Very worried daughter...

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LuvMyDAD
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Date Joined Dec 2009
Total Posts : 315
   Posted 5/19/2010 6:17 PM (GMT -6)   
Hi guys my dad just took another PSA reading (after being on hormones for 2.5 months and halfway through radiation.) It came back again at a .1. Isn't it supposed to be zero at this point?????
Does this mean, his pc is more likely to be hormone resistant?? Any info would be greatly appreciated. Thank you!
Father diagnosed Nov. 9, 2009
Open radical prostatectomy Dec. 21, 2009, post op pathology report T3a, Gleason 7
5 week post op psa .55
Combination therapy, hormone and IMRT. 40 sessions 72gy.
Hoping and praying for a cured dad.


BB_Fan
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Date Joined Jan 2010
Total Posts : 1011
   Posted 5/19/2010 6:25 PM (GMT -6)   
Others will respond, but I think that if hormone treatment got PSA down to .1 and it is not on the rise then it is not yet hormone resistent. It may well still be on the way down.A PSA at .1 at this stage seems to me to be a good thing.
Dx with PC Dec 2008 at 56, PSA 3.4
 
Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 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

Aril 10 MRI and Bone Scan show lesion on lower spine, SRT on hold pending further testing.


60Michael
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Date Joined Jan 2009
Total Posts : 2222
   Posted 5/19/2010 6:26 PM (GMT -6)   
Luvmy dad,
I think the good news is the significant trend downwards. Other can chip in that have had the Combo Tx., but from what I can gather, the news is good so far. Keep us posted and my best to you and your family.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
 started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5 on 11/28/10
Starting IMRT on 1/18/10, Completed 39 tx at 70 gys on 3/12/10
6 week Post IMRT PSA .44 a drop from .5 but maybe more
Great family and friends
Michael


LuvMyDAD
Regular Member


Date Joined Dec 2009
Total Posts : 315
   Posted 5/19/2010 6:30 PM (GMT -6)   
Thank you guys for responses, but I forgot to mention that it was at .1 before he starting radiation and after 1 shot of Lupron. He has had two shots since then and is half way through radiation. It hasn't budged for 2.5 months. Shouldn't it have?
Father diagnosed Nov. 9, 2009
Open radical prostatectomy Dec. 21, 2009, post op pathology report T3a, Gleason 7
5 week post op psa .55
Combination therapy, hormone and IMRT. 40 sessions 72gy.
Hoping and praying for a cured dad.


BB_Fan
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Date Joined Jan 2010
Total Posts : 1011
   Posted 5/19/2010 7:10 PM (GMT -6)   
At this point I wouldn't worry to much. I know, easier said than done. But, hormones have gotten the PSA down to .1 (a very low level) and is keeping it there. The worst that can be said is that SRT is not YET taking effect. Hang in and see the effect full treatmen.
Dx with PC Dec 2008 at 56, PSA 3.4
 
Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 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

Aril 10 MRI and Bone Scan show lesion on lower spine, SRT on hold pending further testing.


Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 5/19/2010 8:09 PM (GMT -6)   
LuvMyDAD said...
It came back again at a .1. Isn't it supposed to be zero at this point?????
I understand your high level of worry.  You might have seen in other posts at this site about the "zero club", and lots of talk about "zeros."  Naturally, when your dad's PSA result was not "zero" at a time when you thought it, too, should be reported at "zero"...then this has caused you great anxiety.  Very understandable.
 
Here's what you probably didn't know...there is no such thing as a "zero" PSA in a living, breathing man. 
 
The concept of the "zero club" is a misnomer that has been adopted here, and unfortunately every couple of weeks someone else (like you) gets—lets just use the words you've already used:  "very worried"—about not being at "zero."  The "zero club" here has meant a low level, or an undetectible level (below the detection limits of the test), depending on who you might ask.
 
So, let's talk about your dad's PSA result.  First thing to be very keen on (because they are easy to mix up) is the decimal places.  A PSA test reported as 0.1 ng/mL could mean something very different from a result reported as 0.10 ng/mL, even though mathematically they are the same.  The first implies that it was measured with a "standard" PSA test which has a lower detection limit of 0.1 ng/mL; whereas the second result implies it was measured with a "ultra-sensitive" PSA test which has a lower detection limit of 0.04 or 0.01 ng/mL (typically one of these two, although other versions are also available).  If it was the "standard" test, it might have actually been reported the way that they report the lowest possible result, which is "<0.1 ng/mL", meaning "less than 0.1."  Did your dad's actual result have a "<" (less than) sign in front of it?
 
You reported the result as ".1", but use of the "ultra-sensitive" PSA test for someone on HT is much more common because the doctor would want to track closely the lowest point (nadir), and so this indicates to me that there might be a decimal point issue here.
 
Double check the actual written results of the test.
 
I hope this provides some helpful information...
 
 
 
[edit:  the two "0's" in red, above, were added later in an edit/correction]

Post Edited (Casey59) : 5/20/2010 7:54:49 AM (GMT-6)


LuvMyDAD
Regular Member


Date Joined Dec 2009
Total Posts : 315
   Posted 5/19/2010 8:19 PM (GMT -6)   
Thank you Casey I thought about that right away and called the lab. They told me the lowest possible PSA reading at the lab is a 0.03, so I know its still detectable..
I am just so surprised and scared at the same time. How long does it generally take hormone therapy to bring the PSA to below detectable? And he more than halfway done with his SRT as well. It just seems like neither have had an effect. Here are his stats:
5 weeks post op .55
After one week of Casodex .4
Stopped Casodex and given a lupron shot and three weeks after .1
Since then he has had another lupron shot and completed 25 of his 40 radiation treatments (2.5 months since last psa reading and still .1!) Sorry I am rambling... I am just soooo down.
Father diagnosed Nov. 9, 2009
Open radical prostatectomy Dec. 21, 2009, post op pathology report T3a, Gleason 7
5 week post op psa .55
Combination therapy, hormone and IMRT. 40 sessions 72gy.
Hoping and praying for a cured dad.


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 5/19/2010 8:49 PM (GMT -6)   
Well, detailed understanding of radiation or hormone therapy is not my forte...I have had neither, but I'll try to answer with what I believe I understand to be the case.  I'll tee-up a response, and undoubtedly others who have been down this road can correct me or fine tune my response.
 
Basically, I don't believe you should be so concerned at this point.  What I do know is that with RT it takes some time for the PC cells to actually die from the radiation.  In fact, my understanding is that usually (always?) the PSA result continues to drop even after the final treatment until it reaches it's nadir. 
 
Question for you guys who have had radiation:  When does your doctor ask you to get a PSA test?  And, how long after your last treatment until you hit your nadir?
 
Luv, you also asked in your first posting about becoming "hormone resistant."  My understanding is that becoming refractory, when PC no longer responds to hormone therapy, would not occur with the essentially the first dose.  It usually takes at least months and usually years of HT.  Even then, doctors have some other combinations to try to "shock" the tumor into responsiveness again.
 
So, according to what my understanding is, you should try to relax because his result doesn't seem that out-of-the-ordinary to me at this point.
 
Hope this is helpful...

BillyMac
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Date Joined Feb 2008
Total Posts : 1858
   Posted 5/19/2010 8:49 PM (GMT -6)   
LuvMyDad,
I don't know what the timespan should be to deliver a very low reading on the PSA, but the effects of HT and especially radiation are cumulative so it may take a little longer to get the desired result. i would try to bide my time especially till the radiation has run its course.

Casey
there may be a couple of typos or omissions in your post. I would be surprised to see any lab using equipment whose lowest level of sensitivity was 0.1 ng/mL nowadays. The most common equipment now has a sensitivity of either 0.03 (generation2) or 0.003(generation3). Most urologists do not want to know about anything below 0.1 and for this reason many labs, although their test delivers an ultrasensitive reading, will issue the report as <0.1 undetectable. Undetectable on Gen 2 means <0.03 and on Gen 3 undetectable is <0.003. There are different manufacturers of assay tests and equipment out there so some may specify either 0.03 or 0.04 as the lowest level of detection.
Bill

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 5/19/2010 8:55 PM (GMT -6)   
BillyMac said...
...
Casey
there may be a couple of typos or omissions in your post. I would be surprised to see any lab using equipment whose lowest level of sensitivity was 0.1 ng/mL nowadays. ...
I respectfully disagree, Bill.
 
Ever heard of "PSA Anxiety"?  The notion of "PSA Anxiety" is all about guys getting 2-decimal points of detail, and the naturally occurring variation which occurs when one gets the "ultra-sensitive" test when they don't need it.  Please go to this link and scroll down to the bottom in the yellow box:  http://www.phoenix5.org/Basics/psaPostSurgery.html
 
Someone who has had positive surgical margins, or EPE, or some other reason to think that they need the close monitoring post-surgery, then the ultra-sensitive test is absolutely for them.  BUT, the majority of men who were low risk going in to surgery (which is the majority of men diagnosed these days) also come out of surgery with nothing but clearly organ-confined disease, the ultra-sensitive leads to nothing (in the opinion of some, but not everyone) but unnecessary anxiety.
 
The "standard" test remains much more common post-RP than you may believe, and of course it is the only test used diagnostically.
 
respectfully...

Post Edited (Casey59) : 5/19/2010 9:23:06 PM (GMT-6)


LuvMyDAD
Regular Member


Date Joined Dec 2009
Total Posts : 315
   Posted 5/19/2010 8:56 PM (GMT -6)   
Thanks guys I feel somewhat better now.. I hope you are right. I guess like you said we just have to wait and see.
He did take the PSA at a different lab (just out of curiousity) to see where it was, maybe that can account for something??
Stupid PSA
Father diagnosed Nov. 9, 2009
Open radical prostatectomy Dec. 21, 2009, post op pathology report T3a, Gleason 7
5 week post op psa .55
Combination therapy, hormone and IMRT. 40 sessions 72gy.
Hoping and praying for a cured dad.


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/19/2010 11:30 PM (GMT -6)   
Luv,

I do agree with posts above with respect to reporting of undetectable PSA. My doc at Duke said they are using .1 and <.1 interchangeably. But let's discuss what if it is a real number.

As others mentioned, it would be very very unusual for cancer to become hormone refractory in just two-three months. If it did, the PSA would be rising, not staying steady. One wild guess would be that the hormonal blockade is not very effective. If that is so, then the cancer may not react as fast. The easy test for this is testosterone level. If it is above 20, then drugs need to be adjusted (by adding Casodex and Avodart for example). Do you know your dad's T level?

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


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 5/20/2010 12:17 AM (GMT -6)   
Hi Luvmydad

The important part of the info you started this thread with is that he is only halfway through RT.

RT takes a while to have its effect. My doc for instance said I was only going to start noticing side effects when I was about halfway through RT

BUT most importantly she said it would be long after the RT finished before it had done all its work. Thus they do not do any PSA testing during RT nor when it finishes, but wait until THREE months after RT finishes to retest PSA.

It that old story of the patient having to be patient. (I know all about PSA anxiety)

Hang in there

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
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 5/20/2010 7:13 AM (GMT -6)   
Bill, I agree with Casey...both our urologist (with inhouse lab) and internal practitioner (uses Quest) only report using first generation (in my husband's case, <.1). It's possible that the uro's lab does use 2nd or 3rd generation tests but the results come back 1st generation.

Casey, when John's PSA was trending upward last summer, I asked him to speak with the uro about using 2nd generation testing. Uro said that in his 25 years of experience with prostate cancer, he (and the 3 other uros in his practice) have found no value in knowing whether the PSA is 0.03 or 0.07. In their minds (and I'm still not sure I agree with this), the important thing is whether the PSA is less than or greater than 0.1 and how fast it's rising.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 5/20/2010 7:52 AM (GMT -6)   
Darn it!  I DID have a decimal place error in my first posting in this thread (9:09pm)...
I wrote:  "...a "ultra-sensitive" PSA test which has a lower detection limit of 0.4 or 0.1 ng/mL..."
 
I should have written:  "...a "ultra-sensitive" PSA test which has a lower detection limit of 0.04 or 0.01 ng/mL..."
 
It just goes to show how the importance of being attentive to the decimal points in PSA results...a point I have made to others in more than one posting...!  I humbly request forgiveness.  blush  [blush] 
 
 
I think BillyMac tried to nicely tell me I had made an error, and in return I blew him off and focused on emphasizing the beneficial continued use of the "standard" PSA test (with 0.1 ng/mL as the lower detection limit).  I didn't thoroughly re-read what I had written and see my error until this morning.  Thanks, for the heads-up, Bill
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