concerns about doubling time and aggressiveness

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tigre
Regular Member


Date Joined Sep 2010
Total Posts : 69
   Posted 1/9/2011 4:10 PM (GMT -6)   
not sure of exact dates but i suspect my pc journey began in 2007 when psa was 3.0 at regular physical. my age was 45. about a year later, psa was 3.4 and approximately 6 months after that 3.9. would not have gotten tested the third time so soon if not for my brother having been diagnosed a year earlier (with psa 3.7). the 3.9 warranted biopsy.  i don't think the rise in my psa at that point constitute a rapid rise however, after rp in 2009, my initial psa was 0.02 and two months later it was 0.05. uro suggested rt immediately as these numbers pretty much confirm persistence or recurrence. my question i guess is this, does the 0.02 to 0.05 in two months indicate perhaps it is more aggressive than what i first thought? Uro says using ultrasensitive tests, this is not necessarily the case but due to my age he still recommended rt asap as the younger you are it can sometimes turn out to be more aggressive.
my gleason was 3+3 both before and after rp
had two psa's after rt and both are <0.1, next test is Feb.
another question is about rt success percentages. i was under the impression that after recurrence if done before psa goes above 0.05, chances of cure approaches 70 percent.
any thoughts would be appreciated.

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 644
   Posted 1/9/2011 5:00 PM (GMT -6)   
Hi, Tigre

Welcome to the site, though sorry you have to be here.

It would be helpful if you could post more about your post-surgical path report, margin status, seminal vesicles, capsule confined, and staging, etc. It is unusual to have PSA rising so soon after RP for a gleason 3+3. But not impossible.

Did you have your diagnosis and RP/RT done at a major cancer center? If not, (and perhaps even if so) I'd recommend getting a second opinion. You can have the pathology work reviewed by one of the top labs and see if you really have a 3+3 and not something more aggressive.

But at this point if I understand your post correctly, you have already had the RP and RT so you are in a position of watching the PSA and deciding what to do if/when it rises.

The odds of success of salvage RT are complex to figure and I think the projections would certainly depend on factors such as doubling time, gleason, PSA levels, and not be a single number. IF you want to research the literature on this (it's complicated) you can go search on pubmed.com. You might find something useful here: www.mskcc.org/applications/nomograms/prostate/. Good luck.

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 1/9/2011 5:15 PM (GMT -6)   
Tiger,

If any of us really knew the answer to your questions, we would be rich and famous. Doctors usually have ro respond with things like not usually, it depends, or we just don't know.

As was mentioned above, we can make better gueses free looking at tour pathology. Apparently tho, the surgeon didn't get it all, and based on ou post rp numbers, the rt did.

You may drive yourself nuts trying to guess. Comgrats on th good numbers. Now go enjoy your life.
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

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/9/2011 5:34 PM (GMT -6)   
Welcome Tigre,
Without knowing the post surgery pathology it is a somewhat difficult to comment other than to say your doc's anxiousness to pull the salvage radiation trigger is a little unusual at .02-.05. Most urologists would not seem to concede there has been a failure of surgery till a figure of 0.2 has been reached. There are no shortage of members here who after surgery have had readings at the 0.02 and a little higher indefinitely.

Whoops------now I re-read your post am I correct in assuming that you have already had the salvage therapy? If this is the case then stay with the ultrasensitve test ------ you have always been <0.1 since surgery so getting tested at the standard level now is not helping with seeing if the salvage had any effect on your PSA. It is important to stay with the same lab using the same testing protocols. As to your question about aggressiveness------normally a quick doubling time of PSA indicates that the tumour cells are more aggressive. But given the figures you spoke about i.e. 0.02 and 0.05 ...... there is a bit of variability at this very low level (particularly if different labs are involved) so I would not automatically assume that your PSA actually doubled in that time frame, despite the apparent figures.
Bill
Biopsy

4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007

Post-op

Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct '07 <0.1 undetectable
PSA Jan '08 <0.1 undetectable
PSA April '08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August '08 <0.001 undetectable (disregarded due to lab "misreporting"-----it is not possible for any lab to get a reading of less than .003)

Post-op pathology rechecked by new lab:

Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September '08 <0.01 (new lab)
PSA February 09 <0.01
PSA May '10 <0.01

www.yananow.net/Mentors/BillM2.htm

Never underestimate old people ............ you don't get to be old by being stupid.

tigre
Regular Member


Date Joined Sep 2010
Total Posts : 69
   Posted 1/9/2011 7:11 PM (GMT -6)   
thanks for the responses,
sorry i left some info out. uro says gleason is 3+3 pre and post rp. upgraded from t2 to t3 due to one positive margin however, uro says the location of the positive margin is where you want it if you have to have one because in simple terms, there is nothing around it. no lymph node or seminal ves. invasion. perin. invasion present. though. dx was done by uro at urology of greater atlanta. surgery performed by uro at St. Josephs in atlanta area and rt at radiotherapy center of ga.
i did ask uro and radiation oncologist why we are not getting ultrasensitive tests after rt and both agree that curative measures are exhausted and while everything looks really good at present, the ultrasensitive may cause needless anxiety. both seem really happy about two consecutive <0.1 results.

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3887
   Posted 1/9/2011 8:30 PM (GMT -6)   
tigre,

You have been treated at two well renowned centers in Atlanta. My wife has just completed her radiation for breast cancer at RCOG with Dr. Levitt. I didn't use them because I went the HDR route. I have a good friend that just completed his primary treatment at St. Josephs. All I can say is to stick with your doctors and add a medical oncologist that specializes in PCa as your lead advisor.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 1/9/2011 10:31 PM (GMT -6)   
Tigre,
Even with a positive margin G6s rarely move to mastastic state. If you had a slight positive margin the radiation should have easily taken care of it. Because of your age and positive margin your doctor was being very agressive in pulling the salvage trigger so soon. At this stage there is really no reason for the ultrasensitive psa test.
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.

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/9/2011 11:09 PM (GMT -6)   
It is interesting you would say that John re. ultrasensitive. Tigre's doc certainly did adopt an unusually aggressive approach pulling the trigger at 0.05 which is probably understandable given Tigre's age. He obviously thought post surgery that ultrasensitve testing was appropriate in order to detect early signs of surgical failure. However failure would not have been apparent so early using the standard test ie <0.1 (undetectable) following surgery. Given the remaining canon in the arsenal is HRT and his doctor is pro early intervention then why not apply the same ultrasensitive testing logic to the success or otherwise of SRT (again for early intervention) rather than changing to standard testing.
Bill

Post Edited (BillyMac) : 1/9/2011 9:12:12 PM (GMT-7)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/10/2011 7:55 AM (GMT -6)   
Read more on psa anamolies and fluctuations, can change hourly, daily etc. I got two psa tests about 1 hour apart or so. The numbers were not identicial, Terry Herbert did it for 30 days in a row to prove a point, and did so big time...many years ago. Varied like you wouldn't believe. You need history over time, trends, velocity, doubling times etc...to get more perfection in analyzing or charting and with Psa tests...always confirm tests for possible errors, mistakes and even changes, is considered the best course.

www.yananow.net/PSA101.htm    (great info on Terry's site for everything on PCa issues)
 
 

Post Edited (zufus) : 1/10/2011 6:07:50 AM (GMT-7)


ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 1/10/2011 9:42 AM (GMT -6)   

 

1st you did not have recurrence.  You had a positive margin.  Surgery did not remove all your cancer.

 

2nd I was diagnosed at 42 with 3+3=6.  I had surgery at Johns Hopkins had they told me several times that my age has absolutely nothing to do with the how aggressive PCa is in younger people.  There have been many studies that show this to be true.  G6 in a younger person is not more aggressive then in an older person.  This was straight from Dr. Epstien.  You simply had a positive margin not more aggressive cancer.

 

You Dr. is mis-guided about that notion.


tigre
Regular Member


Date Joined Sep 2010
Total Posts : 69
   Posted 1/10/2011 10:54 AM (GMT -6)   
thanks once again for the replies. i can't begin to tell you how much HW and you all have eased this journey for me. to know that the initial overwhelming anxiety and depression are quite normal. it's hard to accept early on in this battle that these fade and things will get better however, at least for me life is better for having endured to this point, in no small part thanks to you all.
both uro and radiation onc agree that there is no point presently for ultrasensitive because psa would have to rise quite a bit before anyone recommends ht (something neither expects to see).
and at least for me, i can certainly do without anxiety over something that may not even be there. seems i don't thinks so much about it anymore except a week or so before each big test.

tigre
Regular Member


Date Joined Sep 2010
Total Posts : 69
   Posted 1/10/2011 11:07 AM (GMT -6)   
chrisR,
thanks for the reply. i agree completely that the positive margin was just that and not recurrence. at least i sure as heck hope so. i think my uro was just trying to tie in higher testosterone levels in younger men with potentially more aggressive cancer. in any event, i think i feel pretty good about treatment decisions to this point. maybe we jumped the gun a little bit with rt and i may rue that one day down the road, but for now the only real unpleasant side from rt isimpotence. after surgery and before rt i was just starting to make a little progress too.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 1/10/2011 2:34 PM (GMT -6)   
Billy Mac,
You misunderstood me or I didn't make my post very clear. I fully support ultrasensitive psa after surgery in order to spot a reoccurrance as soon as possible, and agree with what the doctors recommended in this case. After radiation the ultrasensitive psa is not very useful.
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.
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