New PSA reading of 0.45 DR suggusting Avodart?

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larryandangieohio
Regular Member


Date Joined Jan 2010
Total Posts : 44
   Posted 4/9/2010 6:28 PM (GMT -6)   
I had my 3 month post-op checkup on Wed and the doctor just called with the results. In the past I had his clinic do the reading and they could only go to <.04 . Since being a member here and reading this forum, I had requested the additional testing be done at the lab so that I would get a more defined number. It came back today at 0.45 .... not a startling number but the doctor now wants to but me on avodart for two months and watch what happens! He tough the increase might be a false reading due to a benign glandular issue .... DOES ANYONE HAVE ANY EXPERIENCE WITH THIS? Should I ask for more testing of some sort or go with his instruction?
 
Larry


Dx Age:58  PSA 8/06 8.74,  10/09 7.46,  12/22 6.50 Needle Biopsy  11/10/09: 16/16 cores positive 2 - 85% of tissue

Gleason score 7 (3+4 with tertiary pattern 5). CT,Bone, and PET scans all negative.

Da Vinci laparoscopic prostatectomy performed on Jan. 07, 2010 at IU Simon Cancer Center…  Indianapolis, IN  Prostate size: 42 g Gleason score (primary + secondary):  4 + 3 = 7

Primary pattern (%):4, 60%  Secondary pattern (%): 3, 35%   Tertiary pattern (%): 5, 5%

Histologic type: Adenocarcinoma   Variant histology present: No   Multifocality: Yes

Extraprostatic extension: Yes   Seminal vesicle invasion: No   Cancer at surgical margin:No  

Bladder neck involvement: No    Lymph-vascular invasion: No    Perineural invasion: Yes

Catheter removed Jan-19-10  Dry Nights 1 pad/day as of 2/4/10 Baseline PSA 2/3/10 <0.04

 

Post Edited (larryandangieohio) : 4/10/2010 4:46:40 AM (GMT-6)


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/9/2010 10:09 PM (GMT -6)   
Larry, a PSA below .1 is generally considred undetectable. No point in worrying until you see a rise to .1 or more. Besy of luck. Frank
Dx with PC Dec 2008 at 56, PSA 3.4, Biopsy: T1c, Geason 7 (3+4)

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 4/10/2010 1:32 AM (GMT -6)   
Larry

I agree with Frank that your PSA is what most docs (mine included) regard as a "zero" and therefore should not give much cause for concern. (I never made it as far as <0.1 though). I have no knowledge about Avodart but your doc may be thinking of extra treatment due to certain parts of your post op-pathology specifically:
The upgrade from 3+4 to 4+3 (I had the same upgrade)
The presence of a bit of 5
The EPE.

I would however have thought that the doc might consider waiting to see what a 6 month PSA test showed.
And I'd ask for a bit more explanation about WHY he wants to try Avodart this soon.
Alfred
Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc.
Nov 17th 2009 PSA = 0.1
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist


larryandangieohio
Regular Member


Date Joined Jan 2010
Total Posts : 44
   Posted 4/10/2010 5:53 AM (GMT -6)   
BB and Alf ... Thank you for responding! Last night we had some confussion here when we were on the phone with the doctor. I thought he had said the new reading was .045 my wife heard 0.45 ..... as usual she is correct! He called back and the 0.45 was confirmed by his assistant. From what I had read, Avodart is used before surgery to srink the prostate. and that using it post-op can give false numbers. I was wondering if I should start other treatments instead of wasting two months.

Dx Age:58  PSA 8/06 8.74,  10/09 7.46,  12/22 6.50 Needle Biopsy  11/10/09: 16/16 cores positive 2 - 85% of tissue

Gleason score 7 (3+4 with tertiary pattern 5). CT,Bone, and PET scans all negative.

Da Vinci laparoscopic prostatectomy performed on Jan. 07, 2010 at IU Simon Cancer Center…  Indianapolis, IN  Prostate size: 42 g Gleason score (primary + secondary):  4 + 3 = 7

Primary pattern (%):4, 60%  Secondary pattern (%): 3, 35%   Tertiary pattern (%): 5, 5%

Histologic type: Adenocarcinoma   Variant histology present: No   Multifocality: Yes

Extraprostatic extension: Yes   Seminal vesicle invasion: No   Cancer at surgical margin:No  

Bladder neck involvement: No    Lymph-vascular invasion: No    Perineural invasion: Yes

Catheter removed Jan-19-10  Dry Nights 1 pad/day as of 2/4/10 Baseline PSA 2/3/10 <0.04

 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/10/2010 6:14 AM (GMT -6)   
Question everything and always is my motto and for plenty of reasons. Avodart will mask your true psa number, do we want to do that right now??? Like you could not possibly go and get other psa tests now or month(s) or weeks from now...you don't need any docs permission to go get a psa test..go elsewhere..even pay for it if you have to. Are people afraid of upsetting their doc by doing tests or going elsewhere for second opinions? Why worry about upsetting a doc, you are the one with the omnious future and not the doc.

It might be interesting to see what some other doc says right now, that is not affiliated in any way with the current doc.
Youth is wasted on the Young-(W.C. Fields)


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 4/10/2010 6:23 AM (GMT -6)   
Larry,

if it is indeed 0.45 (and not 0.045 - I would request result in writing) then your PSA increased ten fold in two months. It is unlikely, so I would request another test.

Avodart is a component of hormonal therapy and will reduce the PSA reading, but will not cure cancer, if 0.45 is real reading. Given that your PSA has been undetectable after surgery, you should talk to radiation oncologist and medical oncologist. I havenever heard of Avodart being used this way, so I would suggest second opinion.

Best of luck,

Greg B.
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
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)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/10/2010 6:48 AM (GMT -6)   
Larry, I agree with the recommendation on second opinions. As you can see from my signiture, my PSA recently increased from .05 tp .28 and I am a gleason 8. My doctor immediately ordered a second test to confirm the increase. I have set up an appointment with a local medical oncologist and I hope to set up an appointment at Dana Farber (close to my home) early next week. I am waiting for a call back. Also, I have a regular post op appt with my surgeon in two weeks. Talk to a few other Drs about your options. Good luck. Frank
Dx with PC Dec 2008 at 56, PSA 3.4, Biopsy: T1c, Geason 7 (3+4)

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 4/10/2010 6:53 AM (GMT -6)   
BTW, when the Dr called with the PSA test result my wife took the call and heard 2.8. I darn near hit the floor when she told me. But it was such an unlikely result. I didn't worry (too much) about it and called the Dr back in the morning.
Dx with PC Dec 2008 at 56, PSA 3.4, Biopsy: T1c, Geason 7 (3+4)

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31


larryandangieohio
Regular Member


Date Joined Jan 2010
Total Posts : 44
   Posted 4/11/2010 6:39 AM (GMT -6)   
Hi Guys .... Thank you all for responding! We haven't heard back from the DR this weekend (not hearing was sort of expexcted) but I will be in touch with him first thing Monday morning. I've tried to readup on Avodart and couldn't find much! Like Zufus and Geebra have said this doesn't seem the way to go at this point unless the Doc can fully explain it. If the real number is .045 I would expect we'd be looking at radation treatments in the near future.

How would we know where to treat? I know they could treat the empty prostate bed but the problem could be elsewhere in the body. Does anyone know what other test are availablt to locat or pinpoint PCA elsewhere in the body?

I'm not in panic mode but very concerned and disappointed.

Dx Age:58  PSA 8/06 8.74,  10/09 7.46,  12/22 6.50 Needle Biopsy  11/10/09: 16/16 cores positive 2 - 85% of tissue

Gleason score 7 (3+4 with tertiary pattern 5). CT,Bone, and PET scans all negative.

Da Vinci laparoscopic prostatectomy performed on Jan. 07, 2010 at IU Simon Cancer Center…  Indianapolis, IN  Prostate size: 42 g Gleason score (primary + secondary):  4 + 3 = 7

Primary pattern (%):4, 60%  Secondary pattern (%): 3, 35%   Tertiary pattern (%): 5, 5%

Histologic type: Adenocarcinoma   Variant histology present: No   Multifocality: Yes

Extraprostatic extension: Yes   Seminal vesicle invasion: No   Cancer at surgical margin:No  

Bladder neck involvement: No    Lymph-vascular invasion: No    Perineural invasion: Yes

Catheter removed Jan-19-10  Dry Nights 1 pad/day as of 2/4/10 Baseline PSA 2/3/10 <0.04

 


dsmc
Regular Member


Date Joined Jul 2008
Total Posts : 149
   Posted 4/11/2010 8:53 AM (GMT -6)   
Hi Larry,
I would surely get another PSA and see what it read. If it is 0.45 then I would consult with Rad and Med Oncologist pretty quick. I kept a good psa,<0.04,
for 3 years then it started to climb. My doc calls it recurrence when it reaches 0.1 or 3 consecutive rises which over a few months I had both. The general thought on this is the earlier the better with Salvage Radiation. My PSA immediately dropped to <0.04 after SRT.

I am sorry you have this to be concerned with this and maybe its a glitch!

best of luck

David
Age 55
Pre-op PSA 4.3
Surgery Feb. 17 2005
Post-op Path : Gleason 3+3=6
Right pelvic lymph nodes: negative for metastatic carcinoma
Left pelvic lymph nodes: negative for metastatic carcinoma
extent: right lobe 40% left lobe 10%
capsular penetration: Absent
Seminal vesicles and vasa differentia: Uninvolved
Prostate: 26 grams
Post-op PSA's <0.04 for 3 years
Feb. 08: 0.07, March 08: 0.08, June 08: 0.09 and Sept. 08: 0.1
IGRT scheduled.....November 17th....
FINISHED 01/14/09
05/14/09
1st PSA after SRT <0.04
12/03/09
2nd PSA after SRT <0.04


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4235
   Posted 4/11/2010 12:11 PM (GMT -6)   
Larry,
I agree that Adovart doesn't make a lot of sense. The point of radiation is to go for a cure assuming the PC is still in the prostate bed; if it is not, radiation is just a waste of time increasing your side affects. There is no way to accurrately this at this point in time. There were a number of tests that could have been run before surgery that would have given a probability of organ confined PC.
I would run your pre surgery numbers through partin tables and artificial neural networks (download from Hopkins and the PCRI) There are also some nomograms in which to plug your post surgery numbers available at Hopkins. Once you have looked at this data you can make a better decision on what to do next. If your doctor did not use these tools and explain them to you before your treatment you may want to find a doctor that does.
Good luck,
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


deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 250
   Posted 4/11/2010 7:23 PM (GMT -6)   
Larry I agree with Zufus and John T get some information
DEERHUNTER
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


larryandangieohio
Regular Member


Date Joined Jan 2010
Total Posts : 44
   Posted 4/12/2010 8:19 PM (GMT -6)   
First and foremost thanks to everyone that responded! I did as advised and when to see the doc today for a retest of the PSA. There was great news the PSA was actually .045 not the .45 as stated on Friday. It was a rough weekend thinking that it had jumped so much in only two months. We are going ahead with the Avodart treatment. He explained that if the current PSA is due to a benign tissue then the Avodart will cause the count to go down within two months, but if the PSA is due to cancer still being in the system them the count will remain at .045 or continue to increase. I trust him so we're going with it! Thanks again guys .... it truly is a comfort having this forum!

Dx Age:58  PSA 8/06 8.74,  10/09 7.46,  12/22 6.50 Needle Biopsy  11/10/09: 16/16 cores positive 2 - 85% of tissue

Gleason score 7 (3+4 with tertiary pattern 5). CT,Bone, and PET scans all negative.

Da Vinci laparoscopic prostatectomy performed on Jan. 07, 2010 at IU Simon Cancer Center…  Indianapolis, IN  Prostate size: 42 g Gleason score (primary + secondary):  4 + 3 = 7

Primary pattern (%):4, 60%  Secondary pattern (%): 3, 35%   Tertiary pattern (%): 5, 5%

Histologic type: Adenocarcinoma   Variant histology present: No   Multifocality: Yes

Extraprostatic extension: Yes   Seminal vesicle invasion: No   Cancer at surgical margin:No  

Bladder neck involvement: No    Lymph-vascular invasion: No    Perineural invasion: Yes

Catheter removed Jan-19-10  Dry Nights 1 pad/day as of 2/4/10 Baseline PSA 2/3/10 <0.04

 


skeener
Regular Member


Date Joined Dec 2009
Total Posts : 214
   Posted 4/13/2010 5:47 AM (GMT -6)   

So glad that decimal got moved to the left!!

Skeener


Age:  63 
Biopsy: May 09 showed 2 of 12 cores positive for prostate cancer -- 1 at 5% and 1 at 25%.  Cancer indicated as non aggressive.  Gleason Score: 3+3.
RRP on Oct 23/09 in London, Ontario.  Excellent surgeon. 
7 Weeks Post Op -  The fears I had about bad things about the operation and recovery did not materialise except of course ED!!.  Otherwise, everything went very smoothly.  Incontinence not a problem.  Wear a pad when out just in case. Pain was never a problem.
Pathology:  Unremarkable 
First followup PSA and Visit: Feb 11/10 - 0.0.
 
Next PSA May
Next doctor's visit in 6 months      


larryandangieohio
Regular Member


Date Joined Jan 2010
Total Posts : 44
   Posted 4/13/2010 4:33 PM (GMT -6)   
Thx Skeener me too that was HUGE !

Dx Age:58  PSA 8/06 8.74,  10/09 7.46,  12/22 6.50 Needle Biopsy  11/10/09: 16/16 cores positive 2 - 85% of tissue

Gleason score 7 (3+4 with tertiary pattern 5). CT,Bone, and PET scans all negative.

Da Vinci laparoscopic prostatectomy performed on Jan. 07, 2010 at IU Simon Cancer Center…  Indianapolis, IN  Prostate size: 42 g Gleason score (primary + secondary):  4 + 3 = 7

Primary pattern (%):4, 60%  Secondary pattern (%): 3, 35%   Tertiary pattern (%): 5, 5%

Histologic type: Adenocarcinoma   Variant histology present: No   Multifocality: Yes

Extraprostatic extension: Yes   Seminal vesicle invasion: No   Cancer at surgical margin:No  

Bladder neck involvement: No    Lymph-vascular invasion: No    Perineural invasion: Yes

Catheter removed Jan-19-10  Dry Nights 1 pad/day as of 2/4/10 Baseline PSA 2/3/10 <0.04

PSA 4/7/10 0.045

 

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