Definition of Bio-chemical recurrance?

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compiler
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Date Joined Nov 2009
Total Posts : 7269
   Posted 12/31/2010 2:02 AM (GMT -6)   
stats below.
 
Getting my PSA blood draw shortly and will have another number Monday.
 
At what point do we say a BCR has happened?
 
What has to happen and would another reading beyond this (to confirm results) be needed and if so is that reading usually done in 2 weeks or a month or...?
 
I've never quite been sure of this.
 
Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06

English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2217
   Posted 12/31/2010 3:09 AM (GMT -6)   
Mel,
Looking at your numbers I can imagine that you are expecting a rise from 0.06. The previous numbers suggest it is not a question of if you have a BCR but when.

Having not had a zero after surgery my doc said he would be looking for something over 0.2 to regard it as a BCR. So clearly a large number, such as my own 0.4, counts as a very obvious BCR. I'd guess that your doc would therefore think that anything such as a rise from 0.06 to 0.12 say, that confirms that you have a rising trend would also been seen as a BCR, but if might be less clear for both of you if it is simply up from 0.06 to say 0.07.

A rise of any magnitude is however not really good news but if the latest result doesn't really clarify for you (or him) what's going on then I'd say it would be very reasonable to ask to have another test sooner rather than end up having another period of PSA anxiety.

I hope that that 0.06 was a blip and that your next PSA is in fact not up at all.

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

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 644
   Posted 12/31/2010 4:28 AM (GMT -6)   
compiler,

There are two different answers to the question, depending on the context:

For most of the research studies, recurrence is defined as PSA > 0.2 (not .02) *and* two rises on successive tests. Researchers are encouraged to use this definition consistently so that results from different research projects can be readily compared.

However, doctors have leeway under the guidelines to begin treating a recurrence *before* the PSA level crosses above 0.2 depending on the total facts and circumstances of each case such as the likelihood of a recurrence based on path report, PSA, etc. and the speed and regularity of the upwards trend.

I hope yours is down next time, but if it is up slightly , it is up to you and your dr. to decide whether to treat it as a recurrence.

knotreel
Veteran Member


Date Joined Jan 2006
Total Posts : 654
   Posted 12/31/2010 10:24 AM (GMT -6)   
Well I am just wishing you a nice drop in the numbers. Good luck
06-08 1st biopsy neg psa 4
10-09 psa 5.5 2nd biopsy 1/12 pos. 10%, G(4+3) age 65
12-15-09 RRP Tulane NOLA Dr Lee
Path, 1%, clr marg, no EPE, no SVI, nodes cl, G(4+3)
100% incontinent after 3 mo. PT
ED, pre-op severe, post op total
10/10 Dr Boone, Baylor recomended AUS
AUS and IPP scheduled 1/11/11
post op psa's 0.04,<0.1,<0.1,0.01@12 mo.

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 12/31/2010 11:05 AM (GMT -6)   
compiler said...
At what point do we say a BCR has happened?
 
Hi Mel,
 
The American Urological Association (AUA) is the governing body which publishes the PSA-related medical standards of interest to you. 
 
The AUA has an easily-readible, free online document which would be of direct interest to this thread titled "Definition of Bio-chemical recurrance?"  The document is titled:  "Prostate Specific Antigen BEST PRACTICE STATEMENT:  2009 Update", and I will give you the hyperlink below.
 
The first part of the document deals with pre-treatment PSA information, and the second part deals with post-treatment (after surgery, in your case).  Starting on page 37 is the section titled, "The Use of PSA in the Post-treatment Management of Prostate Cancer"...this is, of course, the section for you.
 
You undoubtedly realize that after treatment, the PSA blood test is the overall best-available means of detecting prostate cancer recurrence...thus giving meaning to the term is Bio-Chemical Recurrence, or BCR.  Different definitions of BCR exist after surgery and radiation, but the AUA defines post-surgery BCR in this way:

The AUA defines biochemical recurrence as an initial PSA value 0.2 ng/mL followed by a subsequent confirmatory PSA value 0.2 ng/mL.  (page 38)

The document goes on to very clearly state that "This cut-point [≥0.2 ng/mL] was selected as a means of reporting outcomes [of BCR], however, rather than as a threshold for initiation of treatment."  In other words, the threshold for "official" BCR and the threshold for action are not necessarily the same, depending on each case's specific details.  If your post-surgery PSA starts rising (it appears that it might or might not be headed in that direction for you), then your doctor might start you thinking about/planning for SRT (Salvage Radiation Therapy) even before you reach BCR.
 
 
I hope that this information adds value.  This answer differs slightly from proscapt's answer in that there is only one real definition of BCR.  Where one might take action is a different question, and depends on one's individual circumstances.
 
Here's the link to the AUA document, and I recommend reading the entire second half about post-treatment management of PSA; you will learn more about BCR, plus other important information:
 
 
Have a blessed New Year...

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 12/31/2010 11:31 AM (GMT -6)   
Casey, et. al.:
 
Oddly enough, this issue just came up in a daily Digest that I get. Check this out:
 
According to
http://www.ncbi.nlm.nih.gov/pubmed/17222629?dopt=AbstractPlus
<http://www.ncbi.nlm.nih.gov/pubmed/17222629?dopt=AbstractPlus>"Of 13,800
citations, a total of 436 articles were selected. Among these, a total of
145 articles contained 53 different definitions of biochemical recurrence
for those treated with radical prostatectomy. Of these, the most common
definition (35) was a prostate specific antigen of >0.2 ng/mL or a slight
variation thereof. In addition, a total of 208 articles reported 99
different definitions of biochemical failure among those treated with
radiation therapy."

Thanks for the info, Casey
 
Mel

Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 209
   Posted 12/31/2010 11:41 AM (GMT -6)   
Mel, my Mayo doc says when PSA hits 0.2 following surgery its time for SRT.  He said that SRT is most effective when PSA is under 0.7. (and then only 50/50 if primary gleason pattern is 4) I hope your psa does not go up. Happy New year, the Old Sailor. 

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7078
   Posted 12/31/2010 11:42 AM (GMT -6)   
Casey,
 
That is a good article. It does clarify a number of positions my uro took to be completely within the "specs". It did not bring any new questions to my mind, and settled a doubt or two.
 
A good read for the end of the year - less mental baggage for New Year's Eve.

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 12/31/2010 12:04 PM (GMT -6)   
As uncomfortable as it has been for me while resisting the urge to DO SOMETHING NOW!, the Radiation Oncologist I consulted in Oct. goes by the rule of: defines biochemical recurrence as an initial PSA value ≥0.2 ng/mL followed by a subsequent confirmatory PSA value ≥0.2 ng/mL. (Thanks, Casey59 for the quote.)

I will get my next result Tuesday, and like you, am expecting a continued rise. The question will be- how much? My Uro. and Oncologist agree to move me to a 3 month testing cycle. I am being tested by my Family Doctor in Jan, and the Uro. in Feb, and will continue to do so thru the year, until the trip wire is hit. So far, the 2 seperate testing labs and results are matching each other, so I am getting a very good tracking of whatever is happening. When that may be (.2 for 2 tests) is projected to be late winter next year. He also said he had seen several examples of surgery guys approaching .2 and then stopping- not rising any further and even declining again. The Rad. doc said that it would be premature to hit anything there now, as it would be very small amount of cancer cells and there would only be one shot at it with radiation, so we needed to wait to take that shot. I am accepting his advice and experience with that aspect of it. I know others here pulled the trigger at the first sign of a reoccurance, while still below the normal .04 test detection level. That's a personal decision for them and one I won't second guess. You have to factor in the risk of damage to continence and ED recovery, if any, and whether you ware willing to risk gains now in those areas. There are serious side effects from radiation treament, and that's a big part of the euation for most men, I think. Or it should be, at least.

Mel, there's no real way of knowing except for just waiting for it to rise to a trigger point. That trigger point should be decided by you and your Radiation Oncologist, using the best formula for determining when. I can't remember if you have already been to the Rad. Onco. yet, but you should be talking with them now if you haven't. This decision is a very personal one, and should be made with consultation with an experienced Radiation Oncologist. Good luck, and here's wishing your result Monday will drop back down to -.000001. cool
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh, next in Jan & Feb.
ED-total-Bimix 30cc

Post Edited (James C.) : 12/31/2010 10:14:19 AM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/31/2010 12:27 PM (GMT -6)   
Mel, like all things PC, no one definitive answer.

My uro and my rad. oncologist used the same standard for BCR. They delcared it with me, after 3 consecutive rises above .10 post surgery.

My uro feels, that post surgery, if your initial reading is at .05 or above, then there is still the prescence of PC. The rad. oncologist confirmed his thinking on the subject.

You are already getting a good range of answers. In the end, let it be decided between you and your doctor(s).

And don't open my file yet!!!

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

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 12/31/2010 1:09 PM (GMT -6)   
As others have mentioned .2 is the standard cut off for determining BCR. Dr Strum says that 3 consecutive rises in the ultra sensitive psa can determine reoccurrances up to three years earlier than the .2 cutoff.
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.

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 12/31/2010 4:36 PM (GMT -6)   

Mel and James, each of you have been monitoring a low-level increase (of just a step or two) in your ultra-sensitive PSA test results.  The position you are in of “monitoring” PSA changes is not one I’ve personally dealt with, yet I still feel an appreciation for the anxiety you are feeling now.  There certainly are many others whose footsteps you are following, and many who will follow your footsteps both soon and later.

 

James, if you will allow me the liberty to pick-up on a select few of your words in your last reply¾and I hope that you will instantly recognize (at least before you finish this posting) that I do this solely for the benefit of our relative newcomers here at HW who are reading, learning and educating themselves from the posts of others (rather than their own) or may reference this or other posts in the future.  You wrote that you are …resisting the urge to DO SOMETHING NOW!”, and that you are “…just waiting for it to rise to a trigger point.” 

 

I am not wanting to start a riot or insurgence of the naysayers here, but James and Mel, there are many, many guys here at HW who would tell you that there is many things someone in your shoes could/should be doing now to help “stack the odds in your favor” for the outcomes you both want…and dare I say that you want very badly.  As you know, we have guys on AS who are proactively holding their PC in-check, and other guys who are in post-treatment like you who are also taking very deliberate steps to fight-back possible recurrence…both of these sets of guys also want very badly to continue to have good outcomes.  These guys are controlling the levers of change that are “within reach.”  Not everything is “within reach”, but you know the prayer:

GOD, grant me the Serenity to accept the things I cannot change, Courage to change the things I can, and the Wisdom to know the difference.

 

So, for the lurkers, newcomers and other fellows who are open to educating themselves or are in “monitor-mode” like you and may be following in your footsteps sooner or later, James, I suspect that you probably didn’t mean to imply that you were taking a strictly passive route as the selected words I extracted (above) may have implied, did you?  This may be a “teachable moment” for you (James) and Mel to comment on what you are doing…

 

 

 

I’ll also note that your fellow moderator, Tony, recently provided a link here at HW to a doctor in his area practicing Integrative Oncology.  The web site has numerous helpful links for the type of holistic, cancer-fighting steps that doctors wish people would take before recurrence (or occurrence) of cancer, rather than after.  Furthermore, I also provided a link here at HW to the Integrative Medicine program at the University of Michigan, where Mel has consulted. 

Tony’s posting:  http://www.healingwell.com/community/default.aspx?f=35&m=1958546

UMich link:  http://www.med.umich.edu/umim/food-pyramid/

The key points in those programs?  (a) What food you put into your body, (b) what food you avoid putting into your body, (c) daily exercise, no matter what shape you are in now, and (d) stress relief, relaxation.  Specifically regarding diet, (a) and (b), many who have researched prostate cancer and diet (not just one or the other) say the standard, “moderately healthy” western diet does not go far enough alone, in the typical case, to help tip the odds in one’s favor.



James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 12/31/2010 5:45 PM (GMT -6)   
Casey59, thanks for your well thought out post. The last time we entered this discussion, difficulties ensued, and the pro's and anti's of diet, supplements and alternative medicines came out in force. I can foresee nothing but the same again, on this thread, if we enter into a prolonged discussion of it. The subject is BCR, so let' not lose our focus and wander, or lead those tender newbies, off the trail, ok?
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RRP, Path: pT2c, 110 gms., all clear except:
Probable microscopic involvement of the left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09- Uh-Oh, next in Jan & Feb.
ED-total-Bimix 30cc

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4271
   Posted 12/31/2010 6:16 PM (GMT -6)   
Casey, not to be a PIA but I totally agree with James' point.  Personally I believe diet can be important BUT....please...enough already...it's really starting to sound like you are nagging, harping, etc.  You have made your point so IMHO, it is not necessary to keep bringing up the same thing over and over and over and over...
 
Happy New Year.
 
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 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 12/31/2010 6:26 PM (GMT -6)   
OK, James. We'll let some time pass. We do need to be sharing the evidence and knowledge with the steady stream of newcomers, however. And although we've had lots of newcomers recently (as you yourself recently commented), it might still be too fresh (or dare I say "stale", as evidenced by Tud's reply) in the minds of our "regulars."

tigre
Regular Member


Date Joined Sep 2010
Total Posts : 69
   Posted 12/31/2010 8:18 PM (GMT -6)   
mel,
my psa was 3.9 at age 45 at time of dx. had rp and first psa following was 0.02. i did have a positive margin in an area where he said that if you have to have a positive margin, this is where you want it. two months later psa was 0.05 and uro said this confirms either persistance or reccurence and immedidately scheduled rt in hopes that the cancer had not escaped the bed area. his justification and the radiation onc. agreed that is because of my age i was at risk of it being more agressive so we should be as aggressive as possible. my gleason was 3+3 (6) before and after rp. i was upgraded fom t2 to t3 because of the margin but in uros words, it only matters on paper because of the location of the margin.  have had two psa's post rt and both were <0.1. next test scheduled for feb.8. 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 12/31/2010 8:32 PM (GMT -6)   
Should have known this might turn into another war of words on the all empowering wisdom of diet and supplement. None of this has anything to do with a thread on BCR, which is a very legitimate discussion and topic.  Thanks, JamesC, for putting the brakes on that before it got out of hand.

From the answers, there is an "official" answer, one stated more than once here, and then some more "per individual" responses, mostly generated by real-time experiences with our own doctors. And that makes sense to me. In my case, and it doesn't mean it would apply to anyone else (but it could), the concern of my Uro and Radiation Oncologisit has been consistent from the start of my PC journey, how do you deal with rapid PSA velocity, regardless of Gleason scores, etc. So I am sure what I posted above, on 3 consecutive rises above .10 constituting BCR is applicable in my case. Also, neither doctor wanted me to even wait to a rise of .20 for SRT, for the same reasons stated, being that the odds of SRT working were low to start with, and was further factored downward because of the velocity issue.

It's a tough subject, that many, many of us have had to wrestle with. Mel, and James, thinking of you guys in particular, and I know the fear and anxiety going on, and to be expected. James, you have had a pretty good run on the PSA front post surgery, Mel - though nothing bad has been determined on you post surgery, I understand fully your apprehension on the subject.

For me, it was one of my toughest medical decisions of all time, being that I knew first hand how my body reacted to major radiation in the past. What I feared the most, came true for me, and we all know about my previous year of physical hell.

I am not sure I would even turn to radiation for pain management, for future hot spots, etc. My body is still telling me, I have had enough radiation. The bottom line: why did I consent, fearing what I feared in my heat? Simple, without the SRT, I had no chance of stopping the progress of my PC, and even though the risk were high, and the odds not in my favor, it was my one and only remaining curative step to take. And I owed it to myself to take it.

I will know more by the end of February, what I am fearing and anticipating, but hoping to be 100% wrong, that evidence will show that even my SRT has or is failing. It would follow the pattern of a high velocity case. I just want to be wrong.

Good thread, one dear to my heart. No matter what any of you brothers do still pending this situation, you got my backing, and I know it will not be an easy situation or decision time for any of you.

David in SC

Post Edited (Purgatory) : 12/31/2010 6:37:11 PM (GMT-7)

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