Replicant
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Joined: 01 Nov 2006
Posts: 721
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 Posted: Sun Jun 28, 2009 8:04 pm Post subject: PSA and aggressiveness |
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David, we've been concentrating on the Gleason 9 aspect of your case. But there's another aspect that makes me worry for you. It's how fast your PSA has been rising. That makes me think you're going to need a combination. Maybe not right away--but, for example, if you have surgery, you will have a fairly high chance of positive margins. If you have positive margins, you will need to decide on your next course of action.
Walsh, in his book on p. 152, says (emphasis mine) "A major change in PSA can also be a sign that something is very wrong--that there is significant cancer, and that it may be difficult to cure. Two large studies of men who had a PSA velocity of 2 ng/ml within the year before diagnosis were much more likely to have an aggressive form of cancer, and more likely to die from prostate cancer within ten years. Thus, if you have a sudden jump in your PSA...you may have significant disease that needs treatment immediately and that may require more than surgery or radiation therapy to cure.
(Walsh, Patrick C., MD, and Janet Farrar Washington. Dr. Walsh's Guide to Surviving Prostate Cancer, 2nd edition. (New York: Warner Wellness, 2007).
Dr. Walsh is a leading urologist, the one who pioneered nerve-sparing surgery.
I think I may be repeating this bit of information from Walsh, but it seems directly relevant to the conversation and therefore bears repeating. Your PSA, as you reported, seems to have been taking just such sudden jumps.
Some of us have been watching New York Times columnist Dana Jennings, who went into surgery thinking he had Gleason 7, and organ confined disease. It turns out that in surgery, he was found to have T3b disease (the tumor had escaped the capsule) and it was Gleason 9. His doctors gave him quite a combo at that point--radiation and hormone therapy. His story is quite compelling and well-told. No holds barred (there I go again!) http://well.blogs.nytimes.com/tag/jennings/
Anyway, as always, best wishes for your health.
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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 |
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