Here's what Dr Strum has to say:
Lou Antonelli ||
> Then in 2006 when ultra sensitive equipment was introduced readings
>were as follows:
>Jun 06 .04
>Sep 06 .06
>Dec 06 .05
>Mar 07 .06
>Jun 07 .06
>Jan 08 .08
>Apr 08 .10
> Jul 08 .11
> Oct 08 .13
> Jan 09 .13
> May 09 .14
<Stephen Strum, MD> These kinds of numbers strongly suggest LOCAL recurrence and the PC TOOLS II program at the PCRI website can be used to determine PSAV (PSA velocity) post RP and then the nomogram for LOCAL versus Distant recurrence. Most likely, the above, if not changed a lot, reflects local recurrence. This can be further evaluated with DRE (digital rectal exam) and with 3T MRI of the prostate. Unfortunately, Combidex no longer exists to rule out nodal metastases and the use of CT & bone scan in this context is worthless, and a waste of healthcare dollars.
|| Dean & Lou Antonelli ||
> Oct 09 .19
> Jan 10 .22
> May 10 .27
>PSADT Since Jan 09 14 months
>PSADT Since Apr 08 18 months
>Since Jun of 06 till May of 09 psa increases were very small
>But the last three readings show an acceleration and the prospect of
>radiation and/or ADT is now being reintroduced. I have so far twice
>declined. I have tacitly agreed to go ahead at psa .4 or .5.
<Stephen Strum, MD>
You made the mistake of so many patients focusing on WHAT TO DO rather than to determine STATUS (what is happening at a biological
level) which then leads to a rational STRATEGY. If you are seeing a
serial increase in PSA, then go ahead and treat this situation now before the PC population mutates further. Do your investigations now because any treatment will alter the value of further testing such as MRI or labs.
|| Dean & Lou Antonelli ||
> From my amateur research, I learn that men at the lower risk of
>progression do so much better with RT and/or ADT than those with a
>higher risk of progression. So much so that it brings into question
>whether the treatment was of any net benefit. Herein lies my dilemma in
>determining when or whether to treat.
<Stephen Strum, MD> I am not clear as to your thinking expressed above. RT efficacy depends on WHERE THE PC IS since Radiation PORTS of treatment can only kill cells within that field. ADT efficacy depends on the sensitivity of the PC population to the drugs used and how complete the androgen deprivation (AD) approach is. This varies a lot with the treating physician and his or her knowledge of the endocrinology and intracrinology of PC.
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.