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Thread: Question on BCR - Using PSA to predict time until serious symptoms

  1. #11
    Senior User
    Join Date
    Jan 2019
    Posts
    311
    Quote Originally Posted by Another View Post
    I can't imagine any doctor recommending RT with no benefit. You will not have to worry about that possibility. There are other treatment choices besides RT.

    That view and use of language reinforces my recommendation you be screened for depression. You need some help with this.
    Then maybe you can explain how a low but rising BCR source will be indentified. With LVI it it totally possible the surgery collected all the regional cells and other cells long left the farm.

    Do I have depression? Sure I do and anyone with a high risk PCa DX that doesn’t have some depression is nuts.
    Last edited by Duck2; 03-17-2019 at 02:57 PM.
    DOB 5/1957

    PSA - 11/2010=1.9, 6/12=2.3, 12/13=2.19, 12/14=2.64, 3/17=5.29, 3/17=3.91, 6/17=3.47, 12/17=4.50, 12/17=3.80, free PSA low risk (local (Uro, “My opinion you don’t have cancer), 8/18=5.13, 10/18=5.1, 10/19 ISO PSA 56% risk cancer. All DREs negative.

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative, (Uro opinion “This has been going on for a year”.... ah, more like 2 years ). Bone scan/CT negative

    2/25/19 R-LESS (Robotic Laparoendoscopic Single Site Surgery) outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carinoma
    T3aNO, GS8, unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk. 38% risk 5 year metastasis.

    PSA 3/27/19 .03. (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)

    ADT started 6/3/2019

  2. #12
    Senior User
    Join Date
    May 2017
    Posts
    131
    Quote Originally Posted by DjinTonic View Post
    In your case, if your PSA goes up, we wouldn't be talking about BCR (biochemical recurrence) because your PSA has persisted after surgery rather than recurring after being undetectable.
    Djin
    Djin your quote just registered with me. The term BCR does not fit my situation. Just so there are no misunderstandings, I'm only collecting information about treatment options. I want to understand ALL my options, pros and cons, and be prepared when I meet with the doc.

    My family history on both sides shows death in the late 70s in most cases. I'm factoring that in too. For that reason I was looking at the no-treatment option to see if it would bring me close to that late 70s age range. I'm the only person that I know of in my extended family that takes physical fitness seriously. So I could potentially be the first person to break through into the 80s.
    DOB 1961
    2010-05 2.42
    2015-07 7.0
    2015-08 5.4
    2016-02 6.2
    2016-09 7.86
    2017-02 7.2
    2017-05 5.65
    2017-06 biopsy 7 of 13 cores G6
    2017-10 7.11
    2018-04 7.47
    2018-11 11.80

    2019-01 Da Vinci RALP
    Pathology report:
    Final stage pT2C
    Histologic type: Acinar adenocarcinoma with focal mucinous features
    Grade: 3+4=7 35% pattern 4
    23% of prostate involved
    EPE-
    BNI-
    SVI-
    PNI+
    LVI+
    Margins focally positive [1-3 mm] 4 locations
    Cribriform pattern noted

    2019-02 PSA 0.1 Abbott Architect Total PSA
    2019-03 uPSA 0.133 Roche ECLIA
    2019-04 uPSA 0.116 Roche ECLIA
    2019-05 uPSA 0.143 Roche ECLIA
    2019-05 PSA 0.1 Abbott Architect Total PSA

  3. #13
    Senior User
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    Jan 2019
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    If your goal is 20 years, you need treatment.

  4. #14
    Quote Originally Posted by Duck2 View Post
    If your goal is 20 years, you need treatment.
    Agreed!

    Quote Originally Posted by Duck2 View Post
    ... with the LVI is there is a reasonable possibility that things are not still regional. Going through RT with possible zero benefit will likely be the recommended treatment.
    If he is evaluated for RT I suspect that any cancerous lymph nodes would show up on the mapping CT. I am no authority on LVI, but when asked, my RO did say something to that effect. I also believe that his positive margin may be as likely to lead to BCR if and when it does occur.

    If he is not a good candidate for RT, then HT could keep the lymphatic system in check. Perhaps MM can shed more light on this.

  5. #15
    Quote Originally Posted by Duck2 View Post
    Do I have depression? Sure I do and anyone with a high risk PCa DX that doesn’t have some depression is nuts.
    Good to know I'm not alone on this!
    Late 2012: PSA 4, age 62 all DRE's 'normal' ... Early 2014: PSA 9.5, TRUS biopsy negative
    2015: PSA's 12 & 20, LOTS of Cipro ... Mar'16: PSA 25, changed Urologist
    Jun'16: MRI fusion biopsy, tumor right base, 6/16 cores: 2-40%+2-100% G8(4+4)
    Aug'16: DaVinci RP, -SM, 11 LN-, 53g, 25% involved, PNI, 6mm EPE, BL SVI, pT3B
    Jan'17: started 18 months Lupron ADT, uPSA's ~.03
    May'17: AMS800 implanted, revised 6/17
    Aug'17: 39 tx (70 Gy) RapidArc IGIMRT
    Jan'18-Jan 2019: PSA's <0.008, T=9 (still on Lupron)
    Apr'18: Dx radiation colitis, Oct'18: Tx sclerosing mesenteritis
    "Everyone you meet is fighting a battle you cannot see"
    Mrs: Dec 2016
    Dx stage 4 NHL/DLBCL, Primary Bone Lymphoma
    spinal RT boost+6X R-CHOP21+IT MTX via LP. Now in remission
    Read our story at CancerCoupleBlog

  6. #16
    Senior User
    Join Date
    May 2017
    Posts
    131
    Quote Originally Posted by OldTiredSailor View Post
    I've written several more detailed threads about BCR and prognosis, which summarize much of the research I've found. Here is one link:

    https://www.cancerforums.net/threads...t-RP-prognosis
    Wow! That is a great thread OldTiredSailor! Lots of interesting information. I'll be reading in more detail this evening. Thanks for your input everybody.
    DOB 1961
    2010-05 2.42
    2015-07 7.0
    2015-08 5.4
    2016-02 6.2
    2016-09 7.86
    2017-02 7.2
    2017-05 5.65
    2017-06 biopsy 7 of 13 cores G6
    2017-10 7.11
    2018-04 7.47
    2018-11 11.80

    2019-01 Da Vinci RALP
    Pathology report:
    Final stage pT2C
    Histologic type: Acinar adenocarcinoma with focal mucinous features
    Grade: 3+4=7 35% pattern 4
    23% of prostate involved
    EPE-
    BNI-
    SVI-
    PNI+
    LVI+
    Margins focally positive [1-3 mm] 4 locations
    Cribriform pattern noted

    2019-02 PSA 0.1 Abbott Architect Total PSA
    2019-03 uPSA 0.133 Roche ECLIA
    2019-04 uPSA 0.116 Roche ECLIA
    2019-05 uPSA 0.143 Roche ECLIA
    2019-05 PSA 0.1 Abbott Architect Total PSA

  7. #17
    Senior User
    Join Date
    May 2017
    Posts
    209
    Busby;
    My Radiation Oncologist said it is difficult to know how long it will take for a cancer to get large enough to cause symptoms. It depends upon how fast it is growing and what your life expectancy is. Personally for me, I would be nervous having anything growing in me - period. This is why I got RP in the first place and will get Radiation if needed.

    While your pathology report isn't terrible, you did have some adverse findings such as ...
    3+4=7 is pretty good but 35% pattern 4 is a pretty large quantity of pattern 4 (I had 3+4 but only 1-10% pattern 4).
    PNI Present is a pretty common finding and most of us on here I think have it
    However, LVI isn't very common and is an adverse finding
    You had a 1-3mm positive margin at four places. While 1-3mm is pretty small, having it at four places isn't good and means there could be the potential for BCR in your future.
    Does your pathology report state what percentage of pattern 3 and 4 was in your prostate (My post-RP pathology states 1-10% pattern 4 though my biopsy stated 5% pattern 4)
    Also, does your pathology state what pattern was at your positive margins (Mine stated pattern 3)? Pattern 3 is less agressive and less likely to spread, pattern 4 is more agressive and more likely to spread.
    Cribriform pattern is an adverse finding as others have said and increases your chances of BCR and your cancer being more agressive.

    I would suggest you monitor your PSA as closely as possible, perhaps even monthly and also search for an expert radiation oncologist to be ready if needed and to get his/her thoughts based upon your pathology. You don't want to be searchng for a Radiation Oncologist if an adverse event occurs and you get stressed out. Due to your adverse findings, you may want to be sure you also have a good Urologist to discuss if it's a good idea to also start Hormone Therapy. Your RO would likely chime in on this question too as mine did who didn't think I needed it given my pathology and long list of side effects from HT.

    I am potentially heading towards BCR after my PSA is beginning to rise slowly 1-1/2 years following RP and I have a RO lined up monitoring my PSA closely and will be ready to start radiation in a month or two if needed. Fore me, my PSA isn't rising that fast and it's still pretty low so there's not a rush to begin treatment according to my RO. He suggested retesting PSA every 3 months but I told him I wanted to test every month so that's what he's letting me do.

    I asked my RO if he thought there was a chance of my cancer spreading beyond the prostate bed (If I do BCR) and while he said it's unlikely he always also said there are no guarantees and for that I appreciate his honesty.

    Good Luck.
    Age at diagnosis: 57
    8/15/14 PSA 2.9
    3/01/17 PSA 5.9
    5/1/17 Biopsy Results
    6 cores positive out of 12
    1. G 6 - 45%, 2. G7 (3+4) - 70%, 3. G6 - <5%, 4. G7 (3+4) - 40% Perineural Invasion Identified
    5. G6 - 15%, 6. G6 - 15%
    CT and bone scan negative
    Biopsy second opinion by the Cleveland Clinic: Still G3+4 (% of pattern 4 in each of two cores = 5% of tumor)
    Pre Surgery PSA = 6.11, Free PSA = 13%
    Davinci performed August 1, 2017 at Cleveland Clinic
    Catheter out August 9, 2017
    Pathology: Pathologic Stage - pT2: Organ confined, Gleason Score 3+4=7: Grade Group 2.
    % of pattern 4: 1-10%, % of pattern 3: 91-100%
    SV -, BN -, LN -
    Margin of resection is focally positive for tumor, Length of positive margin: 1mm
    Gleason pattern at positive margin: Pattern 3.
    Post-Op PSA History: 9/14/17 <.03, 11/10/17 <.03, 5/10/18 <.03, 7/19/18 <.03, 9/15/18 <.03, 11/14/18 .03, 02/18/19 .05, 3/12/19 .05, 4/22/19 .06
    SRT begin 5/7/19, 70.2 gy total in 35 fractions.

  8. #18
    Senior User
    Join Date
    May 2017
    Posts
    131
    I had 30% to 40% pattern 4 so I just said 35% to save some typing. The report specifically stated NO PATTERN 5 WAS PRESENT. The pathology report did not say what pattern of cancer was at the positive margin sites. I was going to ask my doc about that but I thought to myself, if they didn't put that info in the pathology report they probably won't go back and look. If this is something the pathologist will go back and look at, I will ask them to do so. Others have suggested getting genomic testing done. I think I will do that too. I believe knowledge is power and I want the most complete picture of the disease process as possible.

    I logging out and going for a hike. Thanks all.
    DOB 1961
    2010-05 2.42
    2015-07 7.0
    2015-08 5.4
    2016-02 6.2
    2016-09 7.86
    2017-02 7.2
    2017-05 5.65
    2017-06 biopsy 7 of 13 cores G6
    2017-10 7.11
    2018-04 7.47
    2018-11 11.80

    2019-01 Da Vinci RALP
    Pathology report:
    Final stage pT2C
    Histologic type: Acinar adenocarcinoma with focal mucinous features
    Grade: 3+4=7 35% pattern 4
    23% of prostate involved
    EPE-
    BNI-
    SVI-
    PNI+
    LVI+
    Margins focally positive [1-3 mm] 4 locations
    Cribriform pattern noted

    2019-02 PSA 0.1 Abbott Architect Total PSA
    2019-03 uPSA 0.133 Roche ECLIA
    2019-04 uPSA 0.116 Roche ECLIA
    2019-05 uPSA 0.143 Roche ECLIA
    2019-05 PSA 0.1 Abbott Architect Total PSA

  9. #19
    Quote Originally Posted by Busby View Post
    My goal is to figure out if there is a way to predict how long I will have a good quality of life if I decline further treatment. .
    Not really. Those who decline further treatment really are hard to follow up on, I don't know if its possible to calculate this kind of statistic reliably.

    In addition, few medical doctors would give their blessing to the plan, as it definitely does increase the chance of death from PC by an unknown but probably significant amount. Salvage radiation therapy has been proven to be a beneficial therapy.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3

  10. #20
    Senior User
    Join Date
    Jan 2019
    Posts
    311
    Quote Originally Posted by RobLee View Post
    Agreed!



    If he is evaluated for RT I suspect that any cancerous lymph nodes would show up on the mapping CT. I am no authority on LVI, but when asked, my RO did say something to that effect. I also believe that his positive margin may be as likely to lead to BCR if and when it does occur.

    If he is not a good candidate for RT, then HT could keep the lymphatic system in check. Perhaps MM can shed more light on this.
    One of the componts of Lympho - Vascular Invasion is blood vessel invasion.
    DOB 5/1957

    PSA - 11/2010=1.9, 6/12=2.3, 12/13=2.19, 12/14=2.64, 3/17=5.29, 3/17=3.91, 6/17=3.47, 12/17=4.50, 12/17=3.80, free PSA low risk (local (Uro, “My opinion you don’t have cancer), 8/18=5.13, 10/18=5.1, 10/19 ISO PSA 56% risk cancer. All DREs negative.

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative, (Uro opinion “This has been going on for a year”.... ah, more like 2 years ). Bone scan/CT negative

    2/25/19 R-LESS (Robotic Laparoendoscopic Single Site Surgery) outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carinoma
    T3aNO, GS8, unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk. 38% risk 5 year metastasis.

    PSA 3/27/19 .03. (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)

    ADT started 6/3/2019

 

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