Been doing a lot of deep thinking on my own situation. Not so much second guessing, more like analyzing what has happened.
In 2006, at age 54, my PSA was at 3.5. In each of the previous 4 PSA tests starting at age 50, my PSA average an increase of .5 per year, until 2007. In 2007, it crossed the 4.0 mark, and then my GP passed me to my urologist. That was the standard that has been used for years. The 1st biopsy was 12 core, showed no cancer, but lots of PIN, and indicated PNI. A year later, 2008, it had tripled to 12.3, and the 2nd biopsy, also 12 core, showed no cancer, but lots of HGPIN, and PNI. 6-8 weeks later, biopsy 3 was targeted to "suspicious shadows" from the 2nd biopsy, and came up positive with 7/7 cores, Gleason 7, cores were 40-90% cancer, and PNI present again. Just prior to surgery, the PSA rose to 16.x, an increase of 33% or more in a question of weeks. It's important to remember, there was no evidence ever of any kind of prostate problem or infection, and all DRE's were negative
I wonder if I had been biopsied in 2006, could it have found cancer. It's a reasonable assumption, that the cancer didn't appear from nowhere prior to my dx. It had to be in there and growing, or was it agressive enough strand to start up and take off running?
Post surgery, my lowest PSA was .05, and my uro was deeply concerned. It doubled in 3 months.
My highest post surgery PSA reading was .16, when the decision to go for SRT. By some peoples standard, that was "jumping the gun" on SRT. I was encouraged strongly to do so, based on my pre- and post-surgery PSA velocity issues.
Now I had 72 gys of radiation, which is on the high side for SRT, higher than a lot of guys here have had, though not the highest. It was supposedly being targeted to the prostate bed only, not the entire pelvic region.
A question comes to mind, since my bladder was not being protected by being filled, which also aids in protecting the bladder neck, rectum, anus, and other surrounding areas, I wonder if much of the targeted doseage was wasted or mis-directed in the process of destroying my bladder and bladder neck?
Since I had a known deep/narrow prostate bed, and since I was given IMRT, you would think it would have been a narrower and easier target to pinpoint with the radiation machine. 72 gys is often the dose given for men having RT as a primary treatment.
So was some of this radiation wasted, in a manner of speaking, or was the remaining cancer never in the prostate bed to begin with?
Contrary to Dr. Walsh's opinion in his book about PNI, he doesn't put much stock in it. 3 RO's, 1 MO, my uro/surgeon and my GP all felt strongly, and independently, that PNI can be a dangerous situation, and increases the risk factors with any primary or secondary treatment.
The million dollar question to me, is where is the cancer right now? My orignal pathology looked fairly decent, and I even was downgraded from a 4+3 to a 3+4 Gleason, with one minute positive margin. According to one of the RO's, with PNI, you have multiple nerves in the prostate, that to tiny cancer cells, act like giant escape canals, allowing cancer to long escape the prostate and relocate who know where in the body.
Something is going on for sure, to have my post SRT-PSA go from .06 to 1.24 in 6 months, and then to 3.8 in 7 weeks time. I am predicting that my May 31st reading will be in the 6.x to 7.x range, hoping to be wrong of course.
Either I am becoming the poster child for the adovocates of the Inherent Danger of PSA Velocity prior to DX and/or the danger or PNI, or both. Or something else is entirely going on here. Its open to discussion.
David in SC
Post Edited (Purgatory) : 5/8/2011 4:50:57 PM (GMT-6)