First PSA after Salvage RT

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pk5
Regular Member


Date Joined Jun 2010
Total Posts : 20
   Posted 6/15/2010 6:21 AM (GMT -6)   
I've just finished RT (5 weeks ago) after failed DaVinci and my first PSA (got it today) is 0.21 the same as before start of radiation.
Not sure if this is good or bad news so I need a bit of help from you guys out there.
Cheers
pk5
 
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
PSA before surgery 6.3
Biopsy show Gleson 9 (out of 12 samples 3 were 9, 2 were 7 and 1 was 6)
Staged T2c
DaVinci 8 dec 09
From Biopsy report:
Tumor does not extend to apical margin
Evidence of capsular penetration.
Tumor does not extend to circumferential margins.
Tumor infiltration into the base of the Lt. seminal vesicle.
Bladder neck margin confirm this to be free of tumor.
Eight lymph nodes submitted showing only reactive changes.
Gleason 9 confirmed but stage upgraded to T3b.
First PSA 6 weeks after surgery 0.16
Second PSA 10 weeks after surgery 0.21
Radiation started 16 March and finished 12 May.
First PSA after Radiation 0.21.

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 6/15/2010 6:28 AM (GMT -6)   

What did Your doctor say?

Have a feeling the guys with experience in this area will say - get another test in a few weeks/couple months.


Age 55   - 5'11"   215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
05/18/10 - 24 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2222
   Posted 6/15/2010 6:36 AM (GMT -6)   
PK,
My first test was 6 weeks, I think, and it dropped from around .6 to .44, so I would say it is still a little early for any concern on your part. Wont be tested again until November but hopefully will continue to see a downward trend. Did you Dr. say anything about the result of your PSA?
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/15/2010 7:08 AM (GMT -6)   
They did my first post srt at 30 days, not much drop, but then again at 90 days out - big drop. at 5 weeks, probably not going to show much drop, so hopefully your next test will give you some good news
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, 4/8 .04, next one:  July
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- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 6/15/2010 7:43 AM (GMT -6)   
My first PSA came back the same .18 as before IMRT. However, the 6 month came back as 0.00. Relax, give it some time. I was discouraged too. Radiation can work up to two years, I was told by my Rad Doc.
Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin (.3cm)
T2C
4/16/08- Started Bi-mix injections 
5/15/08- 1st Post-Op PSA 0.07 Undetectable
8/11/08 -2nd Post-OP PSA 0.02 Undetectable
8/15/08- No more pads as of today  Whoopee!!!
11/13/08- 3rd post-op PSA 0.02 Undetectable
03/02/09- 1 yr. post-op PSA .09 Undetectable
05/13/09   PSA .18 (ouch)
Started IMRT June 13, 2009
Completed 37 treatments July 31, 2009 (66.6gy)
11/23/09 Post IMRT PSA .18
2/12/10   Post IMRT PSA 0.00


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 6/15/2010 8:27 AM (GMT -6)   
PK welcome to the forum

I think this is too soon after RT finished to draw conclusions.

My doc said we needed to allow 10 weeks to three months for the RT to have a proper effect. RT does not kill cancer cells overnight; it takes time.

However, that said, I think it is also good that your PSA has not gone up since that earlier 0.21

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 of urine
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc. but...
Nov 17th 2009 PSA = 0.1
Can still get erections okay, and almost no leaking of urine, but since December 2009 I don't have orgasms, instead I just have intense pain in place where prostate used to be.
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)
June 11th 2010 finished RT - main side effect tiredness, but also the occasional small leak

Post Edited (English Alf) : 6/15/2010 8:40:58 AM (GMT-6)


pk5
Regular Member


Date Joined Jun 2010
Total Posts : 20
   Posted 6/15/2010 11:21 PM (GMT -6)   
My Oncologist says the number is in line with expectations and want to see me in 6 mth. for another PSA.
 
I still have issues with frequent urination (once 1-2 hours) .
Have tried Flomax but it didn't work. Been given referral to Urologist but that won't happen for a month or two. Anything I can do in the meantime?
Cheers
pk5

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 6/16/2010 1:09 AM (GMT -6)   
pk5

Sorry, but I don't think that 1-2 hours is frequent peeing unless that's at night.
I was peeing about every 20 minutes at one point towards the end of RT, and even now I still can't manage much more than 45 minutes during the day time and 2 hours at night without needing to go. And I don't think I've ever been able to go longer than 2 hours in my whole life without needing to pee.

I tried something like Flomax (different name here in Holland so I'm not sure if it's the same) and that actually made me leak rather than better.

Kegels can still help, but the area near the bladder and the lower section of the bladder will have been really aggravated by RT and will still need a bit more time to heal/recover.

Having just reread your signature I see that you haven't said how old you are.

Alfred

pk5
Regular Member


Date Joined Jun 2010
Total Posts : 20
   Posted 6/16/2010 1:44 AM (GMT -6)   

Once every 1.5 - 2 hours is on a very good day. At nighttime it's more like twice per hour.

I am 60 years old by the way.

cheers, pk5

 

 

 

 

 

bsjoplin
Regular Member


Date Joined Feb 2010
Total Posts : 308
   Posted 6/16/2010 10:59 AM (GMT -6)   
just a quick comment: i'm still in the salvage RT stage, so i can't speak to how soon the PSA starts to drop.  but the way it was explained to me: the radiation doesn't KILL the bad cells, it messes up their DNA.  so when the therapy is over, a bunch of them are still alive.  but when they try to replicate, the DNA will not function/split/reproduce, and the cell dies.  so after the therapy session, you have to wait until the "crippled" PCa cells try to duplicate, then they slowly die off.
does this match what anyone else has heard ??
bob
 
 

Age@dx: 55

5/05             PSA test 1.8  --12/19/07  PSA test 3.7  --7/25/08    PSA test: 4.7

8/26/08        1st Prostate Biopsy: 3 samples out of 6 have irregular cells

11/25/08      PSA test: 6.5

12/11/08      2nd Prostate Biopsy :  of 12 samples, 3 are cancer, and all other 9 are irregular.  original NJ lab sent samples to Johns Hopkins for special reading.  Gleason 3+3=6.  now:read book, and think about options: radiation, surgery, etc

1/22/09        Radical Retropubic Prostatectomy.  main issue was use of BOTH pre-donated units of blood during surgery, and then required 2 additional units in recovery, before going to room

1/25/09        Released from hospital. No drive, no lift >5 lb

1/28/09        Pathology results from removed tissue:  Cancer was seen on 10% of gland, lymph nodes & SV were benign, nothing seen outside of the prostate.  One area of cancer extended right up to edge, but not beyond.  Gleason was re-typed as 3+4=7, staged T2c

2/13/09        PSA=0.1

3/6/09          6week appt, start back to work Monday, 3/9.  script for Cialis

6/8/09          PSA=0.1

10/9/09        PSA=0.1

2/10/10        PSA=0.3 discussed possibility of radiotherapy and/or hormone.

4/7/10          PSA= 0.4  Recurrence of the cancer is probable. Referred me to RO

5/4/10                   First RT.  RO is recommending 37 treatments x 1.8Gy=66.6 Gy


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6947
   Posted 6/16/2010 11:28 AM (GMT -6)   
Bob,
That description of the demise of PCa cells is the same I was told by the therapists.

Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 6/16/2010 11:29 AM (GMT -6)   
Bob, that matches my understanding as well.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 and thereafter <0.1
http://pcabefore50.blogspot.com


pk5
Regular Member


Date Joined Jun 2010
Total Posts : 20
   Posted 6/17/2010 12:12 AM (GMT -6)   
Just want to say thank you to every body who has replied. There is a lot of clever and caring people out there.
Very happy I found this place.
Cheers, pk5

Age 60
PSA before surgery 6.3
Biopsy show Gleason 9, Staged T2c
Da Vinci 8 Dec 09
From biopsy report:
Tumor does not extend to apical margin.
Evidence of capsular penetration.
Tumor does not extend to circumferential margins.
Tumor infiltration into the base of the Lt.
Seminal Vesicle.
Bladder neck margin confirm this to be free of tumor.
Eight lymph nodes submitted showing only
reactive changes.
Gleason 9 confirmed, but stage upgraded to T3b.
First PSA 6 weeks after surgery 0.16
Second PSA 10 weeks after surgery 0.21
Radiation started 16 March and finished 12 May.
First PSA after radiation 0.21
 


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 6/17/2010 1:10 AM (GMT -6)   
Yeah Bob, the DNA effect on replication is what I was told too; it's just simpler to say "Kill" sometimes. And more satisfying!
Alf

bsjoplin
Regular Member


Date Joined Feb 2010
Total Posts : 308
   Posted 8/6/2010 2:58 PM (GMT -6)   
glad i found this thread. i just got back my first PSA after my SRT.  at six weeks after the end of RT, the number is 0.2, which is half the 0.4 when we started the RT.  i knew it takes awhile to go down, but it was good to see other guys' numbers.  apparently, 6 weeks is plenty early, and when i get my next number at 6 months (additional), that should be a much better indicator of what's going on. i of course was hoping for lower, but i'll take my 0.2, and wait a few more months...thanks for hanging your numbers out here so we can compare!
bob
Age@dx: 55

5/05 PSA test 1.8 --12/19/07 PSA test 3.7 --7/25/08 PSA test: 4.7

8/26/08 1st Prostate Biopsy: 3 samples out of 6 have irregular cells

11/25/08 PSA test: 6.5

12/11/08 2nd Prostate Biopsy : of 12 samples, 3 are cancer, and all other 9 are irregular. original NJ lab sent samples to Johns Hopkins for special reading. Gleason 3+3=6. now:read book, and think about options: radiation, surgery, etc

1/22/09 Radical Retropubic Prostatectomy. main issue was use of BOTH pre-donated units of blood during surgery, and then required 2 additional units in recovery, before going to room

1/25/09 Released from hospital. No drive, no lift >5 lb

1/28/09 Pathology results from removed tissue: Cancer was seen on 10% of gland, lymph nodes & SV were benign, nothing seen outside of the prostate. One area of cancer extended right up to edge, but not beyond. Gleason was re-typed as 3+4=7, staged T2c

2/13/09 PSA=0.1

3/6/09 6week appt, start back to work Monday, 3/9. script for Cialis

6/8/09 PSA=0.1

10/9/09 PSA=0.1

2/10/10 PSA=0.3 discussed possibility of radiotherapy and/or hormone.

4/7/10 PSA= 0.4 Recurrence of the cancer is probable. Referred me to RO

5/4/10 First RT. RO is recommending 37 treatments x 1.8Gy=66.6 Gy

6/25/10 Final RT. ended up w/ 36 treatments, 64.8 Gy. First PSA after SRT: 8/5 (6 weeks out) PSA=0.2

pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 437
   Posted 8/7/2010 3:16 PM (GMT -6)   
pk5,
 
I was always trying to get them to check my PSA after SRT before their firm 3 month time frame...  They always told me no...   They were not interested in results until the 3 month mark and anything before may just cause needless anxiety and worry...   So,  I had to wait...   This being said,  I would indeed wait for the 3 month or greater test as being the better indicator...  And seems like your doctor still considers you inline with expectations...        
 
God Bless!    
After 3-4 years of annual PSA 4-6, biopsy recommended
59 y/o
3/13/2007 - 12 point biopsy - Left 0/6  Right 1/6 Gleason 3+3 T1c
4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6  T2c Nx Mx, approx 20% of prostate involved, positive margin, but only at 2 focal points.  
6/28/2007 9 weeks incontinance... Overnite, went from 4-6 soaked pads a day from prev 8 weeks to 2 barely wet pads a day.
7/12/2007 11 weeks post-op  Minimal leakage...  one small pad a day
7/18/2007 First Post-Op PSA...  0.01 !!! 
9/10/2007 Pad free and ED at 75% with 100mg Viagra generic
6/26/2008 2nd Post-OP PSA at 14 months...  0.02 
12/2/2008 3rd Post-OP PSA at 20 months...   0.03
10/30/2009 4th Post-OP PSA at 31 months...   0.13 (moved and diff lab)
11/3/2009 Retest at my original lab...  0.11  (followup with Doc sched 11/10)
11/10/2009 Discussion indicated biochemical reccurrence and need for salvage radiation treatment. 
1/21/2010 Another PSA test at 34 months...  0.14
1/26/2010 IMRT Salvage Radiation Treatment started
                  32 sessions for 64 gys total.
3/12/2010 Finished 32 sessions...  No side effects to date except a little
tiredness.  Slight changes in bowel movements the last week...  
4/8/2010  Some rectal prostitis, but no change in urgency.  No urinary effects at all.  Now just waiting for the upcoming PSA test in June.
6/7/2010 First 3 month PSA result after SRT = 0.02   WAHOO!  as good as could ever be expected at the 3 month mark!  Thank You Jesus!
 

Jakester
Regular Member


Date Joined Aug 2009
Total Posts : 285
   Posted 8/7/2010 8:56 PM (GMT -6)   
Sorry about being late in adding my experience, but similar to others my 3 month post SRT psa was .2 down from .3 at the start. I foolishly insisted on getting my psa tested during SRT at 6 weeks and my psa had continued to rise to .4 so my drop at 3 months was either 1/3 or 1/2. My understanding also was the cancer died while trying to replicate and this could continue for a year after SRT. Additionally the RO stated the lower grade gleason cells took the longest to die because they weren't as deformed.

Take care,
Jake
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09
broke ankle bones 6/09
9/21/09 Bone scan clear, psa still .2
11/12/09 chest xray was clear, psa however up to .3,
01/05/10 psa still .3, radiation setup done with tats, 01/19/10 started 39 sessions 70.2gy, psa at 6th week salvage IMRT up to .4
Post SRT psa at 10 weeks (5/31/2010) down to .2
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