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sumobiker
New User
Joined: 19 Mar 2008
Posts: 5
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 Posted: Wed Mar 19, 2008 1:29 pm Post subject: Rising PSA after radical |
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| Had prostate out in Aug. of 2002 after a PSA level of 8 and Gleason of 7. Am now 55 and PSA has risen from .03 right after surgury up .01 every 6 months. Now is .14 and will have it checked again 3-21-08. Was sent to oncologist a year ago, and was told to do 2yrs. hormone therapy and radiation. She was a breast cancer specialist, so I opted for a second opinion. Went to Dana Farber in Boston. Was told because of the slow rise I could do radiation then or maybe wait a year or till it got to .2. If my next check up goes up another .01 I 'm not sure what I should do. Any advice? thanks |
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johnw100
Senior User
Joined: 15 Apr 2006
Posts: 111
Location: australia
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| Posted: Wed Mar 19, 2008 6:10 pm Post subject: Re: Rising PSA after radical |
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Slow rise in PSA often suggests a local recurrence, although it is difficult at this time to gauge location of any recurrence to determine whether it's local or early metastases which would probably not yet show up on scans. Sometimes remaining benign tissue can also cauce a rise in PSA.
Have DREs been done?
Your advice from Dana Farber is logical: it's a grey area, and it depends on how agressively you want to approach it.
It's worth reading the chapter of Dr Scardinos book on Rising PSA after surgery. |
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Replicant
Moderator
Joined: 01 Nov 2006
Posts: 124
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| Posted: Wed Mar 19, 2008 6:17 pm Post subject: oncologists |
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Yikes--I'm glad you went to Dan Farber. That sounds like good basic advice. See my blog (referenced in my signature). In my blog I summarize and link to a lot of research about when and if to try salvage radiation.
From my layperson's understanding, they're correct in that it probably won't matter to wait until 0.2. Oncologists who know a lot about PCa and urologists know that there is a small group of men whose PSA will progress to 0.1 or 0.2 after surgery *and then progress no further*. So they want to see some subsequent rises past a certain point, like 0.1 or 0.2. The key is they want to see a trend over time. Of course, you have seen a trend over time, albeit mostly with ultrasensitive tests. So I'd say again, they're correct. Start soon, or wait. If it were me, if I saw another increase at this point, I'd lean towards getting started with radiation.
Andrew Stephenson, a urology researcher who has done a lot of good work in the area of salvage radiation, says for optimal chances of success, salvage radiation should start before PSA hits 0.5. If that's not possible, then it should be started before 1.0. Outcomes are much better the earlier it's started.
Adding hormone therapy to radiation has been shown to increase its effectiveness.
Were your surgical margins positive (cancer extending to the cut edge of the removed tissue) or negative (clear of cancer)? Do you know about lymph nodes and/or seminal vesicle involvement?
_________________
Replicant
Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, 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 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com |
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brainman
Site Admin
Joined: 13 Oct 2005
Posts: 3008
Location: Tennessee
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sumobiker
New User
Joined: 19 Mar 2008
Posts: 5
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| Posted: Thu Mar 20, 2008 6:10 am Post subject: Re: Rising PSA after radical |
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| Not sure what DRE's are. My surgical margins were neg.Have put off on the salvage radiation because of the side affects, and because my doctor originally told me they wait till PSA gets to .2 .Looked into Proton therapy also but was told I wouldn't be a candidate. I'll see what my level is today, and do some more research. I'm thankful for the input on this site, I only wish I'd checked into it before. I've gotten more answers here than from all the doctors I've talked to. |
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johnw100
Senior User
Joined: 15 Apr 2006
Posts: 111
Location: australia
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| Posted: Thu Mar 20, 2008 7:17 am Post subject: Re: Rising PSA after radical |
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"DREs"
Sorry about the shorthand, it might sound unusual.
To quote Dr Scardino, " An annual digital rectal exam (DRE) should be part of the standard monitoring after radical prostatectomy. If the doctor feels a suspicious area on DRE, a biopsy of the suspect tissue is indicated. Cancer regrows in the prostate bed (the area left behind after surgery) with disturbing frequency. In several studies, cancer was detected on biopsy in a whopping 40 percent of patients who had a rising PSA after radical prostatectomy." |
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sumobiker
New User
Joined: 19 Mar 2008
Posts: 5
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| Posted: Thu Mar 20, 2008 9:06 am Post subject: Re: Rising PSA after radical |
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| I will ask about the DRE today, I haven't had one. Thanks for the info. |
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sumobiker
New User
Joined: 19 Mar 2008
Posts: 5
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| Posted: Sat Mar 22, 2008 8:42 pm Post subject: PSA rise after radical |
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Got my results back today and PSA went up from a .14 which was that for a year, to .19. Been going up only .01 every 6 months since radical pros. in Aug of 2002. Going to be sent to oncologist, they will probably suggest salvage radiation. Any other options other than waiting another 6months? Is hormone therapy given without radiation? Dr. didn't do a DRE, did a rectal exam and didn't feel anything abnormal. Said if PSA were higher she would have done DRE. Very confusing. Trying to get all the info I can before I make any rash decisions. thanks
6-02 PSA 8. Gleason 7. 3+4-7. Neg. |
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brainman
Site Admin
Joined: 13 Oct 2005
Posts: 3008
Location: Tennessee
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sumobiker
New User
Joined: 19 Mar 2008
Posts: 5
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| Posted: Sun Mar 23, 2008 5:48 am Post subject: Re: Rising PSA after radical |
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Free PSA. Don't recall anything said about this. What is it and why wouldn't they check? Read your story Jim, you've been through a lot and I'm impressed with the help you have given others.
Terry |
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swimom
New User
Joined: 14 Nov 2005
Posts: 7
Location: Michigan
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| Posted: Tue Mar 25, 2008 8:51 am Post subject: Re: Rising PSA after radical |
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Hi Sumo,
You wondered if hormones could be given without radiation and the answer is yes. Hormone therapy has some pretty severe side effects for "some" people while others do pretty well. Too bad there wasn't a test to know who would do which. My opinion, radiation doesn't seem unreasonable but, I'm not the one having to endure treatment either. Your's sounds much like a local recurrence. My thought is that radiation alone might also be a consideration.
Also, a free PSA and DRE were mentioned. Free PSA isn't really going to tell you anything right now and if Doc did a rectal, you had a DRE :>)
Hang in there,
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swim |
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Beth56
Regular
Joined: 30 Mar 2008
Posts: 11
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| Posted: Mon Mar 31, 2008 10:14 am Post subject: Re: Rising PSA after radical |
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[quote="sumobiker"]Looked into Proton therapy also but was told I wouldn't be a candidate.[/quote]
May I ask who told you this and why you would not be a candidate? Just curious as my husband had Proton Beam Therapy for his cancer. |
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