In another thread that got into some mathematical weeds, I was trying to understand the trend of my PSA since coming off of hormone therapy in March 2016. Having worked that out, it's clear now that the underlying trend is very straightforward. It can be easily seen in this graph
. So, based on that, here's a list of dates and PSA, with bold values being predicted from what's been measured.
My MO said, "We'll check in June, if it's like 1.0 or so, we'll consider some follow up, scans and so on.". That's fine, I like a measured approach. However, it seems to me the recurrence situation may already be manifest, and it's just a matter of picking some point along the way to "do something". The old ASTRO definition of 3 consecutive rises is certainly fulfilled, and the underlying trend is solidly visible. If this trend holds, we'll be well over 1.0 by June, and hit the Phoenix definition of recurrence (PSA>2.0) by July.
I'm wondering if I should make an April appointment for a follow up check, since it's entirely likely to hit 1.0 by mid-April. Or, just wait till May? June? At what point in such a PSA progression does it make sense to re-engage?
The point here isn't to get wound up over some number. However, if the point is the pattern matters, then the pattern is already clear, at least to me. With my diagnosis, I'm inclined to "do something" sooner rather than later. (As a G9 with primary type 5 cells, stage cT3 by MRI, with now an apparent approximately 3 month PSA doubling time for a possibly recurrent setting, studies would be rather pessimistic in any case).
But, if it takes more advanced disease to drive further measures, just what would it take? (Maybe the projections are all wet, but my goodness what a perfectly straight line underlies them today).Date
Bx: 6/12 pos, G9=5+4 (80%, 60%), 4+5 (2@100%, 80%, 10%), PNI+
cT3a (3TMRI: Bilateral EPE, NVB+, SV-, LN-)
Date PSA fPSA
9/12 4.1 15%
3/13 5.2 12% PCA3=31
IGRT by IMRT, 44 done 8/28/13: 50.4 Gy pelvic nodes, 79.2 Gy prostate
ADT2 3 yrs: Lupron/Casodex, ended 3/16
Post: (age now 59)
PSA <0.1 : 8/13 - 5/16.
PSA 0.2-8/16, 0.5-12/16, 0.7-3/17, TBD-6/17