Lifelong Yearly Prostate Specific Antigen Surveillance is Not Necessary for Low Risk Prostate Cancer

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ChrisR
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Date Joined Apr 2008
Total Posts : 831
   Posted 7/30/2010 2:47 PM (GMT -6)   
Interesting study from the Mayo Clinic.
 
The authors suggest that PSA test once every 2 years is sufficient for us Gleason 6 guys...
 
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010

Sephie
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Date Joined Jun 2008
Total Posts : 1804
   Posted 7/30/2010 3:15 PM (GMT -6)   
Chris, dont' care what the Mayo Clinic says - once every two years seems foolish to me. It's not like it's a CT or bone scan...just a simple vial of blood that you don't even have to fast for. Once every two years may be sufficient but I think it's taking a big chance...wouldn't want my husband to be one of the "unlucky" whose PSA creeps up and we go two years without catching it. Just my opinion, of course.
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!

goodlife
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Date Joined May 2009
Total Posts : 2692
   Posted 7/30/2010 3:30 PM (GMT -6)   
Is that after a biopsy ?

We have men here who had a biopsy of G 6 and after surgery found 7,8 and even 9's.

My first biopsy showed High grad pins, but no adenocarcinoma. One year later it showed Gleason 9.

All that stuff is fine and dandy for the research paper guys, not for us guys who been there, done that.
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
1 year psa (364 days) .01
15 month PSA <.01

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 7/30/2010 3:31 PM (GMT -6)   
The abstact says "Prostate specific antigen measurements every 2 years should capture *the majority* of low risk patients who experience progression." I am sure that is true. But do you want to take the chance that you are not in "the majority"? Also, this says "Biochemical failure was defined as a prostate specific antigen greater than 0.4 ng/ml". But many post-RPs would want to know before things get to .4 ng/ml, to consider SRT -- especially with mounting evidence that earlier SRT yields better results.

Chris - what does JHU recommend, in terms of post-RP PSA testing intervals? Is it true that JHU does not recommend using the ultra-sensitive test?
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 

gold horse
Regular Member


Date Joined Nov 2009
Total Posts : 360
   Posted 7/30/2010 4:34 PM (GMT -6)   
It sound good,but I still like six months. tongue

DIAGN=46 YEARS
GLEASON=3+3
FATHER HAD PC,THEN I THEN MY BROTHER STILL HAS TWO BROTHER PC FREE.
MARRIED,TWO CHILDREN.AGE 13 AND 8.
LAPROSCOPY SURGERY 6/2005
PATOLOGY REPORT.
GLEASON=3+3
TUMOR VOLUME=5%
LYMPHOVASCULAR INVASION=NEG
PERINEURAL INVASION=POSI
TUMOR MULTICENTRICITY=NEG
EXTRAPROSTATIC INVASION=NEG
SEMINAL VESICLES BOTH=CLEAN
MARGIN ALL=NEG
PT2ANXMX
DEVELOP SCART TISSUE AND NEEDED A SECOND SURGERY BECAUSE COULD NOT URINATE,
PSA 6/05=0.04,0.04,0.04,6/06,0.04,0.04,0.04,6/07,0.04,0.04,0.04,6/08,0.04,0.04,1/09
0.04,10/09,0.04
 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/30/2010 4:40 PM (GMT -6)   
I totally disagree with that as advice. You have Prostate Cancer, your biopsy indicates that is Gleason 6, you don't really know if that is the full extent of that or not. If it were me, I would still want to have my PSA checked at least twice a year, if not more.
Age: 58, 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: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 7/30/2010 5:06 PM (GMT -6)   
I think some people are getting confused.  It is not after biopsys.  It is after successful RP.  The first 3 years are at 1 year intervals.  After that your chance of recurrence becomes very slim and every 2 years in their opinion is safe.
 
Johns Hopkins says for Gleason 6 organ confined if your first 3 month PSA is 0 then you go to yearly testing right away.  They also don't use the ultra sensitive test either.
 
I just thought this was an interesting point of view.  Maybe after 3 years and certainly 10 years of an undetectable maybe reccurence happens so slow that every 2 year would be safe to them.  The article is somewhat confusing to read.  I think that having someone like the site master at Prostate Cancer Info. Link read this would be good.
 
Johns Hopkins also says that if you make the 10 year mark you are "probably cured"
 
Gold Horse, whatever you like, but you are 5 years out with Gleason 6, I think you could go to yearly easily and not loose anytime if you have recurrence...
Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 7/30/2010 5:36 PM (GMT -6)   
Why does Hopkins say "don't use the ultra-sensitive"? I assume because it just causes unnecessary anxiety? (I wonder how many of their patients get the tests every 6 months and use the ultra-sensitive anyway...)
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 7/31/2010 10:07 PM (GMT -6)   
It is not that difficult nor expensive to do a PSA test. Even if I was a Gleason 6 I wouldn't want to take a chance a test every 2 years.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/31/2010 11:28 PM (GMT -6)   
We are talking about a test that you should be paying no more than 150.00 for (if you lack coverage). And a co-pay with good insurance. I understand where Mayo is coming from, but there is no negative to monitoring it every 6 months after a confirmed positive biopsy. Perhaps once a year, but I would not do it.

Johns Hopkins and MSK both recommend a repeat biopsy after year 1 or with any sudden changes...not just a PSA test...

I have a hard time seeing why someone would do "less active" or "inactive" surveillance...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 8/2/2010 4:21 PM (GMT -6)   

Again, "this is not after biopsy."  This is after RP.  There would be a huge cost savings if the 100,000 men who got one every year stopped doing this....

 

Again,

This is not after biopsy, it is after RP.


Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/2/2010 4:34 PM (GMT -6)   
I took the time to contact Mike Scott at the "New" Prostate Cancer InfoLink. Mike posted this from this study yesterday:

tinyurl.com/2epyfwh

I don't necessarily agree with 100% of what he is saying, but I highly respect his opinions. If anyone would like to comment on it here or there make yourself at home. Personally I agree with most of it. But we are not talking "huge" savings. For those who are not insured, there is some savings, but there are inexpensive ways to be tested for PSA. With community based screening events in just about every major city, free tests are available but call ahead. For those with insurance, co-pays are all you are into. For me that is 20.00 per doctors visit. So checking once a year for a decade is 200.00, I think a good price for peace of mind over a decade. I do not fall into this category of low risk, so I get to enjoy multiple tests per year. But I just may be reduced to 2 per year for a while.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/2/2010 6:18 PM (GMT -6)   
I agree completely with you on this one, Tony. But then again, I am not low risk either.
Age: 58, 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: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 8/2/2010 7:33 PM (GMT -6)   
I read Mike's assessment and I tend to agree with him.   All this study says is that if you are a low risk patient and you had and undetecable PSA at 3, 5 or 10 years then "nobody" had recurrence in the first 12 months following their last test.  It happened more then 1 year laters, therefore going to every 2 years would still catch the reccurrence at the same time as if you tested yearly.   That is "nobody" had reccurence in the next 12 months following an undectable PSA at those marks.
Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/2/2010 8:32 PM (GMT -6)   
This is a cohort of 2,200 patients in a country where there are over a million probably fit the criteria. There will be quite a few that might miss an opportunity. But the thing is that, even with a relapse, there is still time to decide on a salvage intervention. For me, if I was in that situation, i would at least complete that first decade with annual monitoring. But I know that most can bypass it. Just isn't "pricey" enough to try to justify not doing it...


Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/2/2010 8:32 PM (GMT -6)   
This is a cohort of 2,200 patients in a country where there are over a million probably fit the criteria. There will be quite a few that might miss an opportunity. But the thing is that, even with a relapse, there is still time to decide on a salvage intervention. For me, if I was in that situation, i would at least complete that first decade with annual monitoring. But I know that most can bypass it. Just isn't "pricey" enough to try to justify not doing it...


Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 8/2/2010 9:41 PM (GMT -6)   
I am astonished at the cost of the PSA test that is levied in the US. I know that the test here (ultrasensitive) is billed to our universal health scheme at about $28-00. The equipment in Australia is the same and I would assume wages in the field much of a muchness. This is the amount charged to the Federal government by independent, privately owned pathology labs for this service and the patient has no out of pocket expenses. All pathology tests are covered in this way. Pathology providers are most certainly a profitable enterprise here so who is making all the money over there.
Bill

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 8/3/2010 12:02 AM (GMT -6)   
I had a PSA test done at a walk-in lab in Guaymas, Mexico for $35. They took the blood right there and I had the results six hours later...
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