Sorry to hear about the bounce and can imagine the surprise after the long, relatively calm, 6 years. I wish you all the best for the path forward. As noted by others, with likely SRT in the near term, decisions to be made around ADT and/or a wider field of focus for radiation. Passing on my wishes for this being a misread on the latest PSA.
Saipan Paradise said...
Retest, BB. Retest.
There's a lot of research on cancer dormancy, esp. prostate cancer. Two types: (1) fake dormancy -- cancer cells are dividing/growing at the same rate as they're dying, and (2) true dormancy, the cancer's asleep for some reason, waiting for a favorable environment for growth. Some evidence that dormant cells are particularly hard to kill.
Here's an article on cancer dormancy from NCBI:
Thanks for your thoughts and advice, guys, and everyone else as well! So, I finally heard from my docs office, and my "plan" is moving forward! Boy are they excited about
this leap upward! ;) I talked with either his nurse or the nurse practitioner, not sure which. An it's almost funny to listen to them, it would be for anyone who frequents this forum, as they assume we know zilch. (when I talk to my doc, he does not do that, with me at least, as I gave anesthesia for his surgeries in years past). So, she gently explains to me that there has been a slight increase in my reading, from .06 to 0.2. (yes, I know, and I don't call it slight, a 3.3 times increase, but call me paranoid. But, I did not say that to her, I just said "uh huh, yes, I understand". ) So Doc wants a retest on 4/1(so, 42 days from yesterdays test) and then another on 5/14(after an additional 43 days, and I see the doc. So they are clearly not quite as excited about
all of this as I was yesterday. Of course, they did not more than triple.
Also, I realize that most of these docs are not like many of us here at this forum. Many of them still would not yet call my single .2 a BCR. Many of us start paying serious attention once .03 or greater. But here is one definition "To describe biochemical recurrence after RP, a panel of experts from the American Urological Association (AUA) evaluated 53 different definitions of BCR following RP observed in the literature, and recommended adoption of a single definition. This involved the presence of a PSA greater than 0.2 ng/mL
measured 6–13 weeks after RP, followed by a confirmatory test showing a persistent PSA greater than 0.2 ng/mL.9
Ultra-sensitive PSA assays have recently improved detection levels down to 0.01 ng/mL, and may possibly lead to better treatment outcomes through earlier adoption of salvage radiation therapy following RP.10,11 However, false positives occurring because of trace amounts of PSA produced by residual benign prostatic tissue, along with uncertainty about
whether ultra-low levels of PSA will be followed by continued PSA increases, have led practitioners to continue to rely on the AUA definition for determining when clinically-relevant biochemical recurrence has occurred after prostatectomy.
The definition of BCR following RT is more problematic............." https://www.ncbi.nlm.nih.gov/pmc/articles/pmc3624708/#__ffn_sectitle
This was from 2013, it may well have changed since then. It would appear my docs go more by this approach.
One other thing. I was looking around for BCR after more than just a few years(which, again, and surprisingly, I don't seem to actually have BCR YET, I was unable to supply the numbers needed for the MSK BCR normograms ), and one study I looked at calculated the odds of mortality vs 5, 10 and 15 years and they found 3 most important variables: G score, doubling time, and BCR < 3 years or > 3 years. Obviously I am screwed on the G score. Doubling time, I don't have one yet as they are not calculated on uPSA numbers. But the number of years to BCR, I figure that included the bad G #s and bad doubling time in those groups. In fact, "Most patients had pathologically extraprostatic disease and high-grade disease". So, the outcome difference between <3 years vs > 3 years was large. Or, those with > 3 years after RP before BCR had very high 10 and high 15 yr survival rates. I will have to wait and see what my doubling time(DT) is in months. According to this study, a G8-10, with a greater than 15 month DT and a BCR > 3 years(mine is 6 years) had 15 year survival of 87%(vs 94% for Gleason<8). https://cdn.jamanetwork.com/ama/content_public/journal/jama/4985/joc50067t3.png?expires=2147483647&signature=ft6tzkshwffvi9ia4-rnjtsuoqkuhw2blym0xmoggdv7lcodnhpz73won38sbdtvehrktfmjjh8qpt11uiaacd6lh-~iutbycaxvupqkzxx3rfooms0ersheykt7yg6qtefbjowzaamflr3s6uw7alzcd6nzw3cjih9sajmgrdfzzwhcg8vjt1w4tggtiybqptasdrsasgg65dkduvm86lprshesrqxvwhzj87rqddtk3sby97kc9k6dupnckmvm7xeavrk-wtawmmumcnljjgqknjs9pzsx5wria9vzibb0icuemafzejw5thyw8gk3ct4eta~wzkd5x-swwdwjbg__&key-pair-id=apkaie5g5crdk6rd3pga
(hope that crazy link works)
Simply looking at BCR < 3 yrs vs > 3 yrs, 15 year survival appears to be about
82%(for BCR >3yr) or more vs about
50% for BCR = < 3 yr. Whether I have some RT in my immediate future or not( I assume these folks had further treatment?), I am not going to worry too much about
this(maybe that is why my docs don't seem too worried either?), because those odds are more than acceptable, I am more likely have a stroke or heart attack or something else. https://cdn.jamanetwork.com/ama/content_public/journal/jama/4985/joc50067f1.png?expires=2147483647&signature=fmc2joztmwghy69gft~5sedyrkes7a6k5kv~anxuojdk6hv128baf2cep9zqmxlzsg3lyrblyvwp8kknklf1dip4jezu9iqfds-feetck8bixdyqoikaxlmqgbnj7skughqeoz2gsugga-wsbzxj9nndd8bng7m62wax2~z9ohljit56wb50eukmg1i~qcwuvuznydrg1r~8k5pb~1x4oalf1nipcw-jjfh2kucwcau91ho1oypdi8iivro~51dfbmavyxcyaizxrninrioumtdlixtxn2tcbbru36inz0ro9m4hb71jm9wne4hz9ecljzotl~y3nxbb8dkihdg3cg__&key-pair-id=apkaie5g5crdk6rd3pga
Those links are graphs and tables, here is the whole study(BTW, this study was way back in 2005, I imagine things have improved for us since then) : https://jamanetwork.com/journals/jama/fullarticle/201291
Post Edited (BillyBob@388) : 2/20/2020 8:24:47 PM (GMT-7)