support group--interesting topic

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compiler
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Date Joined Nov 2009
Total Posts : 7270
   Posted 4/20/2011 7:55 PM (GMT -6)   
A local medical oncologist will be speaking at tomorrow's monthly support group meeting.
 
His topic: "How do oncologists handle a rising PSA after tx."
 
I'll let you know if I learn anything new/interesting.
 
Mel

60Michael
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Date Joined Jan 2009
Total Posts : 2243
   Posted 4/20/2011 8:26 PM (GMT -6)   
Thanks Mel, hopefully some useful information will come from the his speech. Let us know.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4
Started IMRT Jan. 2010 72gys
7month post SRT PSA.27

60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2243
   Posted 4/20/2011 8:26 PM (GMT -6)   
Thanks Mel, hopefully some useful information will come from the his speech. Let us know.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed, 61 yo 2010
Robotic surgery 5/09
Gleason upgraded to 3+5, volume less than 10%
2 pads per day, 1 depends but getting better,
started ED tx 7/17, slow go
Post op dx of neuropathy
T2C left lateral and left posterior margins involved
3 months psa.01, 6 month psa.4
Started IMRT Jan. 2010 72gys
7month post SRT PSA.27

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/20/2011 9:07 PM (GMT -6)   
looking forward to what you learn
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 margin
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, 2/11 1.24, 4/11 3.81
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 9/10

Magaboo
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Date Joined Oct 2006
Total Posts : 1211
   Posted 4/20/2011 9:52 PM (GMT -6)   
Hi Mel,
I'll be looking forward to your report as well. I'm a couple of years ahead of you and are always wondering what to do if I have another recurrence.
Hope the rest of your SRT will be uneventful and hopefully banish the beast for good.
All the best.
Mag

Born 1936
PSA 7.9, Gleason Score 3+4=7, 2 of 8 positive
open RP Nov 06, T3a, Gleasons 3+4=7, Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; at SRT Start=0.1,
Salvage RT completed (33 days-66Gy) 19 Dec 08
PSA: in Jan 09 =.05, all tests to date (Jan 11) <.04

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 4/21/2011 10:55 PM (GMT -6)   
Well, we had our support group meeting tonight. I will invite Roadrunner to comment, as he was also there.
 
It was not a good meeting -- rather shocking, in fact.
 
First of all, the speaker went over a lot of basic stuff that I'm sure everyone knew (and certainlly most of the regulars on HW would know). He gave assorted scenarios and invited comments about what tx. would be best. I won't bother to elaborate. Basic stuff, but okay.
 
But then the question came up: person has surgery. PSA starts rising. At what level does one decide to get further tx. such as SRT. Well, he said 2.0. I questioned him on that, stating that 0.2, not 2.0, is often cited as a critical value. He INSISTED it was 2.0. The guy who asked this is in this situation. I think his PSA is about .09 or maybe 0.11. The doctor repeated quite a few times that the number should be 2.0 before starting SRT. As far as I know, 2.0 is the point where it's probably too late for SRT.
 
This, from a medical oncologist.
 
Roadrunner, did I lose something in the translation?
 
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. 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- yes.. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13,3/1/11--0.27. Now doing SRT

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/21/2011 11:43 PM (GMT -6)   
mel, i believe your thinking is correct on this one.

i was told that .2 was a good place to start, and that at .5 still effective, and at 1.0 or above, starts dimmishing the effectiveness, this came from all 3 rad onclogists i met with prior to my srt. i am sure the answer is all over the place.
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 margin
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, 2/11 1.24, 4/11 3.81
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 9/10

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 4/22/2011 12:04 AM (GMT -6)   
I KNOW my thinking is correct on this. Many of us have dealt personally with this.
 
I just can't believe a medical oncologist would make the statement he did, but as I said maybe I missed something
 
Mel

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 4/22/2011 12:50 AM (GMT -6)   
Mel was that all he covered?

Some doctors will agree with this assessment. But I just posted how our meeting went and Dr. Vogelzang made a couple interesting comments that apply to your thoughts here. One particular comment was that 50% of all doctors are below average.

Your meeting kinda shows that to be true...

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

Roadracer
New Member


Date Joined Sep 2010
Total Posts : 18
   Posted 4/22/2011 7:19 AM (GMT -6)   
Mel, you heard the same thing I heard. The doctor said he was relying on treatment guidelines from the NCCN and that one should consider SRT after prostatectomy when the PSA rises to 2. I went to the NCCN website, registered and looked at the standard treatment recommendations. I haven't read the 50 or so pages that displayed on my IPad completely but what I did get through says that results from SRT are poorer if the starting PSA level is >2. I haven't found the 0.2 recommended value for biochemical failure and starting point for SRT in the NCCN guidelines as yet but maybe a doctor who participates in this forum can clarify things for us.

Road racer
Oct 2007 - PSA 7.0
Nov 2007 - Biopsy Positive in three cores - Gleason 7 (3+4) - Age 64
Jan 2008 - RLRP @ Henry Ford Hospital in Detroit
Post-op, Gleason 7, T3a/N0/M0 Microscopic positive margins
Apr 2008 - PSA <0.01
Aug 2008 - PSA <0.01
Dec 2008 - PSA <0.01
Mar 2009 - PSA <0.01
Sep 2009 - PSA <0.01
Jan 2010 - PSA= 0.09
Apr 2010 - PSA <0.01
Jul 2010 - PSA <0.01
Jan 2011 - PSA <0.01

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 4/22/2011 11:53 AM (GMT -6)   
RoadRacer:
 
But he cites that site as indicating 2.0 is the trigger for SRT. Obviously, it is saying that 2.0 is not a trigger but is in fact a negative indicator for SRT success.
 
Incidentally, this is probably another good example as to why, when it becomes necessary to consult a medical oncologist, one should absolutely get one specializing in PC.
 
In the back of my mind, I was hoping this guy would be good, with an eye towards consulting with him if he is willing to follow the dictates of a true medical oncologist specializing in PC (eg: Dr. Hussein at Umich or Dr. Scholz). If I go to see them, I might need someone locally to coordinate tests, etc.
 
 
 
Mel

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 4/22/2011 1:18 PM (GMT -6)   
compiler said...
...But then the question came up: person has surgery. PSA starts rising. At what level does one decide to get further tx. such as SRT. Well, he said 2.0. I questioned him on that, stating that 0.2, not 2.0, is often cited as a critical value...
 
Mel,
 
Perhaps I can clarify.  The way I've described this before (in the context of use of the ultrasensitive PSA test)  is to keep separate the patient monitoring for BCR (biochemical recurrence) threshold from the management decision-making threshold.  The management decision-making has multiple variables to consider.  The issue is starting SRT in a timeframe which is considered "early"...or at least earlier than was the former norm.
 
You started THIS thread back in September of last year, and I will simply copy/paste a portion of one of my responses below, but you might need to go back to the thread itself to get the full context.  Here's what I wrote back in September, with the 2nd bullet containing the main point relevant to your comment above and bold added for emphasis on the key words:
 
 

Coupla quick replies to the recent posts (obviously I'm not a doctor shakehead , just an avid reader):

·         Yes, there are variations in the definition of BCR.  There really is no more authoritative source than the AUA, which defines it as ³0.2ng/mL with a follow-up confirmational test result over 0.2.

 

·         Separate (the verb, not the adjective) ultrasensitive PSA testing for patient monitoring from management decision making…they are not the same.  The very early possible trending that James might be seeing [reference to a James C post on his possible rising PSA and possible BCR], for example, is not enough—from the work of the esteemed doctors referenced in the Choo report—to trigger SRT management actions.  There is no established “standard of care” for when to start SRT; but, when these reports speak of the benefits of acting early on SRT, they are talking about at the 0.5 to 1.0 ng/mL levels.  Not starting early generally means after PSA is above 2.0 ng/mL.  Furthermore, the report does also speak about SRT overtreatment which would occur with patients monitored by ultrasensitive PSA tests when the trigger for SRT is pulled too early; some increases at the very low levels of utrasensitive measurement capability are just natural variation (measurement variation plus biological variation) and will not result in BCR.

 
 
Hope this helps clarify...
 
 
 
 
edit:  typo

Post Edited (Casey59) : 4/22/2011 12:31:07 PM (GMT-6)


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 4/22/2011 5:29 PM (GMT -6)   
Casey:
 
We are talking about TODAY. There are ample reports that starting SRT after the PSA gets to 2.0 is a waste of time. In fact, Walsh even mentions that in trhe 2007 edition of his book.
 
I still cannot believe the "expert" told the guy not to do anything until the PSA gets to 2.0.
 
Mel

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/22/2011 6:28 PM (GMT -6)   
I fully agree, Mel. Unless he made an honest speaking mistake, I think that was bad advice to be spewing out.
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 margin
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, 2/11 1.24, 4/11 3.81
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 9/10
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