what i don't understand about my PSA......

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F8
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Date Joined Feb 2010
Total Posts : 3802
   Posted 6/16/2011 9:05 PM (GMT -6)   
i'm a year past BT, and about nine months past lupron and IGRT.  my testosterone is at 540 which is in the high normal range.  my PSA recently came in at .2.  i'm pretty sure that with such a high T level my PSA is no longer being "masked" ... or am i wrong about that?
 
what i don't understand is why other radiation guys have higher PSAs to begin with that trend down over time.  can i expect my PSA to rise a bit more?  is it just that much different from person to person?
 
thanx.
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl!

fulltlt
Regular Member


Date Joined Nov 2010
Total Posts : 264
   Posted 6/16/2011 9:13 PM (GMT -6)   
The difference may be the lupron.
location: Batavia, IL
dx age 57 2/2010 PSA 8.2
biopsy 2/2010 - 2 of 8 left & 2 of 8 right positive, Gleason 3+4=7
attended support group - advised to get a second opinion
second opinion on pathology from Johns Hopkins 4+4=8
PSA 15 4/2010
5 weeks IMRT 4/2010-6/2010 at Copley Hospital in Aurora, IL
91 palladium 103 seeds 7/2010 at Chicago Prostate Center, Westmont, IL
PSA
Oct 3.97
Dec 2.78
Mar 2.42

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3747
   Posted 6/16/2011 9:21 PM (GMT -6)   
Since you never had surgery to remove the entire prostate, there may still be enough prostate tissue left (having survived the radiation) to create some PSA which is being detected in your blood..PSA readings are affected by many variables and the ultra-sensitive test compounds the problem because it can have variations too..Your PSA will level off at a low level or it will not..Not much you can do about it until a clear trend is established..So try not to get caught up in the PSA anxiety thing or rush into treatment that may not be necessary..JMHO..

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3802
   Posted 6/16/2011 9:31 PM (GMT -6)   
Fairwind -- why is my PSA so low?  other radiation guys have much higher PSAs to begin with that trend downwards.  i'm not worried i'm just curious.  my radiation oncologist said it could have been 3x higher and still excellent.
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl!

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3802
   Posted 6/16/2011 9:33 PM (GMT -6)   
>>The difference may be the lupron.<<
 
 with a T level of 540 i find that hard to believe unless there is something i don't understand (which is what i'm asking).
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl!

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3747
   Posted 6/16/2011 9:45 PM (GMT -6)   
There is a lot going on with this disease that NOBODY understands...You had the combined treatment, seeds and IGRT which is starting to look like the new Gold Standard of PC treatment..I would not worry about your PSA at all until some event occurs that forces you to give it your full attention. In the meantime, try to put it out of your mind and occupy yourself doing things you enjoy...Or doing things you DON'T enjoy but you must do them anyway...!!
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3802
   Posted 6/16/2011 9:56 PM (GMT -6)   
fairwind -- i'm only interested in the things i don't understand cool .  look, if my PSA is still supposed to rise more i'd like to know about it.  i'm really not worried.  i've done everything i can and soon i am moving on the the second phase of my recovery, which is getting off a couple of drugs and regaining my youthful figure.
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl!

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 6/16/2011 10:18 PM (GMT -6)   
F8,
The effects of the Lupron should be long gone. Your psa is normal for your treatment. I had the exact same treatment except Casodex for Lupron. My psa went to .1 pretty fast and has stayed there. Some patients have a slow decent to nadir and some fast. It really doesn't matter according to my oncologist, just as it gets low and stays there.
You have excellent results and shouldn't worry.

JohnT
66 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, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3802
   Posted 6/17/2011 12:28 AM (GMT -6)   
thanx John T.  that's what i wanted to hear.
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl!

don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 6/17/2011 8:39 AM (GMT -6)   
Ed, your numbers are great. In general, the longer it takes to reach a nadir the better the outcome. Usually one to three years. Also, a nadir of less than 0.5 is also a good sign. Here's hoping things continue to go well for you.
 
Don
 
Diagnosed 04/10/08 Age 58
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
IGRT/IMRT with adjuvant HT (lupron) 2yrs
PSA:
02/08 21.5
07/08 0.82
10/08 .642
09/09 0.32
03/10 0.32
06/10 0.32
07/10 0.10
09/10 1.00
03/11 2.38

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3802
   Posted 6/17/2011 5:36 PM (GMT -6)   
>>your numbers are great. In general, the longer it takes to reach a nadir the better the outcome.<<
 
thanx Don.  that almost sounds like a contradiction there but i know what you mean (i think). can you or anyone provide a link that explains why this so?  thanks.
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl!

don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 6/17/2011 6:39 PM (GMT -6)   
Hi Ed,
 
Here is an article from medpage on the subject.
 
Don
 

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3802
   Posted 6/17/2011 7:15 PM (GMT -6)   
thanks Don.  the article is referring to guys who had external beam radiation only.  besides IGRT i also had BT and HT.  so maybe that's why my numbers are closer to John's?  i'm all ears if anyone knows cool .
 
ed
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl!

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3753
   Posted 6/18/2011 3:38 AM (GMT -6)   
Ed,  my PSA acted the same as you and John T.   It dropped immediately due to the HT.   One month after IMRT I asked my onco what the PSA would be and he said <0.1.   I was ready to bet the farm that he was wrong as everything I had read about RT showed a slower decline.   Sure enough the next week it was <0.1.
 
I expect mine to stay undetectable as long as I am on HT.  Then we will see what happens.   I do expect some PSA as my rad onc says that some prostate remains and may produce a small amout of PSA.   I don't think that the usual RT PSA bump is as likely to occur due to the HT.   It appears that John T is at the time that the bump should occur and you are approaching it as well.    It usually happens between 12-36 months after RT stops.   My rad onc says don't be surprised if it occurs but he thinks the HT will negate the normal bump.   One of the leaing BT practices is here in Atlanta and they look for a nadir of 0.2 and for it to stay there except for the bump period when BT and IMRT are used without HT.
 
Celebrate undectable, hopefully for a very long time.   Your treatment combination has proven to be the most effective at long term control and cure.   Trust that it will work and verify that it is working.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010
HDR Brachytherapy December 6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.
PSA <.1 on 4-7-2011
Second Eligard shot on 4-7-2011

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3802
   Posted 6/18/2011 9:18 AM (GMT -6)   
JNF -- at this point i'm fairly optimistic.  i am making longer range plans again.  another thing to keep in mind is .2 is my one-year PSA post BT.  my rad onc said he would have been very pleased even if my PSA was three times higher.
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl!
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