A website to provide support for people who have or have had any type of cancer, for their caregivers and for their family members.
Page 3 of 3 FirstFirst 123
Results 21 to 28 of 28

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

  1. #21
    Experienced User
    Join Date
    Feb 2019
    Posts
    80
    My view on this: if there is doubt that the hoped for life extension will materialize in the vicious combination of a mental health condition and prostate cancer, it may still be reasonable to defer cancer treatment and first seek help with the mental health condition. Ideally get help with both in parallel.

    Now the bad news: men 50+ may have a very hard time finding qualified help. Especially if that help is sought from an under-resourced public system, the combination of being over 50, having a job, and not being openly suicidal may lead psychiatrists to the conclusion they better spend time on supposedly more urgent cases, like teenagers cutting wrists. Just as if shrugging off PSA readings of 7.5 was a good sign.

  2. #22
    Hi Busby! While you are doing a great job of examining all of your options moving forward, the option to Not Treat is extremely unwise and should not appear on your list of considerations. Even if you headed down this non treatment pathway, intervention with HT/ADT would still be mandated fairly early.

    You are currently facing about a 70% chance of Complete Cure from your RALP in January. In the event of recurrence, there will still be a 2nd opportunity for 100% Cure via SRT.

    Here is a Golf analogy to consider: Expert Golfers approach the game differently than an amateur golfer. The amateur will stand on a Tee Box and think about where they wish they could hit their tee shot. The expert will do the opposite: They develop their strategy by starting at the end of the hole at the flag stick and work it backwards to the Tee Box to develop their strategy to play the hole shot by shot. Thus, if you start at the end of PCA = Death and all of the associated morbidity, you will rethink your strategy and play your entire round of PCA Golf quite differently!

    If you have a wife or family members who will be your eventual caretakers, you will be doing them a great disservice by opting to not treat.

    My true sense is that you are simply examining all of the possible options. Hoping that this will be the 1st one crossed off of your list of Good Options!

    When is your next appointment with your URO Surgeon? I'm guessing it should be around the 3 month mark which will be April. Discuss these issues with the URO Surgeon. Determine when your next PSA should be drawn. Also request a referral to an RO to prepare for the next steps to a Cure IF necessary.

    Re "I'm trying to find out if there are any general guidelines as to how long it would take before someone (post prostatectomy) started to present with symptoms of metastatic prostate cancer:" Some thoughts:

    - Prior to RALP, most MDs feel that if one's PSA = <20ng/ml (and assymptomatic) that there is little chance of metastatic disease to bone.

    - Following RP, there is no longer a prostate gland, so remnant/recurrent PCA is no longer "contained." Thus, I suspect the propensity to metastasize is now greater.

    - PSA Kinetics will be a major factor.

    - Micrometastases & CTCs may/will play a role

    Definitely discuss the above with expert URO MDs and please let us know their advice.

    A hypothetical example: Post RP PSA has increased to 1.0 with a low PSA DT of 3 months:

    - The PSA will be 256 ng/ml in eight cycles = 24 Months = 2 years. I suspect that one would be symptomatic by this point. Without treatment, life with PCA and eventually death by PCA become extremely unbearable.

    Don't allow your thought processes to become a runaway train. You are still early post RP and have NOT been confirmed BCR!

    Stay strong and optimistic! You still have lots of unused arrows in your quiver - IF ever needed!

    MF
    Last edited by Michael F; 03-19-2019 at 12:29 AM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = Gleason 7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left Positive Margins + EPEs. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO / Prostate Size = 32 grams; Tumor = Bilateral; 20% / Perineural invasion: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  3. #23
    Top User garyi's Avatar
    Join Date
    Apr 2017
    Posts
    1,107
    Busby....I totally understand your thinking about the do nothing option. I did. But I'm 14 years older than you, and I still quickly ruled it out.

    I had a better pathology than you, and quickly rising PSA, immediately after surgery. I PSMA PET scan an ercMRI identified the probable cause as being a one inch tumor remaining on my prostate cavity wall.

    Next step...SRT and one six month shot of Lupron (probably unnecessary). Even at my age, an in very good physical shape, the side effects of surgery and RT were minimal, and ADT were minor. At your age, the effects most probably will be a cake walk...in the Everglades. Remember, lots (most) of the guys posting are because they are the exceptions, and are here due to ongong problems. The vast majority, with few if any issues, aren't here.

    I'm now having some uncomfortable effects because the radiation ignited my ulcerative colitis, which had been in remission for over 20 years. Luckily not a concern for you.

    I researched my many options at length. If I were in your position, I would be researching persistent PSA, getting a uPSA monthly, having a Decipher test, finding a very experienced RO, and preparing myself for SRT....SOON. In your case, moving quickly is quite important, IMHO. Spending any time considering doing nothing, at your age, would be a very poor use of your resources. Good luck to you
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2c pNO pMn/a Grade 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor remains in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19
    We'll see....what is not known dwarfs what is thought to be fact

  4. #24
    Quote Originally Posted by KarlEmagne View Post
    ...the vicious combination of a mental health condition and prostate cancer... the bad news: men 50+ may have a very hard time finding qualified help. ...the combination of being over 50, having a job, and not being openly suicidal may lead psychiatrists to the conclusion they better spend time on supposedly more urgent cases, like teenagers cutting wrists. Just as if shrugging off PSA readings of 7.5 was a good sign.
    This combo hit me like a wrecking ball. Literally. First my Uro dismissed my steadily rising PSA, and used a (false) negative biopsy to convince me that there was nothing wrong. Later that same year my wife broke my heart. When I should have been researching "rising PSA" instead I spent the next two years in the pit of despair.

    My GP was no help when I sought emotional help. Then all kinds of merde a frappé le ventilateur, and my cancer progressed for years while I cried my eyes out. And then came Lupron, the coup de gras.

    Okay, I know all I do here is gripe. But eventually I discovered venlafaxine... ANY of my doctors could have easily written a script for this miracle drug. Or maybe tried a little harder to find that tumor that had consumed 25% of my prostate. But no. As Duck2 said earlier, "anyone with a high risk PCa DX that doesn’t have some depression is nuts."
    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.com

  5. #25
    "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". As someone with several adverse pathological features, I have done some reading about all of them, and spoke to my Uro/RO in detail. There does not seem to be any consensus as to the prognostic significance of having LVI on your path report. It is not the same as positive LN...in fact as I understand it, LVI will or has to proceed +LN. As has been pointed out, many forum brothers have had LVI...but not +LN. I am one of them. To that end, does that mean all your LN were clear, or just the one's that the surgeon happened to excise? The surgeon will pick the LN that he thinks are most likely to be +, that i think would be the ones leading to the spinal column, since PCa seems to want to find it's way to the bones...At the end of the day, if u have SRT/RT they are going to radiate the entire field, so what does it matter? Put in a sentence I would say that LVI is just a risk factor for +LN. When I asked my RO how worried I should be about it, she answered... "no more or less worried than anything else I have to deal with". The RO did say that having the NO at the end of your pathology was more important...FWIW..hope this helps those concerned...MM
    DOB:Feb 1958
    PSA: 9/15: 5.9 PC/Father
    DRE: Negative
    Biopsy: 10/1/15. Second Opinion University of Chicago. 9 of 12 cores positive. G6: 5 cores, G7 ( 4+3) 4 cores
    10/12/15: Ct scan/bone scan- Negative
    Clinical Staging: 10/28/15 T2c
    ( RALP) University of Chicago 12/29/15

    Final Pathology Report; Jan. 6 2016

    15 lymph nodes; no tumor present
    gleason upgraded to 9 ( 4+5)
    +EPE
    +LVI
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PI present
    PM
    pT3bNO
    uPSA 2/9/16 0.05
    uPSA 3/23/16 0.11
    Casodex 4/1/16-8/5/16
    Lupron 4/15/16-5/15/18
    SRT 6/14/16...8/5/16 38Tx
    uPSA 8/10/16---2/14/19 <0.05
    Feb. 2017 Loyola Chicago
    11/15/2018 AUS 800 Implanted
    12/18/18...T Levels...Free T 42.8...Total T...262

  6. #26
    I agree with MM: LVI is one of the adverse findings in an RP path report and I would think that if positive nodes were removed, LVI should be revealed in the path report.. If BCR occurs and no positive lymph nodes were found, perhaps one was missed---something to be checked on imaging (especially if there was LVI).

    With many organs, the first/closest lymph nodes on the chains of nodes leading away from the organ are called the sentinel nodes. These are the ones that surgeons try to collect during a RP, and, in theory, the ones most likely to be positive. Usually, for intermediate- and high-risk cases the surgeon will collected all the LNs inside an anatomical template, a specific area delineated by anatomical structures, such as the larger blood vessels. Last visit my uro drew for me the one he uses: it had the shape of a fairly squashed rhombus (he removed 16 of my LNs). We can see from Brothers' signatures that the higher the risk, the more LNs are usually removed. If your cancer has spread along the LNs, you want to know how far. The problems with identifying prostate sentinel nodes and using them as indicators are several, as this editorial explains.

    Editorial: Sentinel nodes in prostate cancer– are we chasing a ghost? [2017]

    ... Altogether, the consensus group concluded that extended PLND should remain the standard of care, at least in patients with intermediate- and high-risk prostate cancer. This conclusion is laudable, but to be fair, we have no level 1 evidence for this either. ...
    [PLND = Pelvic lymph node dissection, dissection being the identification, separation, and removal]

    Also:

    The impact of lymphovascular invasion in patients with prostate cancer following radical prostatectomy and its association with their clinicopathological features [2018, Review, Full Text]

    Conclusions

    In summary, although certain limitations exist, the results of the present study provide strong evidence that LVI was associated with a more aggressive tumor phenotype and could be regarded as a poor prognosis indicator for BCR in patients with PCa. These findings indicated that LVI expression is a potentially novel clinical prognostic factor in identifying individuals at an increased risk for BCR progression.
    Last edited by DjinTonic; 03-20-2019 at 02:49 PM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. biopsies, PCA3 -
    2013 TURP (90→30 g) then PSA 2x/yr, DRE yearly
    6-06-17 DRE: nodule R, PSA rise, on finasteride: 3.6→4.3
    6-28-17 Biopsy #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 5% RLM
    Bone scan, CTs, X-rays: negative
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE LVI SVI LN(16): negative, PNI+, nerves spared
    pT2c pN0 bilat. acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5 x 5 x 4 cm, 64 g)
    11-10-17 Decipher 0.37=Low Risk: 5-yr met risk 2.4%; 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 weeks) PSA <0.1; Pomi-T (2/day)
    LabCorp uPSA (Roche ECLIA):
    11-28-17 (3 mo. ) 0.010
    02-26-18 (6 mo. ) 0.009
    05-30-18 (9 mo. ) 0.007
    08-27-18 (1 year) 0.018
    09-26-18 (13 mo) 0.013 (checking rise)
    11-26-18 (15 mo) 0.012
    02-25-19 (18 mo) 0.015

  7. #27
    Senior User
    Join Date
    Jan 2019
    Posts
    182
    https://bmccancer.biomedcentral.com/...885-017-3307-4

    Presence of LVI significantly increased 5-year and 10-year BCR rate compared to patients without LVI (60.2% vs. 39.1%, 60.2% vs. 40.1%, respectively; p < 0.001). Ten-year rate of metastasis and cancer-specific mortality was also significantly higher in LVI group (16.9% vs. 5.1%, p = 0.001; 6.8% vs. 2.7%, p = 0.034, respectively). When stratified according to T stage and surgical margin status (Fig. 3), LVI increased the risk of BCR independent of the margin status in T3 patients. Not only LVI in T3 with negative margin patients increased the 10-year BCR rate (59.1% vs. 36.4%, p = 0.00 to a level comparable to T3 positive margin (vs. 60.4%, p = 0.937) or T4 patients (vs. 71.0%, p = 0.65, but also in T3 with positive margin, 10-year rate of BCR for LVI patients were significantly higher than patients without LVI (76.5% vs. 59.1%, p = 0.005).
    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 )

    1/2/19 Bone scan/CT negative

    2/25/19 R-LESS (Robotic Laproendoscopic Single Site Surgery) outpatient Cleveland Clinic, Dr Kaouk.

    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.

    First PSA 3/27/19. .03

  8. #28
    Thanks to all for posting the studies...I think one thing is for certain: If u have LVI, you probably have other high-risk features which would make you take aggressive treatment action. At the end of the day, LVI is a leading indicator for +LN, and another way for PCa to travel to unwanted parts of your body. In my case it made no difference in my treatment, just another thing to deal with. For those on the fence, take it seriously. Thanks to all for the information. MM
    DOB:Feb 1958
    PSA: 9/15: 5.9 PC/Father
    DRE: Negative
    Biopsy: 10/1/15. Second Opinion University of Chicago. 9 of 12 cores positive. G6: 5 cores, G7 ( 4+3) 4 cores
    10/12/15: Ct scan/bone scan- Negative
    Clinical Staging: 10/28/15 T2c
    ( RALP) University of Chicago 12/29/15

    Final Pathology Report; Jan. 6 2016

    15 lymph nodes; no tumor present
    gleason upgraded to 9 ( 4+5)
    +EPE
    +LVI
    Right SV Positive
    Left SV and vasa deferentia, no tumor present
    PI present
    PM
    pT3bNO
    uPSA 2/9/16 0.05
    uPSA 3/23/16 0.11
    Casodex 4/1/16-8/5/16
    Lupron 4/15/16-5/15/18
    SRT 6/14/16...8/5/16 38Tx
    uPSA 8/10/16---2/14/19 <0.05
    Feb. 2017 Loyola Chicago
    11/15/2018 AUS 800 Implanted
    12/18/18...T Levels...Free T 42.8...Total T...262

 

Similar Threads

  1. (K) Post-Treatment PSA – BCR – Adjuvant & Salvage RT
    By DjinTonic in forum DjinTonic's SUBFORUM FOR SPECIAL STUDIES & REPORTS
    Replies: 153
    Last Post: 04-17-2019, 01:21 PM
  2. Replies: 2
    Last Post: 12-21-2017, 01:34 PM
  3. Replies: 17
    Last Post: 10-29-2017, 01:20 PM
  4. Time until treatment
    By k_a_s in forum Uterine and Endometrial Cancer Forum
    Replies: 5
    Last Post: 09-07-2011, 01:40 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •