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Thread: After almost six years... Not a Zero

  1. #11
    Senior User
    Join Date
    Jan 2019
    Posts
    391
    Quote Originally Posted by Honeybun078 View Post
    @ddayglo Sorry you saw a PSA increase, hopefully it will drop back down and then you'll be back in the zero Club. .. I'm still learning but did you have any positive margins, EPE, sv or Lymphs.?i didn't see anything in your signature.
    His signature has G4+3, T2bNxMx, which means he didn’t have EPE, SV, or LNI. There could have been undetected cells left behind from surgery or he was systemic prior to surgery.
    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, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + 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
    Ddayglo, the higher your PSA, the better the chances of the newer, more sensitive PET scans revealing the site/sources of a confirmed rise. If it's local to the prostate bed or a pelvic node, SRT could kill it off. ADT can keep recurrence at bay for many years. One step at a time! Keep us posted.

    Djin
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. biopsies, PCA3 -
    2013 TURP (90→30 g) path neg, then 6-mo. checks
    6-06-17 Nodule on 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) 3% RLM
    Bone scan, CTs, X-rays: negative

    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 bilat. acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 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 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018
    09-26-18 (13 m) 0.013 checking rise
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015

  3. #13
    @Duck systemic!!!!??? Clarify please..that's what's so scary about this. 6yrs at undetectable and then it could be back. Wspewid margins,, sv, ece and lymph being neg.

  4. #14
    Quote Originally Posted by Honeybun078 View Post
    @Duck systemic!!!!??? Clarify please..that's what's so scary about this. 6yrs at undetectable and then it could be back. Wspewid margins,, sv, ece and lymph being neg.
    Keep in mind that ddayglo had G7 (4+3), not G6 (3+3). Anything from G7 to G10 can metastasize. Clearly that can happen only if prostate cells were left behind at the time of prostate removal. It can take years, even decades, for micro lesions to grow to clinically detectable lesions. The culprits could be cells left over in the prostate bed that proliferate, or circulating tumor cells in the blood that settle in a bone, or cells that migrate through the prostate's lymphatic system to a lymph node before RP. Perhaps some microlesions remain in a quiescent state until something triggers growth years later(?)

    This is why PSA is monitored for years in all men after primary treatment. Recurrence can happen with disease assessed to be prostate-confined at the time of treatment. The situation is similar for non-metastatic PCa that recurs locally. Fortunately, as the years go by the chances of recurrence do drop.
    Last edited by DjinTonic; 06-18-2019 at 02:28 AM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. biopsies, PCA3 -
    2013 TURP (90→30 g) path neg, then 6-mo. checks
    6-06-17 Nodule on 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) 3% RLM
    Bone scan, CTs, X-rays: negative

    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 bilat. acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 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 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018
    09-26-18 (13 m) 0.013 checking rise
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015

  5. #15
    Makes sense now.. Thank you sir.

  6. #16
    Top User
    Join Date
    Aug 2016
    Posts
    1,536
    To be clear, your PSA went from <0.064 to 0.1 in 6 months after 6 years? Then retested at 0.1 with no change?

  7. #17
    Quote Originally Posted by Another View Post
    To be clear, your PSA went from <0.064 to 0.1 in 6 months after 6 years? Then retested at 0.1 with no change?
    I suspect that the two 0.1 readings were not done with a uPSA test (otherwise more decimals should have been reported!) But if BCR has been taking place, and his PSA crept up from something very low to, say, 0.060 (still below the LLD of 0.064), then an additional rise of 0.03 or 0.04 (to 0.1) in 6 months doesn't seem implausible. The retest was only weeks later, and it wouldn't be surprising if a one-decimal test gave the same result.

  8. #18
    Senior User
    Join Date
    Jan 2019
    Posts
    391
    Quote Originally Posted by Honeybun078 View Post
    @Duck systemic!!!!??? Clarify please..that's what's so scary about this. 6yrs at undetectable and then it could be back. Wspewid margins,, sv, ece and lymph being neg.
    All of us with a component of G4 hope our cancer is regional. What makes aggressive prostate cancer aggressive is it’s tendency to grow quickly and circulate in the blood or lymph system to another site where it can remain very slow growing or dormant for many years.

    At 20 years the overall BCR is 52%. This means prostate cancer can hide out a long time.

    Cleveland Clinic claims 95% of all recurrence in high risk prostate cancer is distant. That why only having 3s was so positive for your husband. His chance of dying from prostate cancer over the next 15 years is zero, but he does have a small chance (5%) of a measurable PSA over the next 15 years.
    Last edited by Duck2; 06-18-2019 at 03:12 AM.
    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, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + 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

  9. #19
    Top User
    Join Date
    Aug 2016
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    1,536
    Quote Originally Posted by DjinTonic View Post
    I suspect that the two 0.1 readings were not done with a uPSA test (otherwise more decimals should have been reported!) But if BCR has been taking place, and his PSA crept up from something very low to, say, 0.060 (still below the LLD of 0.064), then an additional rise of 0.03 or 0.04 (to 0.1) in 6 months doesn't seem implausible. The retest was only weeks later, and it wouldn't be surprising if a one-decimal test gave the same result.
    Possible, but not what he said. It's important he be clear.

  10. #20
    Senior User
    Join Date
    Jan 2019
    Posts
    391
    Quote Originally Posted by DjinTonic View Post
    Keep in mind that ddayglo had G7 (4+3), not G6 (3+3). Anything from G7 to G10 can metastasize. Clearly that can happen only if prostate cells were left behind at the time of prostate removal. It can take years, even decades, for micro lesions to grow to clinically detectable lesions. The culprits could be cells left over in the prostate bed that proliferate, or circulating tumor cells in the blood that settle in a bone, or cells that migrate through the prostate's lymphatic system to a lymph node before RP. Perhaps some microlesions remain in a quiescent state until something triggers growth years later(?)

    This is why PSA is monitored for years in all men after primary treatment. Recurrence can happen with disease assessed to be prostate-confined at the time of treatment. The situation is similar for non-metastatic PCa that recurs locally. Fortunately, as the years go by the chances of recurrence do drop.


    According to Cleveland Clinic concerning high risk prostate cancer, 95% of recurrence is distal or in other words not left in the prostate bed.
    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, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + 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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