Post SRT PSA/ Choleserol tidbit

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Tim-from-Maine
Regular Member


Date Joined Apr 2010
Total Posts : 83
   Posted 8/30/2010 6:36 PM (GMT -6)   
My next PSA was supposed to be in Oct 2010. I had an annual physical  2 weeks ago and my Primary Care Physician  did a PSA as part of the blood tests. It was .05.  PSA was .17 going into SRT. I'm taking that as good news.  I Thiought that it took a few months for the PSA to go down after SRT. Should I be estatic?
 
Just a note concerning Lipids. I have been on a mostly Vegan diet for the last year and had my total Cholesterol down to 186. I went off the diet for a few weeks just before my physical --- ate hamburgers, ice creame ane hot dogs on a camping trip- my total went to 244 in just 2 weeks of a binge. No more straying from the vegan diet.
PSA Feb 09 - 9
Dx age 62 - March 2009 - Gleason 7

Surgery - da-vinci RP on April 29, 2009 Gleason upgraded to 9

Started VEGAN diet June 2009

3 month PSA - <.04

6 month PSA <.04

9 month PSA .05

12 Month PSA .16

SRT began May 3, 2010

SRT complete June 25, 2010 - 38 treatments
Accidental PSA from Primary care physician = .05 on Aug 16, 2010

60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2222
   Posted 8/30/2010 7:39 PM (GMT -6)   
Tim,
That certainly looks encouraging and you have the downward trend. Wonder if they do the same test for PSA at the PCP? But yes, by all means be happy. My next one was due in Nov. but my physical showed a .3 a few weeks ago, down from a .44.
Michael

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 8/30/2010 8:28 PM (GMT -6)   
Tim, where have you been. I missed you. .05 sounds pretty good at this point. Regarding lipids, I have gone low fat, not vegan and have recently tested out at 190. Maybe if you do the low fat thing you will be less likely to slip. I don't kbnow how you can stay away from the local sea food. I will be in Maine Colombus Day week-end, and I intend to gorge on the local sea food, sans butter.
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
psa May 10 .50

April 10 MRI and Bone Scan show lesion on lower spine, false positive.

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

psa July 10 <.01 HT at work

Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 8/30/2010 8:31 PM (GMT -6)   

Hi Tim,

My PSA went from .1 to .05 6 weeks after completion of my SRT. My Onc was very (and me too) happy with that result. "It means the target was hit and forced into submission".....maybe. Hopefully it will continue to go down or at least stay at that low level.

All the best to you.

 

Mag

 

 


Born 1936
PSA 7.9, Gleason Score 3+4=7, 2 of 8 positive
open RP Nov 06, T3a, Gleasons 3+4=7, Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1, Salvage RT completed (33 days-66Gy) 19 Dec 08
PSA: in Jan 09 =.05, all tests to date <.04

Baptista
Regular Member


Date Joined Aug 2010
Total Posts : 84
   Posted 8/31/2010 8:11 AM (GMT -6)   
Tim-from-Maine said...
My next PSA was supposed to be in Oct 2010. I had an annual physical  2 weeks ago and my Primary Care Physician  did a PSA as part of the blood tests. It was .05.  PSA was .17 going into SRT. I'm taking that as good news.  I Thiought that it took a few months for the PSA to go down after SRT. Should I be estatic?
 
Hi Tim,

 

Congratulations on your successful decrease in PSA. You should not be concern if it took 2 months to get into 0.05 levels because it may have not reached yet its nadir. There are many cases of PSA reaching levels of 0.01. In my case I went from 2.28 post-SRT to 0.05 in 13 months. Never the less, PSA levels after radiation are sporadically unlinear until they settle. Doctors consider a biochemical recurrence only on the third rise from the lowest nadir that can take years to accomplish. PSA tests taken every 3-month maybe better to recognize any variation.

Wishing you the best,

Baptista


bsjoplin
Regular Member


Date Joined Feb 2010
Total Posts : 308
   Posted 8/31/2010 2:44 PM (GMT -6)   
hi Tim!
i'd say rejoice in your numbers!
i too completed SRT on June 25, '10, but my 6 wk PSA [Aug 5] showed 0.2, down from 0.4 (pre-SRT).  sounds like you hit the PSA jackpot, if you are already down to 0.05 !! the office seemed enthusiastic about getting a 0.2 at 6 weeks, and i'm expecting better, lower numbers at 6 months, but i have even heard that my nadir low point might even be as high as the 0.2
i'm not sure why that can happen, but for now, i can definitely live with 0.2  and .05 is the stuff of dreams
have a good one,
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 First Prostate Biopsy: 3 samples out of 6 have irregular cells
11/25/08 PSA test: 6.5
12/11/08 Prostate Biopsy number 2: of 12 samples, 3 are cancer, and all other 9 are irregular. Found out original NJ lab sent samples to Johns Hopkins for special reading. Gleason 3+3=6. 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.
8/5/10 PSA=0.2

pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 437
   Posted 9/1/2010 12:36 AM (GMT -6)   
Tim, 
 
That is a great number at this point in time...   Looking like the beast has been corraled and beaten...
 
Regarding cholestorel,  I was always in the 230-250 range even after cutting back on red meats on some fatty foods...   Family DNA has history of high cholestorel, so doc put me on 40mg simvastatin...   Jeesh...   cholestorel went down to 168 in a month, and a few months later after a few more dietary changes (red meat only about once a week and cheeses cut back), my lastest level was doown to 147.    The good cholestorel values are also in the upper ranges.  There are some studies starting to float about statins and lower PSA and sometimes less BCR...   but now they need to see if the lower PSA and other effects are from the lower cholestorel itself or the statins...  Anyway,  another tidbit involving this PCa beast of a puzzle...  Google "statins prostate cancer" and many articles will pop up...
 
 
 
pasayten
3/2007 - Dx 59 y/o - 12 point biopsy - Left 0/6 Right 1/6 Gleason 3+3 T1c
4/2007 - DaVinci RRP performed - Gleason 6 T2c Nx Mx
PSA 7/07 0.01, 6/08 0.02, 12/08 0.03, 10/09 0.13
11/09 Consult BCR and recommendation for SRT
1/2010 IMRT SRT started 32 sessions at 2 gys for 64 gys total.
6/2010 3 mth PSA post SRT = 0.02 :-)
My Extended Signature

Post Edited (pasayten) : 9/1/2010 12:58:15 AM (GMT-6)


Baptista
Regular Member


Date Joined Aug 2010
Total Posts : 84
   Posted 9/1/2010 6:53 AM (GMT -6)   

Hi Jim, Hi bsjoplin

It seems that you are anxious to see where yours PSA levels go. It happened to me too in 2007. However, the PSA in our cases (post-SRT after RP, without HT) act differently and not as linear as we think. Some guys get to very small numbers <0.03 and some at higher levels of 1.50 ng/ml or more. In cases where the prostate gland is still present, some guys experience a bounce that may last for several months, before it goes down to its real nadir level.

The importance is not the number but what it is considered as each one’s Nadir PSA (nPSA=0.0). In my case, the Nadir PSA is 0.26 ng/ml (nPSA=0.0). It sounds confusing, but Specialists from SMKCC in resent researches (2006), recommend the use of the third rise in PSA after its lowest level, (corresponding to PSA=0.0), to serve as the basis for future prognosis of the PC. My lowest was 0.05, and the third rise was: 0.12; 0.18; 0.26 (reached on the 29th month after SRT).

Because of the discrepancies in the values of PSA among patient, back in 2000, Oncologists got into a consensus that Biochemical recurrence (failed RT) was verified once the PSA has risen three times from its lowest level. Accordingly, each case would have different numbers and different periods from SRT to nadir PSA.

I hope that your Nadirs get as low as possible and that it keeps down there for a very long time, with no “third” rise.

Wishing you the best,

Baptista


Age: 50 at Dx on May/2000; PSA=22.4;
Asymptomatic; Negative DRE and MRI & Bone scan
6x cores biopsy positive; Gleason (2+3)=5
RP surgery performed Aug/2000 Dr Komatsu, Toranomon, Tokyo
Voluminous tumor; seminal vesicles & pelvic lymph nodes (9) negative; capsular penetration
Adenocarcinoma, well-differentiated; pT3apN0
Post-op lowest PSA=0.18 on Oct/2000;
Mar/2001 PSA=0.42 Biochemical Failure; Classified as Micro Metastasis
Watchful Waiting until PSA=3.55 on Sep/2005 (doubling average of14 months)
Nov/2006 SRT (3D IMRT; 68Gy in 37 fractions) Dr G. Vieira, CRMN, Portugal
Post RT PSA=2.28 on Jan/2007
Feb/2008 lowest nPSA=0.05
Aug/2008 MRI negative to metastasis
May/2009 Biochemical recurrence PSA=0.26
Aug/2010 PSA=0.79 (doubling time of 8 months)
Ten years Asymptomatic ; never incontinent
ED since RP; Anorectic symptoms during first year after SRT

Tim-from-Maine
Regular Member


Date Joined Apr 2010
Total Posts : 83
   Posted 9/1/2010 1:25 PM (GMT -6)   
Bapista,

I thought NADIR only applied to people who still had a prostate? I could be wrong. For those of us whi have had surgery, our NADIR should be "0". Maybe I misudertand the term. Perhaps others could chime in.
PSA Feb 09 - 9
Dx age 62 - March 2009 - Gleason 7

Surgery - da-vinci RP on April 29, 2009 Gleason upgraded to 9

Started VEGAN diet June 2009

3 month PSA - <.04

6 month PSA <.04

9 month PSA .05

12 Month PSA .16

SRT began May 3, 2010

SRT complete June 25, 2010 - 38 treatments
Accidental PSA from Primary care physician = .05 on Aug 16, 2010

bsjoplin
Regular Member


Date Joined Feb 2010
Total Posts : 308
   Posted 9/2/2010 9:35 AM (GMT -6)   
i'm with you, Tim.  seems like if we gots no Prostate, then the number needs to creep down toward zero, and anything ABOVE that would represent BAD STUFF.  but after i got my 6 week PSA of 0.2, a nurse i was talking to said my (low value) nadir might end out being somewhere between that 0.2 and zero, and be perfectly okay.... (?).. i didn't understand it, and haven't really found a second source for that anywhere.  if anybody understands this dynamic, please holler...the numbers just don't make sense to my little engineer brain...
meanwhile, i'll wait 'til 6 month number and see what happens.
thanks
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 First Prostate Biopsy: 3 samples out of 6 have irregular cells
11/25/08 PSA test: 6.5
12/11/08 Prostate Biopsy number 2: of 12 samples, 3 are cancer, and all other 9 are irregular. Found out original NJ lab sent samples to Johns Hopkins for special reading. Gleason 3+3=6. 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.
8/5/10 PSA=0.2

pasayten
Regular Member


Date Joined Mar 2007
Total Posts : 437
   Posted 9/2/2010 12:53 PM (GMT -6)   
Not sure what a nadir should be for prostate removal, but I have heard/read that in nerve sparing there may be some benign tissue left that could generate some low psa, but not be a PCa problem. It would generate a trace value, but not rise over time.
3/2007 - Dx 59 y/o - 12 point biopsy - Left 0/6 Right 1/6 Gleason 3+3 T1c
4/2007 - DaVinci RRP performed - Gleason 6 T2c Nx Mx
PSA 7/07 0.01, 6/08 0.02, 12/08 0.03, 10/09 0.13
11/09 Consult BCR and recommendation for SRT
1/2010 IMRT SRT started 32 sessions at 2 gys for 64 gys total.
6/2010 3 mth PSA post SRT = 0.02 :-)
My Extended Signature

Baptista
Regular Member


Date Joined Aug 2010
Total Posts : 84
   Posted 9/5/2010 4:00 PM (GMT -6)   

Hi Tim, Hi bsjoplin

Nadir PSA is a term used by the oncologist to identify the lowest level of PSA after a treatment. The Zero meaning is for a number that may be different from patient to patient (as I gave an example in a post above.

Surely, after RP it is reasoning to think that Prostate-specific antigen (PSA) should be Zero because there is no Prostate gland. However, PSA is not produced only by prostatic cells. It can also be found in semen and at low levels in urethral glands and in body fluids, such as urine and breast milk. You can see its Biochemistry at this site; (http://en.wikipedia.org/wiki/Prostate-specific_antigen).

Hope it helps,

Baptista


Age: 50 at Dx on May/2000; PSA=22.4;
Asymptomatic; Negative DRE and MRI & Bone scan
6x cores biopsy positive; Gleason (2+3)=5
RP surgery performed Aug/2000 Dr Komatsu, Toranomon, Tokyo
Voluminous tumor; seminal vesicles & pelvic lymph nodes (9) negative; capsular penetration
Adenocarcinoma, well-differentiated; pT3apN0
Post-op lowest PSA=0.18 on Oct/2000;
Mar/2001 PSA=0.42 Biochemical Failure; Classified as Micro Metastasis
Watchful Waiting until PSA=3.55 on Sep/2005 (doubling average of14 months)
Nov/2006 SRT (3D IMRT; 68Gy in 37 fractions) Dr G. Vieira, CRMN, Portugal
Post RT PSA=2.28 on Jan/2007
Feb/2008 lowest nPSA=0.05
Aug/2008 MRI negative to metastasis
May/2009 Biochemical recurrence PSA=0.26
Aug/2010 PSA=0.79 (doubling time of 8 months)
Ten years Asymptomatic ; never incontinent
ED since RP; Anorectic symptoms during first year after SRT

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/6/2010 1:13 PM (GMT -6)   
Tim, you are correct in your thinking. The PSA bounce only applies when radiation is being used as a primary treatment. In Salvage Radiation, there shouldn't be any detectable PSA after a couple of readings, and any upward movement after SRT is a sign that the remaining PC was not local indeed. With a primary treatment of RT, you still have a prostate, and though its been slammed with radiation, it can still bounch the numbers up after treatment.

All 3 rad. oncologists I spoke to, told the same story as above, after a salvage, within 1 or 2 readings, it need to drop below .05 on an ultrasensitive test. They consider .05 as still being detectable PC after salvage, and any legitimate upward movement, as evidence of recurrance.

In my case, I dropped to a low of .04 (which was good news), but 3 months later, its back up to .06. Normally, this would still be a great number for a post primary treatment, but since this was a salvage radiation result, may not be good news, especially with me having an extreme high risk factor of fast PSA velocity. My next reading in November will be critical. If it stays the same or goes down, great, it was just a testing glitch, but if it goes up any at all, more likely early indicator that my SRT has/is failing. I will have to wait and see.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.
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