Help - PSA up 160% six months after RT

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

pk5
Regular Member


Date Joined Jun 2010
Total Posts : 20
   Posted 11/27/2010 9:54 AM (GMT -6)   
Help!!!!!!!!!!!!!!!!!!!
What's happening?! PSA was 0.21 when I started RT and one month after I finished but now six month later it's 0.54.
What's going on?

Age 61
PSA 6/15/09 4.9
PSA 8/10/09 6.3
Da Vinci 8. Dec 09
Gleason 9, Stage T3b
Evidence of capsular penetration.
Tumor infiltration into the base of Lt. SV.
8 lymph nodes submitted showing only reactive changes.

PSA 6 weeks after surgery 0.16
PSA 10 weeks after surgery 0.21

Start Radiation.

1. PSA 1 month after RT 0.21
2. PSA 6 momths after RT 0.54

Post Edited (pk5) : 11/27/2010 9:12:48 AM (GMT-7)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/27/2010 10:29 AM (GMT -6)   
PK5,

Welcome to HW. Sorry to hear about your rapid PSA rise.

It would appear that your PCa is systemic, and may have started growing in another location. With your capuslar penetration, and seminal vessical invasion, you have multiple area for it to escape.

I would find an oncologist soon, and start to discuss the next steps, which most likely will be some form of hormone therapy. Be sure and find someone who is experieced in HT. most likely not your urologist. HT is a specialty that not everyone is well versed in.

We have guys on here who had PSA's greater than 3000 who are still doing well. This is not the time to panic. By using HT correctly, you can fight this thing for nmany years.

Good luck on your journey. This is a great place to be.
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

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 11/27/2010 11:14 AM (GMT -6)   
PK5,
Was the radiaton delivered to the pelvic nodes as well as the bed? With SV invasion it is a high probability that lymphnodes are affected and the nodes that are commonly sampled during surgery are not the nodes that are likely to be affected by SVI. You now have to proceed as if the disease is systemic. Read "Beating Prostate Cancer: Hormone Therapy and Diet" by Dr Charles Snuffy Myers. Dr Myers has advanced pc and takes you through the strategies of beating it.
JohnT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Putt
Regular Member


Date Joined Aug 2010
Total Posts : 154
   Posted 11/27/2010 11:18 AM (GMT -6)   
I agree with goodlife 100%.  HT would be your next step, better sooner than later.  I'm sorry you have to go that route, however a lot of us have gone down that road before you, have survived it, and have taken a vacation from the treatment.   Hey, I'm still here after 6 years from Dx and will probably start round 2 of HT early next year, but as someone has said on this forum before, "Its better than looking at the green grass from the bottom side".  Find an Oncologist that is experienced with PC and move forward.  Good luck......
PSA at Dx 105 at age 68, 4/04. ADT (Lupron only), RRP, 5/04. Gleason 4+5=9, Staged pT3bc NO MO, 3D rad, 40 treatments, 8/04. PSA 1/05 <0.01. ADT till 7/07. PSA 0.03 12/08, 0.07 4/09, 0.13 8/09, 0.19 12/09, 0.30 4/10, 8/10 0.37. Will start ADT3 after PSA reaches 1.2.

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 11/27/2010 11:21 AM (GMT -6)   
thanks for writing and yes there is reason for concern however it may not be as bad as you think. I am betting your oncologist or URO will get one more PSA test before making a decision. The hope is that your PSA levels off.
I agree with Goodlife this is not the end heck it isn't even close. Stay positive, stay healthy, and keep us posted.

peace to you
Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
I was on Lupron, Casodex, and Avodart for two years with my last shot March 2009. I am currently (7-22-2010) not on any medication.
My Oncology hospital is The Cancer Treatment Center of America in Zion IL
PSA July of 2007 was 16.4
PSA May of 2008 was.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
PSA July 22nd of 2010 is .71
Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%

pk5
Regular Member


Date Joined Jun 2010
Total Posts : 20
   Posted 11/28/2010 10:14 AM (GMT -6)   
Thanks guys
I can understand that Da Vinci and RT can fail, but a jump from 0.21 to 0.54 in six months?!  Could something have happened during surgery that causes this rise?
 
John T: I'm not sure if the radiation was delivered to the pelvic nodes as well (I know 8 lymph nodes was submitted), but I'm meeting with the radiation oncologist on Wednesday so I'll ask him and get back to you.
 
I don't know if this is a stupid question but I'll ask it anyway: Why do they sample the nodes that are likely not to be affected by SVI and not those that are likely to be?
 
I recall asking the surgeon after the first PSA of 0.16 where he thought it could be coming from and he said something about some nodes he either couldn't get to or they were too close to something!?
I remember he mentioned the word Iliac Crest. So maybe there are nodes there that the cancer has spread to ??!!
 
 

Age 61
PSA 6/15/09 4.9
PSA 8/10/09 6.3
Da Vinci 8. Dec 09
Gleason 9, Stage T3b
Evidence of capsular penetration.
Tumor infiltration into the base of Lt. SV.
8 lymph nodes submitted showing only reactive changes.

PSA 6 weeks after surgery 0.16
PSA 10 weeks after surgery 0.21

Start Radiation.

1. PSA 1 month after RT 0.21
2. PSA 6 momths after RT 0.54

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 487
   Posted 11/28/2010 10:44 AM (GMT -6)   
PK:
In my opinion, this really has nothing to do with the nodes, or surgery, or surgeon, or robot, or radiologist. This is about the G 9 disease. The most honest and experienced surgeons know that most G 4 and G5 disease will fail eventually, often shortly after surgery, with "short" meaning a few months to a few years. This is the point of grading the cancer to anticipate the next step. You do not mention the grade of the biopsy samples. This certainly has bearing on the issue, though now only in hindsight.
You have a very small amount of psa inducing cancer, and with only two data points we are making assumptions on insufficient information. That said, the ~2 1/2 month doubling time is consistent with G4/5 disease. It is likely that the surgeon did as much as possible to extirpate the diseased tissue. Whether open conventional surgery could have accessed more nodes is moot in your case, the discovery of disease in any lymph glands assumes metastasis further on.
Your team has done all that they could. You have embarked on a series of treatments that will likely be lifelong. The good news is that for men who respond to these treatments, though not curative, many years of productive life remain.
I recall the despair of positive lymph nodes at my surgery for G9 disease. I had to deal with it before I could move forward aggressively (Zoloft included). I recommend you find an accomplished oncologist who is experienced with prostate cancer as your next professional teammate.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 11/28/2010 12:02 PM (GMT -6)   
PK,
From what I was told by the world formost researcher on lymphnode PC is there are two paths that PC can take into the lympnodes. One is through extra capsular extensions and the other is through the seminal vessicles. some lymphnode are very difficult to sample due to their location in our body and these are the ones that are the most affected by seminal vesssical invasion.
Dr Barantsz did some studies in Germany and Holland and found that when one had seminal vessicle invasion and lymphnodes that were surgically sampled came in clear there was a 46% chance of the patient still having PC in the lymphnodes that were not sampled.
Tarhoosier makes some good points and getting a good oncologist now will give you the best chance of putting this into remission.
JT
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2215
   Posted 11/28/2010 2:34 PM (GMT -6)   
Not a very welcome development for you pk5. It sounds like the RT missed its target as it were

My PSA after surgery jumped from 0.1 to 0.4 in four months (=400% rise) so I kind of know what it feels like to experience such a sudden jump.
I too had SVI and my worry was that aiming the RT at the prostate bed might be a waste of time if there was already cancer elsewhere if it had escaped. The Docs said that they basically had to assume/hope that the the PSA was being made by cancer cells that were very close to where the prostate had been.
They said that if my PSA did not go down after RT (or continued to rise) it would indicate that the cancer had not been in the prostate bed and they would consider the next stage of treatment (ie HT)

I was therefore more than relieved that post RT I tested as "Less than 0.1"

There are plenty of folk here with very encouraging stories to tell about their experience with HT so all is not lost yet by many means. I too have been noting what they have to say about HT as I won;t be satisfied that my RT was a real success till I have a few more good PSA results under my belt.

Alf
Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr 10 CT
28 Apr 10 start RT 66Gy
11 Jun 10 end RT
Tired
BMs weird
14 Sep 10 PSA <0.1
Erections OK

pk5
Regular Member


Date Joined Jun 2010
Total Posts : 20
   Posted 12/2/2010 8:50 AM (GMT -6)   
Hi there
Talked to the Radiation Oncologist on Wednesday and he suggested we do another test in 3 months. Didn't seem too worried about the 0.54.
 
John T: Didn't get to ask him about the pelvic nodes so I still don't know, sorry.
 
Very happy I've got this forum to turn to.

Age 61
PSA 6/15/09 4.9
PSA 8/10/09 6.3
Da Vinci 8. Dec 09
Gleason 9, Stage T3b
Evidence of capsular penetration.
Tumor infiltration into the base of Lt. SV.
8 lymph nodes submitted showing only reactive changes.

PSA 6 weeks after surgery 0.16
PSA 10 weeks after surgery 0.21

Start Radiation.

1. PSA 1 month after RT 0.21
2. PSA 6 momths after RT 0.54

Post Edited (pk5) : 12/2/2010 9:17:34 AM (GMT-7)

New Topic Post Reply Printable Version
Forum Information
Currently it is Sunday, June 24, 2018 7:17 AM (GMT -6)
There are a total of 2,974,692 posts in 326,201 threads.
View Active Threads


Who's Online
This forum has 161300 registered members. Please welcome our newest member, Dakotab02.
353 Guest(s), 8 Registered Member(s) are currently online.  Details
twingirl812, PAPUN, Ljm2014, Uniform Charlie, OriolCarol, napoleon dynamite, P34, straydog