Posted 11/22/2010 9:09 AM (GMT -7)
Good to see you. We still need to try to hook up locally again. I am in much better shape than the last attempt.
My main source of info, is based on a compilation of opinions from my Uro, my Radiation Oncologist, and the new Medical Oncologist that has most of his experience in dealing with PCa cases. My uro and Rad. both have about 30 years experience a piece.
While they disagree about lots of aspects of PC, I was amazed how much they agreed on this subject. The other source, is a couple of links to studies and reports that show that extreme PSA velocity in the year before dx or treatment, can lead to a 5 to 10 fold in death from PC. Pretty scary stuff. To be fair, some experts disagree with the severity of these findings. I have the links somewhere on my computer, will post them when I find them again.
Its becoming more known, that certain Gleason 7 cases can be very unpredictable and dangerous, and some experts feel that all Gleason 7 cases should be treated as Gleason 8's.
Now, going back to my doctors. My uro was concerned from day one about a PSA velocity that went from 5.8 to 12.3 in one year, and then climbed over 16 from there, in less than 2 months, with no indications of any infection or other reason for a rise.
After my open surgery, my first post PSA reading at 3 months, was .05. I will never forget the disapointment on my Uro's face when he told me the number. Some would simply say, oh boy, its <.10, you got a zero. He believes that after surgery, that .05 still indicates the prescence of cancer, despite any pathology report. Sure enough, in 3 months, it doubled. Then soon I had BCR.
The radiation oncologist felt the same way, that post surgery, that initial .05 reading indicated that the cancer was on the move. Probably why they did a more aggressive dosing of radiation, with 72 gys over 39 treatments. She told me up front, that at best, I should only hope for a 20-25% chance of it working. She did not want to mix HT with it, as she wanted to see what the radiation did on its own.
My uro and the rad. oncol. both are expecting the SRT to fail fast. I had two declines after radiation, then the last check, it rose. I don't know now, as I have postponed the Nov. test. I will be tested in February.
The new medical oncologist completely accepts the troublesome nature of PCa cases that follow the strong PSA velocity route. When I was gathering his opinions on the possiblity of HT (Told you guys I am open minded, even if doubtful), he indicated that in a case like mine, it was unlikely that HT would last long with me if I went that way. He wasnt against trying it, but didnt feel there would be much time before it became refractory. Said its just the nature of extreme PSA velocity cases, and that they are learning more about them as cases come up.
He did alude to the fact, that I may have a particular strand of PCa (some zufus has preached forever here about) that is making it agressive.
He also said that there are men with Gleason 8 and 9's that will last much longer, and have more stable post treatment periods than one dealing with the PSA velocity issue. It's not that the PSA number is so high, i.e., like those that have PSA in the hundreds or thousands, but how it just keeps coming back regardless of treatment.
While not written in stone, and there is varying opinions, of course, among the experts, my particular case is becoming a text book perfect example of the Rapid PSA Velocity theory. I am hoping to break from the clutches of it at some point. Thus it should be easy to understand why I am in no particular hurry to see my next reading. Still hoping to be surprised, in a good way.