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TaurusBull
Regular Member


Date Joined Jan 2010
Total Posts : 91
   Posted 12/13/2010 10:22 PM (GMT -6)   
Had a PSA test on 12/3, the reading was 0.22 - down .01 from the reading in September. This is a strange roller coaster ride, indeed. Next test, March 2011. I have spoken with a rad Oncologist, but I am not yet ready to pull the trigger on SRT. For now, I'll continue my post-prostatectomy AS. I have updated my signature below.

Best of luck to you all.

TB
Dx: in 6/2005, 49 yrs old (54 now), PSA 4.1, 2/10 cores pos, G6, T1c
bone scan: negative
daVinci RRP 8/2005, Hartford Hospital
Post-surgery upgraded G7 (3+4), pT2c, NX,MX, neg. margins, PNI present, tumor focally invades capsule wall, but not entirely through it.
PSA All <0.1 until... 7/2009 0.1, 10/2009 0.2, 1/2010 0.2, 2/2010 0.14, 4/2010 0.16, 8/2010 0.25, 9/2010 0.23, 12/2010 0.22

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/13/2010 11:55 PM (GMT -6)   
TB, I have no objections to AS in most cases, particularly for a primary situation, but with your post surgery PSA readings, and with them steady well over .2, what is it you are waiting for? You seem to have BCR for sure, letting your PSA climb higher over time is only going to lessen the effective nature of radiation, which doesn't have the greatest odds on the best of days.

Just trying to understand your thinking. If you truly have BCR, then it seems like you are gambling away your best shot at your secondary treatment in my opinion.

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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 12/14/2010 12:26 AM (GMT -6)   
On the other hand, with a PSA hovering around 0.2 for a year, it is not moving very quickly and you might be one of the lucky ones where it stabilizes at around its current levels, or drops further.

It is a gamble of course. You are trading off a slightly worse outcome from delayed radiation against the small possibility that you won't need radiation at all. It is a gamble I would be prepared to take too.

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 12/14/2010 12:39 AM (GMT -6)   
It's somewhat unusual ........ you would have said that there's a definite relapse there and then it confounds everything by turning around and going lower. Given that, it is probably fairly acceptable to watch it for a bit longer and see what the next 3 months holds.
Bill

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 12/14/2010 8:48 AM (GMT -6)   
TB

I know you said you weren't ready to pull the trigger yet on SRT, but you met with the rad oncologist. What was his take on this. I know most of us will usually follow what is recommended by our medical staff, so does he agree with this or was this also his recommendation?

What did your surgeon suggest.

I am on a similar path as yours with a higher BCR psa though. Would like to know your reasons if you don't mind.
You are beating back cancer, so hold your head up with dignity

Les

Signature details in Sticky Post above - page 2

TaurusBull
Regular Member


Date Joined Jan 2010
Total Posts : 91
   Posted 12/14/2010 7:04 PM (GMT -6)   
Thank you for your replies, comments and concerns. I appreciate the feedback and support. Truly great folks here!

David: as always, you make very valid points - even more so if you factor in my potential longevity - my father recently passed away at 97 (not from PCa) and my mother is still healthy at 80. To answer your question, I guess I am waiting for an unequivocally rising PSA signifying a malignancy as opposed to a stabilized PSA signifying a possible benign condition. Even though the latest definition of BCR seems to be established at 0.2, this does not necessarily dictate that a reading of 0.2, or higher, is a malignancy. I believe it is important to consider the total PSA and the PSADT collectively. In calculating the PSADT, there are differing opinions on which data (PSA cutoff points) to enter into the calculation. If I use the calculator provided by MSKCC and enter only the values > 0.1 as instructed in the calculator, my PSADT is approximately 36 months. If I include the value of 0.1, then it is approximately 15 months. In my decision to initiate SRT, the negative surgical margin status also plays an important role as it decreases the odds of success.

LV-TX: we do have similar stats, but there are at least three additional fundamental differences that I can identify: 1) you had positive margins, whereas mine were negative, 2) using 0.2 as the BCR marker, you experienced BCR at approximately 18 months post surgery, mine was about 50 months and, 3) your PSADT is shorter than mine. To answer your questions, both the radiation oncologist at Yale and my urologist were supportive of my decision to hold off until more data is collected. The rad oncologist said “we do not have enough significant data on guys like you” and, regarding whether to begin SRT, he said, “it’s a crapshoot with your stats”. He also added, “your PSA is very low and your PSADT is very long, both good prognostic factors”. When asked what he considered the absolute PSA cutoff point after which SRT could no longer be a potential cure, he said “about 1.5”. Personally, I would not wait until 1.5 and I also know that SRT is a “crapshoot” in many (if not most) cases. I just want to ensure that, if and when I start SRT, it is absolutely necessary.

Thanks,
TB
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