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

  1. #51
    Quote Originally Posted by IndyGuy View Post
    So 70% chance that IMRT to prostate bed and local LNs will likely be effective when presenting with rising PSA after RP? This is the percentage one of my ROs gave me during my consultation with him a couple months back. To your point, 30% of the time they are missing the target.
    That was just one study, but your RO's concurring opinion obviously tells us more. Did you discuss the risks/benefits of widening the field?

    Djin

  2. #52
    Experienced User
    Join Date
    May 2019
    Posts
    80
    We did not discuss widening the field but he was definitely of the opinion that I should wait to see a rise in my PSA before considering RT. BTW, I had my 6 month blood draw yesterday and waiting on the results to post tomorrow morning. The waiting, my favorite part...
    DOB: 10/1962

    6-01-15 PSA 2.5
    Having urination flow issue in first half of 2018. Flomax 6/1-6/21 - no help.
    6/25/18 PSA 14.25; Cipro 14 days
    8/1/18 PSA 17.44; rec. Urologist appt
    8/15/19 First Uro appt. + for bacteria. Cipro 4 weeks
    10/2/19 PSA 22.4; Still + for bacteria. Antibiotics 4wks
    12/28/19 PSA 27.5
    1/15/20 Biopsy results 6/12 cores positive - all left side; GS 4+3
    1/18/19 Bone scan and CT scan both negative
    2/15/19 Di Vinci RP
    2/18/19 Path report pT3a, GS 4+3 (60%+35%) 5% GS5, SM +, EPE +; LVI -, SVI -, LNI(9) - ; Tumor size: 3.5cmx3.5cmx1.5cm; single foci left side; right side nerves spared; SM+ at apex limited <1mm; benign prostatic cells at spared right nerve bundle. Prostate size 45gm.
    Cath out at 7 days: 100% continent with some ED; ok with 10mg Cialis.
    Decipher 0.73

    3/26/19 (6 weeks) 0.033
    5/10/19 (3 months) 0.010
    8/02/19 (6 months) 0.019
    8/30/19 (7 months-recheck) 0.024
    9/26-11/19/19 eSRT (70.2 Gy)

  3. #53
    Top User
    Join Date
    Aug 2016
    Posts
    1,928
    Biopsies have a 30- 50% chance of false negative. My chance of post surgery recurrence is 30%. My chance of failed SRT is 30%.

    All sounds par for the course.

  4. #54
    Quote Originally Posted by DjinTonic View Post
    Please remind me, was your path report pNx (lymph nodes unevaluated) because the the surgeon couldn't reach any because of prior surgery? I forget if that was you. Perhaps you could add a comment in your signature.

    Djin
    No prior surgery, and i don't recall discussing lymph nodes with my surgeon. Will check with my surgeon.

  5. #55
    Quote Originally Posted by ddayglo View Post
    No prior surgery, and i don't recall discussing lymph nodes with my surgeon. Will check with my surgeon.
    You should inquire about the number of nodes examined and the number of positive nodes. If any nodes were examined, there were none that were positive, since your assessment was pT2. If you see "pNX" in a copy of your actual path report, it indicates that no lymph nodes were examined at the time the prostate was.

  6. #56
    Update:
    * Lymph nodes were not examined.surgeon said that he felt no need considering my PSA and biopsy results.
    * PSA stayed a .1. the lab messed up and did not do the uPSA test. I'm getting another test on their dime.
    * He stated that is really has to go up to a .4 before a scan will show here the PCa has spread.

    the last statement concerns me a bit. While my surgeon is Director of the Prostate Program a major hospital (northern Westchester), he is a surgeon first. I'm beginning to think about a second opinion if my PSA/uPSA rises any more.

  7. #57
    Quote Originally Posted by IndyGuy View Post
    So 70% chance that IMRT to prostate bed and local LNs will likely be effective when presenting with rising PSA after RP? This is the percentage one of my ROs gave me during my consultation with him a couple months back. To your point, 30% of the time they are missing the target.
    70% at 5 years with the value decreasing after 5 years is what my RO gave me.

    Radiation field is involving most of the pelvic bone and LNs.
    YOB 1957

    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.

    3/6/19. Pathology - Grade Group 4 Intraductal Carcinoma
    T3aNO, 1 mm EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.

    7 Nodes, SV, SM, PNI, and BNI were negative.

    LVI and Cribriform pattern present.

    Decipher .86 High Risk.

    Post Surgery PSA
    3/25/19 .03. (<1 month)
    4/25/19 <.03. (2 months)
    5/25/19 <.02. (3 months)
    9/10/2019. <.02. (6 months)
    11/27/2019. <.02. T<3. (9 months)

    3 Part Modality Treatment

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic,

    ADT - started 6/19, end date 6/21.

    ART - Completed 9/26/19. (78 Gy, yes, I glow in the dark)

  8. #58
    Quote Originally Posted by ddayglo View Post
    Update:
    * Lymph nodes were not examined.surgeon said that he felt no need considering my PSA and biopsy results.
    * PSA stayed a .1. the lab messed up and did not do the uPSA test. I'm getting another test on their dime.
    * He stated that is really has to go up to a .4 before a scan will show here the PCa has spread.

    the last statement concerns me a bit. While my surgeon is Director of the Prostate Program a major hospital (northern Westchester), he is a surgeon first. I'm beginning to think about a second opinion if my PSA/uPSA rises any more.
    IF (big IF) you PSA is rising, tracking it with a uPSA test will let you and you docs determine its rate of rise/doubling time, a factor as important as the actual number. A return this many years after your RP is better, statistically speaking, that one occuring much earlier. You don't really know how close your past PSA "undetectable" readings were to your current one, so stay optimistic!

    The decision to remove no lymph-node at RP is water under the bridge. As far as future imaging, if needed, the newer Ga-PSMA/PET scan performs well at finding lesions at relatively low PSA levels if you do encounter a rising trend, and a genomics test like Decipher might be useful for decision-making in that case. Your hospital should still have some of your RP tissue stored.

    Djin
    Last edited by DjinTonic; 09-10-2019 at 02:49 AM.

  9. #59
    Quote Originally Posted by DjinTonic View Post
    IF (big IF) you PSA is rising, tracking it with a uPSA test will let you and you docs determine its rate of rise/doubling time, a factor as important as the actual number. A return this many years after your RP is better, statistically speaking, that one occuring much earlier. You don't really know how close your past PSA "undetectable" readings were to your current one, so stay optimistic!

    The decision to remove no lymph-node at RP is water under the bridge. As far as future imaging, if needed, the newer Ga-PSMA/PET scan performs well at finding lesions at relatively low PSA levels if you do encounter a rising trend, and a genomics test like Decipher might be useful for decision-making in that case. Your hospital should still have some of your RP tissue stored.

    Djin
    about as good a news as I could get, 0.10

    Retest in Two months.
    BD: 1959 PSA 4.9 11/2012 (no symptoms)
    Biopsy 12/2012 Negative
    PSA 5.9 05/2013 (still no symptoms)
    Biopsy 6/2013 3+4 (thank goodness for PSA tests)
    1 core positive (upper left), 1 suspicious (lower left) out of 12
    DRE: bump right side T1c; PCA-III = 20 (normal)

    Da Vinci 7/18/2013: Invasive carcinoma involves left lobe of prostate only, extends from left apex to posterior mid region of left lobe Gleason 7/10 (4+3); G4 tumor comprises 75% of invasive carcinoma present
    Estimated total volume of carcinoma in entire prostate gland: 10%
    TNM: T2b NX MX (Stage IIA)

    8/13 11/13 2/14 8/14 2/15 8/15 3/16, 8/16, 3/17,9/17,4/18, 9/18 PSA undetectable
    3/19: .1 (damn), 4/19,6/29 retests: .1 (damn)


    My Story:
    T-Minus-36-Hours-until-da-Vinci...
    Catheter is Out!

  10. #60
    New uPSA: 0.09

    I've graduated to three month retest.

 

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