PSA confusion, Brachy, and AS

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kuls
Regular Member


Date Joined Mar 2010
Total Posts : 57
   Posted 9/14/2010 10:59 AM (GMT -6)   
I haven't posted for a while, but my husband has kind of been in "limbo" with the PCa thing.  Post-biopsy, his PSA readings were rising.  In July, it had dropped back down to 4.01.  This morning, I found out that his PSA is down to 2.83.......lower than at time of diagnosis!!
 
Since being diagnosed in Feb. 2009, we have gone through the sheer terror, and have educated ourselves as much as possible.  We met with several urologists and discussed open and robotic prostatectomy options.  I have nothing but respect for both surgeons....they were extremely forthright and honest.  What my husband DIDN'T like was that the robotic surgeon said that the absolute best odds of regaining erectile function were a mere 50/50, and that the risk of having positive post-op margins was 15% (in their experience given his stage/grade).
 
After more research, my husband has decided that when he does pursue treatment, it will be Brachy.  The RO who will perform the procedure is a big proponent of AS, or as he likes to call it "deferred treatment".  We have postponed his procedure date until Jan. 2011, and given this most recent PSA, may defer it even longer.
 
I have to tell you that as terrified as we were upon hearing the diagnosis, we have settled into a relatively normal life....in fact, my husband says that most days he doesn't even think about it.
 
I think if he's going to delay his treatment much beyond Jan., I'd like to see him have a saturation biopsy.  I understand that low PSA does not necessarily mean indolent disease.
 
Anyway, all is well for now, and we're both comfortable with the decisions he's made.
 
Cheers!

-Husband's 1st PSA done (age 45) at routine physical  PSA 3.8
-DRE at physical indicated no abnormality other than slightly enlarged
-Consult with urologist Jan. 2010---DRE negative, PSA 3.89
-Biopsy Feb. 10, 2010:  T1c, Gleason 3 + 3, 2/10 cores pos. (5% in one core, <5% on other core) 1% of core volume positive, gland size     38.84
-consult with "open" prostatectomy uro March 2010
-2 consults with rad. onc. for Brachy March, Apr. 2010....also discussed AS
-latest PSA reading April 8 4.63
-consult with "robotic" uro Apr. 12....tentative surgery date booked July 8
-Have also booked tentative Brachy date of July 20th.
-undecided as yet
_April 27th PSA 5.02!!  Repeat May 19th.  If still high, then a course of antibiotics and repeat.  If still high, proceed with treatment.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 9/14/2010 11:25 AM (GMT -6)   
Your husbands PC is not following the rules and you are very wise to jam on the brakes and find out what's REALLY going on. A high PSA caused by PC seldom goes down unless it is being treated....You might benefit greatly by having a Color Doppler Ultrasound performed, or some other advanced scanning method, even if it means traveling to a distant treatment center to get it...Your case is unusual so you should explore all avenues before you accept a standard treatment for a cancer that is not behaving as expected..
Age 68.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA age 66 9.0 DRE "normal", 2ed biopsy, negative, BPH, Proscar
PSA at age 67 4.5 DRE "normal"
PSA at age 68 7.0 third biopsy positive, 4 out of 12, G6,7, 9
RRP performed Sept 3 2010

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 9/14/2010 9:52 PM (GMT -6)   
I agree with Fairwind. A color Doppler would at least gve you some piece of mind in identifying if the cancer is agressive and needs to be treated. PSA going down is a good sign that you are not dealing with something agressive.
Brachy is a good option if you need to be teated. cure rates are similar to surgery and side affects are much lower.
JT

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.

JohnT


BooMan
Regular Member


Date Joined Oct 2006
Total Posts : 27
   Posted 9/14/2010 10:31 PM (GMT -6)   
Kuls,
I too had a PSA increase after my first biopsy.  After that, it went down slowly.  PSA does not diagnose cancer.  It can be an indicator of several problems, one of which could be cancer.  If your husband's first biopsy was in Feb. 2010, that's when he was diagnosed with cancer.  You get the diagnosis from a biopsy.  The stats you report from that Feb. 2010 biopsy are within the guidelines of most Active Surveillance programs.  PSA doubling time and velocity are problematic in your case as indicators since it goes up and down, just as mine did.  Remember, PSA doesn't measure cancer.  The PSA doubling time,  PSA density, PSA velocity, or an abnormal DRE can be indicators that a repeat biopsy might be in order for someone on AS.  I wouldn't dream of suggesting a treatment or tests.  You've done your research and that's your business.  I've been on AS four years and have no problems sleeping at night.  Periodic repeat biopsies have not changed my course.  The grief over posting about AS keeps me off the boards for the most part.  Since it appears that your husband and you are considering it, I would like to suggest checking the guidelines, or even better, get an appointment at one of the major cancer centers that use AS as an option before going forward with it.  Best wishes no matter what path you follow.  Your choice will be the best for you.
Boo   

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/14/2010 11:22 PM (GMT -6)   
boo,

AS is a perfectly acceptable course of action if one is responsible in following the guidelines for AS, and assuming one meets the criteria. I really don't understand all the nitpicking on the subject either. I only wished I had that as an option. I been through hell and back with my surgery, complications, radiation, and now all of its compications.

Bravo for anyone that is able to engage in AS safely. I hope you can continue years that way to come.

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.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4271
   Posted 9/15/2010 5:56 AM (GMT -6)   

Dear Kuls:

As you can see from reading the various recent threads on this board, AS is not without controversy particularly in a man as young as your husband...even though his statistics read very early stage.  I agree with Fairwind and JT and would also suggest that a color doppler at this point might be appropriate. In any case, a 10 core biopsy is hardly state of the art and there is a good chance that something was missed.  I would also go a step further.  The oversight of AS requires a specific regime of testing (reference Franchot's posts).  This oversight also requires an experienced physician, IMHO.  In general your RO may or may not be equipped with the knowldege to do this correctly.  If it was me, I would be consulting a protate oncologist at this point who can guide you further.

If you ultimately do decide to go the brachy route, it would seem to be a good choice from what I see of your husband's stats.  Assuming his urinary and sexual functionality are good now as well as his physical condition he would have an excellent chance of retaining those functionalities post BT.  Several of us on this forum have done quite well (so far) with that treatment.  Feel free to cut and past the link in my signature if you would like to see how my "journey" has gone.

Best of luck and please keep us infomed of his progress,

Tudpock (Jim)


Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 9/10/10. 6 month PSA 1.4, 1 year PSA at 1.0. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643

kuls
Regular Member


Date Joined Mar 2010
Total Posts : 57
   Posted Yesterday 7:16 AM (GMT -6)   
Thanks for your replies everyone! I have come down with a nasty virus and haven't felt up to posting, but I'd like to respond when my head doesn't feel like it's in a VICE GRIP!! :)
-Husband's 1st PSA done (age 45) at routine physical  PSA 3.8
-DRE at physical indicated no abnormality other than slightly enlarged
-Consult with urologist Jan. 2010---DRE negative, PSA 3.89
-Biopsy Feb. 10, 2010:  T1c, Gleason 3 + 3, 2/10 cores pos. (5% in one core, <5% on other core) 1% of core volume positive, gland size     38.84
-consult with "open" prostatectomy uro March 2010
-2 consults with rad. onc. for Brachy March, Apr. 2010....also discussed AS
-latest PSA reading April 8 4.63
-consult with "robotic" uro Apr. 12....tentative surgery date booked July 8
-Have also booked tentative Brachy date of July 20th.
-undecided as yet
_April 27th PSA 5.02!!  Repeat May 19th.  If still high, then a course of antibiotics and repeat.  If still high, proceed with treatment.
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