Bracing for a long Fight

Hawk · Senior User Joined: 22 Nov 2006 Posts: 424

I get my 6 months post salvage Radiation PSA on Wednesday(results Thursday).

I am bracing for bad news because of Gleason 8, negative surgical margins, but mostly because:
my pre SRT PSA was at least .16
At the end of SRT it was.10
90 days post SRT it was.09

That last drop of only .01 in the 90 days following SRT is the reason for bracing. The only way I can account for that is that while some of the cells are dying, others outside of the radiation field are growing and off-setting the PSA drop.

Until Thurs, I guess it is premature but I see my self researching clinical trials, and the many aspects of HT/ADT Ad Nauseam. My first questions will be the suggestion that HT actually contributes to PCa getting aggressive sooner and whether I should enjoy my symptom free status for as long as it lasts. With a PSA anywhere in the .10 to .20 range I feel I would have time to make clear informed decisions. Obviously I am not an optimist Smile

I always felt those guys are always getting caught off guard. Smile

_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

johnT · Senior User Joined: 27 Apr 2009 Posts: 235

Hawk,
Get the best Prostate oncologist you can, there are about 6 or 7 really good ones in the US and expertise matters even if you have to travel. If you do go on HT it can be done locally and it's good to have someone that's an expert that know all the tricks consulting on your treatment.
There are conflicting opinions if HT eventually makes the PC worse. There is no question it will kill all of the androgen dependent PC, but weather it supports the growth of androgen independent cells is questionable. My oncologist thinks not because these pc cells are agresssive and will grow anyway. many patients have been on HT for a long time with good success.
Your PSA is still dropping which is a positive sign, radiation takes time to work.
Good Luck,
JohnT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

Putt · Regular Joined: 04 Aug 2009 Posts: 36 Location: Kansas

Hawk
Hey friend, you need to RELAX a bit. You have NO immediate crisis, and forget about trials, ADT, and everything else for a while, and enjoy your current success of fighting this monster.

I had to read your post several times and I am still not sure I fully understand your Tx so far, but it looks to me that after your salvage radiation the PSA started going down and is still headed that direction. Hooray, nothing better than that. Even if it starts to gradually go up, you still have time to develop a good strategy for treatment.

You've already had good advice about finding an excellent Oncologist, and start researching ADT and all of its effects. In most cases, it would be the next step when its time, in spite of its side effects. Each one of us must decide our own path. Good luck with the PSA test.
_________________
PSA at Dx 105 at age 68, 4/04. ADT, RRP, 5/04. Gleason 4+5=9, Staged pT3c N0 MX, 3D rad, 40 treatments, 8/04. PSA 1/05 <0.01. ADT till 7/07. PSA 0.03 12/08, 0.07 4/09, 0.13 8/09, 0.19 12/09. Will start ADT3 after PSA reaches 1.2.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 860

All good thoughts flowing your way, my friend.

I understand your anxiety, nothing I can do to change that.

Hang in there. I don't see why your PSA can't continue to trend downwards.

Will be looking for your update.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

mkane09 · Posted: Mon Aug 17, 2009 6:17 pm Post subject: Re: Bracing for a long Fight

Hawk, when I consulted with Dr. Joseph Smith at Vanderbilt regarding SRT, he advised yes to radiation, but said there was no need to rush to ADT. In fact, he advised no ADT until the PSA had risen to at least 5.0.

So, sit down buddy, we'll have a cold one together and relax a bit. Actually, I know EXACTLY how you are feeling right now. Got everything crossed for you.....

mkane09
_________________
PSA 6.48, biopsy Gleason 3+4, robotic prostatectomy 9/17/08, pathology Gleason 4+5, pathologic stage T2c, positive margins, first post-op PSA 10-15-08 0.10; 2nd post-op PSA, January, 2009 0.18; SRT completed May 22, 2009. 1st post-radiation PSA, 8-4-09, <0.06. PSA 12-22-09 <0.06

John M · Experienced user Joined: 27 Jul 2009 Posts: 59

Hang in there, Hawk. If those cells are just sitting there and not dividing much, well, they could stay there and not make trouble for a long, long, long time, even if your PSA doesn't eventually make it down to undetectable. My sister had a low grade ovarian cancer removed 20 years ago, and has had a slowly increasing C-125 level (a more specific tumor marker for that than PSA is for PCa), without ever having any visible recurrence, even on a whole body PET scan. Let's hope you are equally slow.

I wouldn't give you any suggestions about chemo, except, find a good oncologist that you trust to talk to.
_________________
John

Hawk · Senior User Joined: 22 Nov 2006 Posts: 424

Thanks Guys,

I am fine, just a little pre-test anxiety. It is almost like I hardly remember what it was like not to have a PSA-test hanging over my head. Admittedly, they have not occupied my thoughts as much over the years but this one I think will be far more significant than most, probably more significant than ANY. I cannot not imagine an ambiguity after this test. Either my PSA will take a significant fall (from .09 to .06) or...I will clearly be in the mode of managing cancer.

If so I will have lots of questions but we will wait till Thursday rather than prematurely starting down that road.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

Pam

Hi Hawk,

I know my position is very different from yours, as I am a relative of a man with pc, so I am not the one dodging through the hoops, trying to avoid progressing to the next stage of the cancer, like you are.

I have always appreciated your input whenever I've posted something about my dad, and have found your comments invaluable.

You are being a realist and trying to prepare yourself with as much information as you can, and rightly so, to try to be ready for whatever the doctor says about your results, so you'll be in control. I think that's a good idea.

I can't provide you with any medical information, but I wanted you to know that I've got my fingers crossed for you that all goes well with your results.

Keep us all posted. You are in our thoughts.

God bless,

Pam
_________________
My Dad's an oldie but a goodie. I'm going to be strong for him, so that I can help him ride the rest of the journey. I love him so much.

Jean222 · Senior User Joined: 14 Dec 2008 Posts: 262

Hi Hawk,

Hubby and I are sending you lots of positive thoughts and hope that your PSA has dropped as far as you need it to, in order to be happy and healthy for a long time to come.

I agree with John M's post.....makes a lot of sense.

Try to kick back a bit til you know the lay of the land.

Best wishes, as always,

Jean & Hubby

CS53 · Regular Joined: 13 Apr 2009 Posts: 15

[quote]My first questions will be the suggestion that HT actually contributes to PCa getting aggressive sooner and whether I should enjoy my symptom free status for as long as it lasts.[/quote]

Hi Hawk

I am on ADT3 therapy as we speak (8 mo. total) going thru Proton salvage RT at Loma Linda. I asked my prostate oncologist Dr Mark Scholz about the potential of HT contributing to my PCa becoming more aggressive. He said absolutely no truth in that whatsoever.

Thanks
CS53

srtimmons · Posted: Wed Aug 19, 2009 5:00 pm Post subject: PSa test

Hawk - you're going to do fine. Keep that positive attitude.
_________________
Age 58
Dx 6/15/2009; PSA 7.1; 7/12 cores positive; Gleason 6 (3+3) and 7 (3+4); PNI observed. Bone Scan and CT scan negative.
Robotic RP 7/20/2009

Path report 8/11/2009 - clean margins, negative lymph nodes, negative seminal vesicles, Gleason 3+4, Stage T2c; 15% of prostate involved; NoMx.

PSA .006 September 2009
PSA .005 November 2009
PSA .005 February 2010

johnT · Senior User Joined: 27 Apr 2009 Posts: 235

Dr Scholz has treated more advanced PC than probably anyone in the US. I think he has seen enough advanced PC cases to know what he is talking about.
JT
_________________
psa at diagnosis 40 in nov-08
gleason 6 and 7
Treatment choice seeds and IMRT

Operaman · Regular Joined: 01 Jun 2009 Posts: 25

We all know the feeling of waiting for the old PSA results for sure. Hang in there. I know I have benefited from your suggestions and experience, as have many more. Now we can help to support you.

Harry
_________________
Bioposy March 2008 negative
March 19 2009 4+3=7 PSA 26 positive for 6 out of 12 cores
RRP May 20 2009 Path 4+3=7 tertiary 5
5% Mostly right lobe some left
Stage T3a 1 focally positive margin, clean nodes, clean vesicle, all tests for mets clean
June 22 PSA undetectable,
course of Adjuvant RT completed in October with minor side effects
PSA 12/06/09 <0.05 (undetectable)

Hawk · Senior User Joined: 22 Nov 2006 Posts: 424

My dear friends, I almost feel embarrassed and like I owe you an apology. Smile

MY 6 months post SRT PSA dropped from .09 to .06. I feel I am finally out of the area of ambiguity and that the radiation made a solid hit on the cancer. Obviously I will not be running through the board posting "I am cured" but by my interpretation, PCa is not likely to send me scrambling for ADT any time soon.

My Pre SRT PSA .16
Last day of SRT .10
3 month post SRT .09
6 month post SRT .06

That lull at 3 months is still interesting. Maybe the test sensitivity and the tiny amount of PSA is the issue here. If .09 was almost .08 and if .06 is almost .07, the drop has been fairly constant.

What I am finally learning is that PCa seems to very difficult to predict. When I have been most optimistic I got fooled. When I have braced for bad news I got fooled. Could make a guy superstitious.

Thanks for your prayers, well wishes, and support. They truly helped.

Hawk
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2, 8.1, 8.7 - Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06, May .09, Jun .10, Aug .10, Nov .15 -SRT

Jean222 · Senior User Joined: 14 Dec 2008 Posts: 262

Ah Hawk, don't apologize!

I'm sure I speak for everyone on the forum when I say.....

That's just wonderful news, CONGRATULATIONS!!!!

May you be well for many, many years to come!

Good going Hawk!

Jean

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