Sometimes we just need to take a deep breath

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goodlife
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Date Joined May 2009
Total Posts : 2691
   Posted 1/22/2011 10:18 PM (GMT -6)   
Going through a little PSA anxiety.  I know, I know, ultrasensitive tests can do that.  I went from <.01, to .01, to .02 in the last 9 months.  A perfect upward slope.  My mind begins to race.  I want to smash this thing.
 
Spent several hours on the net today, just doing research.  Looking for effectiveness of radiation timing, adjuvant in the sense that it is prior to BCR, but after 2 years, maybe technically salvage.
 
The internet is a marvelous thing.  We can find so many different viewpoints, studies, opions, etc.  Try to find agreement on what PSA level BCR is recognized at.  .05, .1, .2, .4, ???. 
 
I found a set of bullets from Brady Center of Johns Hopkins that just kind of slowed me down and said, Whoa, just relax.  Thought I would post them as a reminder for all of us.
 

If you have a Gleason score of 5-7 Your PSA increased more than two years after surgery
AND your PSA doubling time was greater than 10 months:
Your chance of not developing metastasis (having a bone positive scan) in:

      Three years:  95 percent
      Five years:     86 percent
      Seven years:  82 percent

OR your PSA doubling time was less than 10 months:
Your chance of not developing metastasis in:

      Three years:  82 percent
      Five years:     69 percent
      Seven years:  60 percent

OR your time to first PSA recurrence was less than two years:
AND your PSA doubling time was greater than 10 months:

Your chance of not developing metastasis in:

      Three years:  79 percent
      Five years:     76 percent
      Seven years:  59 percent

OR your PSA doubling time was less than 10 months:

Your chance of not developing metastasis in:

      Three years:  81 percent
      Five years:     35 percent
      Seven years:  15 percent

If you have a Gleason score of 8-10 AND your time to first PSA recurrence was greater than two years:

Your chance of not developing metastasis in:

      Three years:  77 percent
      Five years:     60 percent
      Seven years:  47 percent

OR your time to first PSA recurrence was less than two years:

Your chance of not developing metastasis in:

      Three years:  53 percent
      Five years:     31 percent
      Seven years:  21 percent

 

As a Gleason 9, the numbers aren't the greatest, i will admit, but they also aren't the worst either.  Hard to find data on doubling time calcs for ultrasensitive numbers.  Technically a .01 to a .02 is a doubling, but at 21 months, I  am still doing OK.

Will schedule some visits to oncologists and my URO, but I am back down to earth.  Just breathe deeply, and keep on truckin.  Life is still very good.

Goodlife


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6949
   Posted 1/22/2011 10:24 PM (GMT -6)   
So I'll be on the charts in seven years or less. Won't even be retired when they wheel me out.
 
Glad I didn't find that report. But then I'm not looking.
 
Guess it depends on your age.

EnglishBob
Regular Member


Date Joined Jan 2011
Total Posts : 126
   Posted 1/23/2011 3:14 AM (GMT -6)   
I think i have decided to take life as i find it and live as optimisticly as i can, in my life prior to PC i have had three major accidents where i could haver died, i had 13 rounds of surgery, i am a lower left leg amputee (since i was 16) and i have had my Posterior Crusciate Ligaments fixed 5 times in my right knee, then i had two left inguinal hernia repairs.

So even before PC i fought and WON a lot of battles with my health, not of that stopped me and neither will PC till i am worn out by life itself and i decide that i have had enough. In the UK we refer to it as living your life as if your glass is half full, not half empty.

Sod the internet and stats, if you are Trekkie take Spocks inspiration .... Live Long & Prosper ....

Have fun, Bob.
Age 58
Prostate problems since early 40s
Ed since early 40s
April 2007 biopsy & all clear
July 2010 prostate swollen more, psa up to 5.6 August 6.7
September Biopsy again
October 7th diagnosed cancer, Gleason grade 6 at 10% mass
December 13th 2010 open radical proctatectomy
Pathology results came back Gleason grade 7 at 12% mass BUT clear margins
Catheter out Jan 5th 2011

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 1/23/2011 5:37 AM (GMT -6)   

Ditto.

 

 I’ve gotten rather found of lemonade since life has handed me a few lemons over the years.

 


GOP
Veteran Member


Date Joined Dec 2010
Total Posts : 657
   Posted 1/23/2011 7:09 AM (GMT -6)   
I agree with EnglishBob about being as optimistic as possible. None of us know if PC may eventually win, but it won't be THIS day, so there lots of things that I want to do on THIS and every day that I have.
Diagnosed in October, 08. One sample of needle biopsy showed Gl 6. Did watchful waiting for 18 months. PSA went fro 4.3 to 6.1. Surgery scared the heck out of me. Went to Schifler Cancer Center in Wheeling, WVA and spoke to a radiation oncologist. Had a mapping biopsy where 60 samples are taken. 15 were GL6, 1 was GL7. Had the brachytherapy on Oct. 4, 2010
First PSA post brachy on Jan. 6: 0.24

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 1/23/2011 8:48 AM (GMT -6)   
Many of you know me already, both for my postings here and some of you through face to face visits. I firmly believe that my glass is half full. Sence I have a glass half fool of water and a couple lemons I think I will have some lemonaid today! Be well my friends and live each day as it were your last.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better

Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 3057
   Posted 1/23/2011 10:41 AM (GMT -6)   
Goodlife,

You are doing just fine...

Most of the time, my glass is half full. Also "hoping" that in 7 years, more and more drugs/vaccines/etc... become available to help keep us limping along, especially at my age...

Jerry L.
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 1/23/2011 11:08 AM (GMT -6)   
Goodlife,
Your case is somewhat similar to mine. I'm scheduled for my 2 year PSA test on Monday (1/24). My last test was in October and my PSA was .005.
I'm getting anxious already. Two years is a milestone on my journey. I have seen conflicting reports on how elapse time from surgery to BCR effects the outcome of salvage radiation and the odds on metastatic vs local BCR.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18 months) undetectable
Latest PSA test (21 months) .005

DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 732
   Posted 1/23/2011 11:57 AM (GMT -6)   
Goodlife,

Thanks for posting that info. I'm in a similar position with you and Ed, next test in early February. I'd been undetectable and was optimistic heading into the two year test. It came out as 0.1. Not 0.01, I asked? No, 0.1. That was 2 months ago. Well, I keep breathing, thanks for the advice.

DJ
Diagnosis at 53. PSA 2007 about 2; 2008 4.3
Biopsy Sept 2008: 6 of 12 cores pos; Gleason 4+3 = 7
CT & Bone scan neg
Da Vinci at City of Hope Dec 8, 2008
Rad prostatectomy & lymph node dissection
Cath out on 7th day, in on 8th day, out again 14th day after neg cystogram
Path: pT2c; lymph nodes neg; margins involv; 41 grams,
PSA 1/08, 4/09,7/09, 10/09, 11/09,2/10 <0.01, 10/10 0.1

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/23/2011 12:26 PM (GMT -6)   
Goodlife:

The fact that you are a solid G9, and at almost 2 years out, reporting a .02 is an amazing stat in itself. You are so far under even a basic <.10 reading. By PSA number alone, you are doing great.

In your case, any radiation would be Salvage, not Adjuvant, but that's not even the issue.

There are so many cut-offs, and our clever ones can cut/paste the "truth" on the subject, but I have heard so much variation in the past 2 plus years from a plethora of good doctors local to me.

The trouble with nanoograms/charts/percentages/stats - they are just a collection of numbers, not specific to anyone in particular. With our cancer, each case is so different, one reason we get different answers to common questions. Doesn't mean flaky doctoring, just meansdifferent patient specific information.

My uro/surgeon was deeply troubled with my first post surgery PSA of .05. In his long experience, he knew that there was potentially cancer left, especially dealing with a high velocity patient. He was right, had BCR well under a year, and that being a Stage 2 Gleason 7 case with one tiny positive margin. Would the warning of .05 mean anything to anyone else? Probably not, unless you had similar path.

When I was interviewing 3 different radiation oncologists and 2 medical oncologist (one was my former from cancer 10 years back), independently, they all  thought a reading of .05 was not a good sign, either being post surgery or post SRT. Just so many factors to consider.

After my infamous and painful dealings with SRT this time, the doctor said that any upward movement of PSA, no matter how slight, was already early evidence of failure of the treatment. My last reading, though small, was up a full 50%. When I get my next reading in late February, it will be real interesting, as it will have been a full 6 months instead of 3 months, there is no reason for me to expect that there won't be a big jump at that time. Oh, how I want to be wrong.

For you guys that are G8 and higher, as long as you can pull the low numbers, the longer you dont have to use your second curative card, radiation, I think (not a qualified opinion) I would hold off, enjoy the better pre-radiation quality of life you have now, especially with any lingering ED and/or incontinence issues. Just because you have bad pathology, doesnt guarantee its going to turn bad anytime soon. Sure seems to work opposite the way our logic looks at it.

In the end, its not looking at charts and percentages, its having a good working relationship with quality doctors, and working as a team, between patient and doctor. A good doctor is looking out for your best interest, I believe that in my heart.

David in SC

Post Edited (Purgatory) : 1/23/2011 11:29:32 AM (GMT-7)


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/23/2011 3:33 PM (GMT -6)   
Thanks guys. Most of you got the idea of what i was feeling, even tho i didn't say it very well.

I think my thinking, or paranoia was that once we hit BCR, it is a pretty quick ride to metastisis, and therefore the beginning of the end. I actually took the Brady chart as a positive look. Tomorrow i hit the big 60. Even if things go poorly, i would love to have another 10 years of relatively decent health, but hey, we don't always get what want.

I continue to view adjuvant as action prior to BCR, so even tho it has been 2 years, i am still shotgunning for any cells that may be laying around. Salvage in my mind implies a curative attempt after BCR is reached.

The only other thought i have is the slight increase could be related to the periurethral glands which may be irritated by sexual activity, that I have not been concerned about. Next time i will refrain from anything for a couple of days.

So, after a deep breathe, i am armed with a full list of questions for my local Uro, and may pay a visit to Cleveland Clinic or Umich for a consult to see if there is anything else i ought to do at this point.

Where the heck is that magic bullet ? Hang in there everyone, ain't over til it's over. Life is Good !
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

Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2302
   Posted 1/23/2011 4:10 PM (GMT -6)   
When you're looking at a result that is basically background noise, a doubling doesn't mean much if anything.  In other words, a jump from 0.01 to 0.02 is essentially the same value given statistical variation in test results, etc. If it was a doubling from, say,  0.1 to 0.2, it may be of more concern.   Take care and hang in there...Tim
PSA quadrupled in one year (0.6 to 2.6)
DRE negative Retested at 3 months
1 of 12 biopsies positive (< 5%) G6
RP open surgery June 2006 at age 57
Bilateral nerve-sparing
Organ-confined to one minuscule area, downgraded to G5
Prostate weight 34 grams
PSAs < 0.1

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 1/23/2011 4:28 PM (GMT -6)   
Tim,

Thanks for that perspective. I have searched the Internet for that info, and have not found anything that describes allowable variation.

With 8 PSA's that have been really consistent, I just become a little nervous when it happens on one test.

Goodlife
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
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