Any chance SRT might work?

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Ak123
Regular Member


Date Joined Nov 2016
Total Posts : 211
   Posted 2/22/2018 6:23 PM (GMT -6)   
Hello,
I just got my psa and although it’s from a different lab(at MSKCC). Please see signature, it went down slightly. Any chance the SRT I Finished about 10 months ago might still work? Or this is just wishful thinking?
Thanks
age 63 now, diagnosed on 10/2012 at 58 years old
RP 12/2012, Gleason 3+4, positive margins and extra capsual extention, PNI,. T2c.
Psa on 11/2016 .07
Started external beam radiation on 1/2017
Psa 7/2017 .1 (MSK lab1)
Psa 11/2017 .16 (lab2)
Psa 1/30/2018 .20 (lab2)
Psa 2/22/2018 .17 (MSK Lab1)

InTheShop
Veteran Member


Date Joined Jan 2012
Total Posts : 8618
   Posted 2/22/2018 6:39 PM (GMT -6)   
SRT can take months/years to show effectiveness. As long as your PSA is low, you're golden. SRT PSA can also be bouncy like one of those bouncy houses.

PARTY!!!

Thank you, I am done,
Andrew
I'll be in the shop.
Age 58, 52 at DX
PSA:
4.2 10/11, 1.9 6/12, 1.2 12/12, 1.0 5/13, .6 11/13,
.7 5/14, .5 10/14, .5 4/15, .3 10/15, .3 4/16, .4 10/16, .4 5/17, .3 10/17
G 3+4
Stage T1C
2 out of 14 cores positive
Treatment IGRT - 2/2012
My latest blog post

Progressing
Regular Member


Date Joined Aug 2017
Total Posts : 219
   Posted 2/22/2018 7:03 PM (GMT -6)   
Ak, could you share the name of your RO at MSKCC?
Age 76, excellent health except PCa
Psa 7/13=8 with BPH, 9/17=20.44
7/20/17, Biopsy, 5/12 cores PCa all right side, Gleason 4+3, PNI
MRI and CT no evidence of metastases
Laparoscopic surgery MSKCC 10/31/17, left nerves spared, pathology T3aN0, G4+3, focal EPE, negative margins, no multicentricity, BPH
Continent but ED
12/14/17-psa 0.10; 1/25/18-0.11, appt with RO 3/6

Ak123
Regular Member


Date Joined Nov 2016
Total Posts : 211
   Posted 2/22/2018 7:27 PM (GMT -6)   
In the shop, wait, wait please smile, I never heard that. SRT psa can be bouncy EVEN after RP????????
someone here told me that it can ONLY be bouncy if it’s the main treatment not with surgery. Please explain if you have a moment moment. Thanks

Progressing, his name is James Lee
age 63 now, diagnosed on 10/2012 at 58 years old
RP 12/2012, Gleason 3+4, positive margins and extra capsual extention, PNI,. T2c.
Psa on 11/2016 .07
Started external beam radiation on 1/2017
Psa 7/2017 .1 (MSK lab1)
Psa 11/2017 .16 (lab2)
Psa 1/30/2018 .20 (lab2)
Psa 2/22/2018 .17 (MSK Lab1)

Ak123
Regular Member


Date Joined Nov 2016
Total Posts : 211
   Posted 2/22/2018 9:37 PM (GMT -6)   
TA? any comments on this please? Thank you
age 63 now, diagnosed on 10/2012 at 58 years old
RP 12/2012, Gleason 3+4, positive margins and extra capsual extention, PNI,. T2c.
Psa on 11/2016 .07
Started external beam radiation on 1/2017
Psa 7/2017 .1 (MSK lab1)
Psa 11/2017 .16 (lab2)
Psa 1/30/2018 .20 (lab2)
Psa 2/22/2018 .17 (MSK Lab1)

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10108
   Posted 2/23/2018 2:53 AM (GMT -6)   
"Official" biochemical recurrence after SRT is 0.2. PSA progression can be slow and erratic for a long time, as the mets just put out more PSA sometimes than other times. But don't confuse it with a bounce that guys who've had primary radiation experience. Your PSA is higher a year after radiation than it was before radiation, so I think it's pretty clear that the radiation wasn't curative. The good news is that it's still very low and is not increasing rapidly - prognostic for a very long ride. You have lots of options about how or if you want to deal with it. You have some great MOs at MSK.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Ak123
Regular Member


Date Joined Nov 2016
Total Posts : 211
   Posted 2/27/2018 11:43 AM (GMT -6)   
TA,
I just came back from seeing RO at MSK. He said I am sorry, your radiation didn’t work,
Come back in 4 month and there is nothing I can do for you and see a MD. I already have an appointment with Michael Morris at MSK in April but I don’t want to miss any opportunity I might have with an early pet scan And radiating the pelvic lymph nodes. I only had 72 gs to the prostate bed about a year ago or less. The RO said these pet scans are experimental and they won’t show anything at .17 psa. Is it realiif they won’t show anything to go ahead and radiate the lymph nodes on the hope it might work? What are the statistics of success ? Will it cause more damages from extra radiation when they do it blindly?
Allen, you gave me more options to talk about with the MO which I will discuss with Morris when I see him but with regard to the RO, should I take his words for it or look for another RO?
Thanks all for your input.
age 63 now, diagnosed on 10/2012 at 58 years old
RP 12/2012, Gleason 3+4, positive margins and extra capsual extention, PNI,. T2c.
Psa on 11/2016 .07
Started external beam radiation on 1/2017
Psa 7/2017 .1 (MSK lab1)
Psa 11/2017 .16 (lab2)
Psa 1/30/2018 .20 (lab2)
Psa 2/22/2018 .17 (MSK Lab1)

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10108
   Posted 2/27/2018 12:28 PM (GMT -6)   
No, I do not think it is a good idea to radiate the pelvic LNs without some clear indication that that is where the cancer is. Unfortunately, 0.2 is at the lower limit for PET detection, unless it is rising very rapidly. The only scan that may be able to show any cancerous LNs at a PSA that low would be the Combidex MRI - but you'd have to go to Holland for that.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Ak123
Regular Member


Date Joined Nov 2016
Total Posts : 211
   Posted 2/27/2018 3:48 PM (GMT -6)   
Thanks Allen, one more question please: at what Psa level, I should go and get a pet scan that will be beneficial without missing an opportunity for a cure? Or realistically There is no cure for me at this point ?
Someone from here sent me a table with the pet scan limits for detection and it had a pet-Psma at .6
age 63 now, diagnosed on 10/2012 at 58 years old
RP 12/2012, Gleason 3+4, positive margins and extra capsual extention, PNI,. T2c.
Psa on 11/2016 .07
Started external beam radiation on 1/2017
Psa 7/2017 .1 (MSK lab1)
Psa 11/2017 .16 (lab2)
Psa 1/30/2018 .20 (lab2)
Psa 2/22/2018 .17 (MSK Lab1)

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10108
   Posted 2/27/2018 4:01 PM (GMT -6)   
There's a better, more up to date table here:

/pcnrv.blogspot.com/2016/12/pet-scans-for-prostate-cancer.html
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Ak123
Regular Member


Date Joined Nov 2016
Total Posts : 211
   Posted 2/27/2018 4:20 PM (GMT -6)   
I see sources 2,3,5,6&8 fits .2 psa. I am confused, why then my situation does not apply? Is it because the probability of finding something is small? Between 11.3 to 58% and most patients just ignore it and wait wait until psa gets higher?
age 63 now, diagnosed on 10/2012 at 58 years old
RP 12/2012, Gleason 3+4, positive margins and extra capsual extention, PNI,. T2c.
Psa on 11/2016 .07
Started external beam radiation on 1/2017
Psa 7/2017 .1 (MSK lab1)
Psa 11/2017 .16 (lab2)
Psa 1/30/2018 .20 (lab2)
Psa 2/22/2018 .17 (MSK Lab1)

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10108
   Posted 2/27/2018 4:48 PM (GMT -6)   
Probability is too low - it would cost a lot of money for very little chance of finding anything. If the range is 0.2 - 0.5, you can be sure that most of the detections were at the high side of that range All PET scans, whether in trials or approved, have a minimum requirement for recurrent patients of a confirmed PSA over 0.2. You'd have a hard time getting covered or into a trial.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Tomson
Regular Member


Date Joined Mar 2015
Total Posts : 63
   Posted 3/8/2018 12:53 AM (GMT -6)   
AK123,
If your PSA doubling time is less than 9 months and your PSA gets up to .5, you might qualify for a clinical trial described here. Apalutamide (Erleada) and abiraterone acetate (Zytiga) are being tested in combination with degarelix (Firmagon) versus degarelix alone. You're not a candidate yet. I think MSK is one of the sites in this trial so your medical oncologist will probably let you know if and when you meet the criteria for inclusion for this or other studies. I would recommend trying to get all of the PSAs done at MSK to minimize the risk that your numbers bounce around due to different assays. I haven't read this whole thread so I may have missed something that would make this trial inappropriate for you. If that's the case, my apologies. Although things moved more quickly for me, i also started out as a 3+4 who had an RP that seemed to work just fine for a while and then SRT that did not faze the recurrent PCa. It's a strange experience the first time they tell you that you've graduated from "favorable intermediate risk" to "high risk."
Best, Tomson
Dx 2/15 (age 65) PSA 5.45
PCa 8/12 cores; 3 cores G7 (3+4); 5 cores G6 (3+3)
RALP (UCSF) 4/8/15
Path: G7 (3+4, tertiary 5); ECE-, SM-, LN-, SV-; PNI+
Decipher: 6.6% 5-yr metastasis; 6.3% 10-yr PCa mortality; PORTOS low
PSA thru 11/15: <0.015; 2/16 .031(!!) -->1/17 .194
SRT 70.2Gy 1/5/17-3/2/17
Post-SRT PSA 5/25/17: .338; 8/31/17: .491

Ak123
Regular Member


Date Joined Nov 2016
Total Posts : 211
   Posted 3/8/2018 7:51 AM (GMT -6)   
Thanks Tomson,
I have noticed in your signature that you had a Decipher test which I have no ideas about which they give you 5 years to Mets and 10 to mortality. Is this test accurate? Do you plan your life based on it? Should I get it?
age 63 now, diagnosed on 10/2012 at 58 years old
RP 12/2012, Gleason 3+4, positive margins and extra capsual extention, PNI,. T2c.
Psa 12/12/2016 .07
SRT 1/3/2017 (39 sessions at MSK )
Psa 5/16/2017 .07
Psa 7/15/2017 .10
Psa 2/22/2018 .17

RobLee
Veteran Member


Date Joined Apr 2017
Total Posts : 703
   Posted 3/8/2018 8:19 AM (GMT -6)   
Tomson said...
... i also started out as a 3+4 who had an RP that seemed to work just fine for a while and then SRT that did not faze the recurrent PCa. It's a strange experience the first time they tell you that you've graduated from "favorable intermediate risk" to "high risk."
Oh man, I feel so sorry for you, Tomson and AK123. I had noticed over my short time here that it seems to be the 3+4 guys who start out with favorable pathology that suddenly end up with rapid PSA rise for which SRT has little or no affect. This pretty much tells it all right here:
Tomson said...
Path: G7 (3+4, tertiary 5); ECE-, SM-, LN-, SV-; PNI+
PSA thru 11/15: <0.015; 2/16 .031(!!) -->1/17 .194
Post-SRT PSA 5/25/17: .338; 8/31/17: .491
I can't imagine what a blow that must be. First you get the initial shock of "what, I have cancer?", then are told (most likely) that it is curable... only to be blindsided down the road with this terrible news.

And then there's always the well meaning acquaintances who tell YOU that prostate cancer is totally curable, and you can only say something like, yeah, in early stage, mine is not.

A tough road for you guys. I pray that newer treatments open up a brighter future for you.
2014-15: PSA's 9, 12, 20, 25... Neg DRE's, false neg TRUS biopsy
6/16: MRI Fusion biopsy, Right Base, 2x40%+2x100% all G8 (4+4)
8/16: DaVinci RP, PNI, 6mm EPE, 11 LN-, 53g 25% involved Grp 4, BL SVI, T3b n0m0
1/17: started 18 months Lupron ADT, PSA's ~.03
5/17: AMS800 AUS implanted, revised 6/17
8/17: RapidArc IMRT 39 tx (70 Gy) Aug-Oct 2017
1/18: PSA 0.00, Now test every 3 months for a trend

Tomson
Regular Member


Date Joined Mar 2015
Total Posts : 63
   Posted 3/8/2018 1:02 PM (GMT -6)   
AK,

I don't think the Decipher test results have yet made the slightest difference in any of the recommendations for treatment from my radiation oncologist or medical oncologist. Perhaps it would be otherwise if the test had showed my cancer to be high or low risk but it merely reported it as intermediate risk. Perhaps Tall Allen could imagine a scenario in which this might have influenced my treatment plan, but, so far, I think it is more just another interesting data point. The test is performed on a specimen from the prostatectomy so it tells you something about the genetic makeup of what came out of you when you had your surgery. When the natural history of prostate cancer in all its variations is better understood, this kind of test may make a huge difference. But at this point, the risk factors calculated by the Decipher score are based on a computer sifting through tons of data and mechanically deriving the formula that best predicts outcomes.

When I got the test, the conclusion printed on the Decipher report was that I might benefit from SRT. Well, I didn't. I didn't have ADT at the same time, so the steady upward march of my PSA scores showed that the SRT accomplished nothing. I learned that, wherever the cancer may be, it is not in my, now vacant, prostate bed. I need to update my profile to reflect that I had a Ga68- PSMA PET Scan when I was near .5 PSA and it found no metastases for spot radiation treatment. Although TA has pointed to the lack of evidence that spot treatment of oligometastatic PCa delays metastasis or prolongs life, I would have considered it if the PET Scan had turned up some targets to shoot at. But no such targets presented themselves. I was left with the conclusion that I could wait until my PSA climbed higher and repeat the test or begin systemic treatment. My choice was to forward with systemic treatment, i.e., ADT, albeit ADT with a chance to try out some experimental addons. As it turned out, I wound up being randomized into the degarelix plus apalutamide arm of the trial.

My hope is that your doubling time (once there are more data points) will turn out to be way too long for you to be considered for joining the clinical trial I mentioned in my earlier post. Using the three data points in your latest signature, the MSK doubling time calculator reports a doubling time of 7.74 months, but DTs may slacken or accelerate. My DT is around 6 months, which is significantly worse than 7.74 months, but hugely better than, say, 3 months. If your doubling time remains the same, you would not reach .5 until next February. In my book, that means you don't need to rush into anything. I'd say your 5 years before reaching biochemical recurrence (PSA of .2) after your RP is a very good sign (I got there in less than 2 years). I had tertiary 5 reported in my pathology report after surgery. You don't mention that, so I would guess that's another factor favoring a calm approach.

But to get back to your question and, for the benefit of others who may follow this thread, you've already reached the 5-year mark without metastases. What good would it do to get a report that tells you your chances of doing so based on a tissue sample that is 5 years old? You've already passed that finish line and you are a winner! (Still, talk to your docs and consider carefully anything Allen has to say.)

Tomson

P.S. to Rob Lee: Thanks for your concern. It has been a challenge to keep my head on straight, but I have a lot of resources--a loving marriage, great friends, volunteer work that is very meaningful to me, great terrain for bicycling, and overall good health and fitness. For the reasons you can glean from my response to AK, we are not in exactly the same boat and I'd be delighted to swap my stats for his. We may both have a chance to witness miracles and wonders that put us back in the potentially curable column. He's got MSK in his corner and I've got UCSF so there's a factor in our favor that shouldn't be overlooked.
Dx 2/15 (age 65) PSA 5.45
PCa 8/12 cores; 3 cores G7 (3+4); 5 cores G6 (3+3)
RALP (UCSF) 4/8/15
Path: G7 (3+4, tertiary 5); ECE-, SM-, LN-, SV-; PNI+
Decipher: 6.6% 5-yr metastasis; 6.3% 10-yr PCa mortality; PORTOS low
PSA thru 11/15: <0.015; 2/16 .031(!!) -->1/17 .194
SRT 70.2Gy 1/5/17-3/2/17
Post-SRT PSA 5/25/17: .338; 8/31/17: .491

Tall Allen
Elite Member


Date Joined Jul 2012
Total Posts : 10108
   Posted 3/8/2018 1:17 PM (GMT -6)   
I agree with Tomson that Decipher is only useful if the results are very good or very bad, but most guys are in the middle. I think it should only be considered if one is on the fence about having SRT - but you've already had SRT. It shows the population probability that a man whose prostate had your genomic characteristics will go on to develop metastases in the next ten years if he doesn't have SRT. Besides, I think that most places only keep the prostatectomy tissue around for 5 years, so it may be too late.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

Ak123
Regular Member


Date Joined Nov 2016
Total Posts : 211
   Posted 3/8/2018 1:30 PM (GMT -6)   
Thank you so so much Tomson for your long well written response. It did help to read it and it does make a lot of sense to me. Thanks again. I have an appointment with a first visit to see a MO al MSK next month and I think he is gonna say what you said.
Rob Lee, thanks for your wishes. All I can do at this point is to try to stay on cashless diet and see what happens. People in here are very kind and supportive
age 63 now, diagnosed on 10/2012 at 58 years old
RP 12/2012, Gleason 3+4, positive margins and extra capsual extention, PNI,. T2c.
Psa 12/12/2016 .07
SRT 1/3/2017 (39 sessions at MSK )
Psa 5/16/2017 .07
Psa 7/15/2017 .10
Psa 2/22/2018 .17

Ak123
Regular Member


Date Joined Nov 2016
Total Posts : 211
   Posted 3/8/2018 1:43 PM (GMT -6)   
Thanks Tall Allen. I do understand.
age 63 now, diagnosed on 10/2012 at 58 years old
RP 12/2012, Gleason 3+4, positive margins and extra capsual extention, PNI,. T2c.
Psa 12/12/2016 .07
SRT 1/3/2017 (39 sessions at MSK )
Psa 5/16/2017 .07
Psa 7/15/2017 .10
Psa 2/22/2018 .17
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