is no guarantee either way. If they radiate, they tend to want to hit even a salvage or adjuvant radiation job with pretty high doses of radiation, typical 66-72 gys. But even then, they are shooting blind as to the exact location of any remaining cancer cells. There are other factors that can make your percentage of success with SRT even worse, such as PSA doubling time, time to recurrance, pre-primary treatment PSA history, etc. But for most of us that go through it, its the last curative card in the deck, and even if the odds suck, its better than nothing. A lot to think about here, really, and never an easy decision to make.
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, no problem post SRT
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 3/30/2010 12:19 PM (GMT -6)   
Shot in the dark is another way of saying gamble.  It is a low odds gamble, but at this point in the game with a rising PSA, whatelse can be done.
 
The hope or low odds are, that the PC stayed close to where it started, and took up living quarters in the prostate bed.  Apparently, there is about a 25 to 40 percent chance this is so.  So, nuke the bed, and maybe we can hit the PC.
 
If we were buying lottery tickets, the odds are fanastic.  If we are talking about our life, the odds aren't so great.
 
When it comes down to it, we almost have to take another role of the dice.  Come on Snake eyes !
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 3/30/2010 12:45 PM (GMT -6)   
When radiating the prostate bed it is also important to know where this bit of you is.

So a good CT scan before starting is a must to map out your internal anatomy and to relate it to the post op pathology so as to able to aim everything in the right place. (eg all my tumors were at the top of the prostate near the bladder and in the seminal vesicles (which are up behind the prostate) so it is going to make more sense to cover that part adequately.

And thus the newer treatment machines that are a combination of radiation machine and scanner are an improvement so that the aiming can be fine tuned at each session to take into consideration any small changes inside you, otherwise by the time you are having your last sessions it is several weeks since the scan by which time much may have changed inside you.

The husband of a friend took this shot in the dark after having rising PSA after surgery and he is in now the zero club. So while it's a gamble it's not a wild gamble by any means even thiough I know it may not work completely.
Alfred

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/30/2010 12:52 PM (GMT -6)   
goodlife, your words are better, I was being polite, at best, its a gamble.
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, no problem post SRT
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 246
   Posted 3/30/2010 6:04 PM (GMT -6)   
Again, thanks for all the replies
Zufus, i liked what your DR,Strum has to say on PC
it seems all treatment after the initial treatment is just a shot in the dark[ my on opinion]
THANKS AGAIN EVERYONE!!!!!!!!!!!!!!!!
DEERHUNTERS WIFE
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. psa the last of 7/09was .55 onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see 3/10 psa.05


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5818
   Posted 3/30/2010 6:49 PM (GMT -6)   
What are the odds of side effects , specifically incontinence, as ED will happen with HT, which is the next step after a possible failure? My thought is this, if BCR occurs, with my Path report, odds are its systemic. So Im thinking that with hopefully a slow rising psa I can delay HT, hence side effects, and keep it at bay with alt therapy, then HT, into my 80' or 90's with therapy not yet discovered. These are plans for in the " natural ", In the spirit, I am healed, I DO NOT think that is contradictory to making plans, as a retired air traffic controller, I gots to have a plan, even, if I Hope, I don't need it. Not prosletysing, just informing of where Im coming from. I will revise these plans as I recieve more info from wherever. thanks for ear!!
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
8 week psa 0,o

Hypocrisy is vice's homage to Virtue


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/31/2010 11:38 AM (GMT -6)   
Logo- great thinking to keep looking ahead and even way down the road, as we have choices and if not cured you better find out what is what. Some of the best layperson's come to my mind whom have walked this walk way before us and helped pave the road with things you can find on the internet, because of them. Bill Aishman (no longer with us) checked out about every chemo protocol known at the time of his era and many other protocols of which he even did and documented (some are available thru www.prostate-help.org ) and also Howard Hansen of yahoo groups hrpca.org and affiliated with prostate-help.org has information on second line hormone therapies and website international forum with questions, answers. He still is answering questions, pretty darn well for a layperson.

So we can find information other than reading abstracts(try that for fun) and find people or sites we can look at or talk with, you think you need support here, some people on those forums are dealing with life and death in real time. Their needs for information and input is priceless to them.
Youth is wasted on the Young-(W.C. Fields)


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5818
   Posted 3/31/2010 3:26 PM (GMT -6)   
Amen to your last, specifically the last line. God bless us every one!!!
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
8 week psa 0,o

Hypocrisy is vice's homage to Virtue

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