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Thread: Last PSA was not a fluke we have recurrence for second time!

  1. #1
    Senior User
    Join Date
    Mar 2017
    Posts
    111

    Last PSA was not a fluke we have recurrence for second time!

    Well anyone following my PCa journey I had a recurrence 1 year 4 months after RP. I did 42 Radiation treatments, and was on ADT for 2 years 1 month.
    Feb 2019 was uptick in PSA first time since starting ADT. Had been .006 till 6 months ago went to .03 then 3 months later .235 this shows first a 5 times jump and then an 8 times jump. Recurrence is .2 so I'm there again! This while still actively on ADT. This would indicate hormone refractory prostate cancer! I see the URO on friday and I'm sure I will get a different type hormone shot to start with, with more test to follow.
    Any thoughts would be great help to my nerves at this moment...
    steve
    Diag. 56 DOB 2/59 PSA 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    Pet Scan & Biopsy of rib Neg
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, Perineural invasion identified ,Multicentricity multifocal
    Margins Not present on inked margins lymph nodes five negative pT3a,N0
    PSA 10/16 .1 1yr PSA 02/7/17 .4 PSA 02/15/17 .5
    Pet Scan 2//17 Neg PSA 03/17 .6 03/17 Axumin trial 17.4mm recurrence rt. semi vascular bed 03/17 Casodex + Trelstar 2yrs
    04/17 SRT (42)
    08/17 PSA <.1 Last 6 uPSA <.006 uPSA 2/19 <.030 2nd BCR 5/19 <.235 5/19 <3.2 6/19 <.34 7/19 <.06 8/19 <.08 9/19<.056
    7/19 Trelstar, Xtandi, Zoledronic Acid

  2. #2
    Quote Originally Posted by steve135 View Post
    Well anyone following my PCa journey I had a recurrence 1 year 4 months after RP. I did 42 Radiation treatments, and was on ADT for 2 years 1 month.
    Feb 2019 was uptick in PSA first time since starting ADT. Had been .006 till 6 months ago went to .03 then 3 months later .235 this shows first a 5 times jump and then an 8 times jump. Recurrence is .2 so I'm there again! This while still actively on ADT. This would indicate hormone refractory prostate cancer! I see the URO on friday and I'm sure I will get a different type hormone shot to start with, with more test to follow.
    Any thoughts would be great help to my nerves at this moment...
    steve
    Hi Steve. Sorry you're having a rough go of it! Am I correct that your last PSA was .235? Just throwing some ideas around. Would it be helpful to have a Decipher test done on your RP tissue to see the propensity of your PCa to metastasize? Could they tell whether the 1.7 cm recurrence was in a lymph node?

    The RT should have knocked out cells in the prostate bed, but one study showed that for men with a positive pelvic lymph node(s) after SRT, in about a quarter of them the node was outside the radiation field. You can ask your doc about repeat imaging (auxim, Ga-PSMA-PET), although your current PSA might be on the low side to make that effective.

    What imaging picked up the rib lesion that was biopsied, the bone scan?

    I'm sure your doc has a whole arsenal of weapons at the ready, whether, as you say, a different type of ADT and/or some other systemic treatment. Let's see what others have to say. Keep us posted after your upcoming visit, please. I'm certain we'll see your PSA numbers come back down soon!

    All the best,

    Djin
    Last edited by DjinTonic; 05-21-2019 at 07:31 PM.
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (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 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX 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 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    Avg. = 0.013

  3. #3
    Steve,

    Your situation is one none of us hope to find ourselves and I fear daily I am not far behind you. There are still a number treatments that are likely to extend your life.
    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 with Intraductal Carcinoma
    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.

    PSA 3/27/19 03 (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)
    9/10/2019. <.02. (198 days)

    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)

  4. #4
    Hello Steve: Sorry to hear of this situation....kind of hard to tell what has been happening, I have seen many worse pathology reports, mine included. What happened with your psa between your surgery and the .1 on 10/6/16? Not that it matters now, but these were alarming signals even at the 1 year mark. As DJ asked , did u already have the regional LN radiated? Are u seeing a MO at this point? U may be able to get some more solid answers from a RO or MO at this stage of the game...Please keep us posted and keep your chin up...sometimes there may be a reason that is quite treatable for this situation which has happened so early on...Best to u, MM
    DOB:Feb 1958
    PSA: 9/15: 5.9
    DRE: Negative
    Biopsy: 10/1/15. Second Opinion University of Chicago. +9 of 12 cores. G6: 5 cores, G7 ( 4+3) 4 cores
    10/12/15: -CT scan/BS
    Clinical Staging: 10/28/15 T2c
    ( RALP) UC 12/29/15

    Final Pathology Report; Jan. 6 2016

    -15 lymph nodes
    G9 ( 4+5)
    +EPE
    +LVI
    +Right SV -Left SV and vasa deferentia,
    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---8/22/19 <0.05
    Feb. 2017 Loyola Chicago
    11/15/2018 AUS 800 Implanted
    12/18/18...T Levels...Free T 42.8...Total T...262

  5. #5
    Quote Originally Posted by steve135 View Post
    There probaley isn't any mistakes with my testing/ I went from .006 to .03 to .235 in 3 month testing. I ask the girl at Labcorp about me paying she said NO! As soon as she enters my name its shows I have insurance and there for need to put it through insurance at there rates! This is what living in NJ will get you...
    Quote Originally Posted by steve135 View Post
    Well anyone following my PCa journey I had a recurrence 1 year 4 months after RP. I did 42 Radiation treatments, and was on ADT for 2 years 1 month.
    Feb 2019 was uptick in PSA first time since starting ADT. Had been .006 till 6 months ago went to .03 then 3 months later .235 this shows first a 5 times jump and then an 8 times jump. Recurrence is .2 so I'm there again! This while still actively on ADT. This would indicate hormone refractory prostate cancer! I see the URO on friday and I'm sure I will get a different type hormone shot to start with, with more test to follow.
    Any thoughts would be great help to my nerves at this moment...
    steve
    Hi steve135! The very 1st action step to take is to Rule Out Error. Error is reality and there is an incidence of occurrence though fortunately small. There have been at least 3 incidents of error involving post RP uPSA results in the past few years. So, at this moment, you simply can not accept the 0.235 ng/ml as being a correct result.

    Have the uPSA repeated asap and the result ready in time for your MD appointment on Friday. I go to a "local" LabCorp phlebotomy clinic. The sample is sent to a LabCorp main facility in Birmingham, AL and the result is available (to my URO MD) the next AM and then posted on my portal 48 hours later.

    In your previous Thread: https://www.cancerforums.net/threads...-Blood-Testing ; you have expressed uncertainty with the results based on having multiple account #s within the LabCorp System.

    First & foremost, you must obtain, print and digitally save the PDF of the Original Lab Report for each uPSA. Examine each to check that your name, Acct #, Date & Time of collection are all correct. If no one can provide you with this essential info, you might want to think about throwing them all into the trash and starting over. If LabCorp won't provide the Original Lab Reports, then have someone at your MDs office call and request them.

    This may seem like pulling at thin strings (and it is) but accuracy of your latest result must be confirmed or denied. Going from 0.03 to 0.235 in 3 months at this point on your multiple treatments timeline is highly baffling. May the 0.235 be 100% wrong!

    Certainly line up your questions for Friday and insist on good answers! You have been through so much and deserve to be putting your PCa into the rear view mirror.

    4 items that I would ask your MD on Friday are:

    - WTF is possibly going on?

    - What are the chances that there is now lymph node involvement?

    - Why would/could SRT miss lymph nodes?

    - If I am in fact recurrent, I want to know EXACTLY the location(s) of PCa. Where can I get a Gallium-68 PSMA PET/CT scan? At what PSA level should I get such a scan?


    Other FBs have had these scans as part of a clinical trial. There are several trials available to look into:

    https://www.cancer.gov/about-cancer/...abeled-psma-11

    You've been through a lot Steve and certainly do not need a rising PSA added to your Signature. Let's determine your current uPSA level with a repeat test. If the result stands, then its time to pinpoint locate the site of remant/recurrent PSA and eradicate it!

    Stay Strong & remain Optimistic!

    Good luck gaining better clarity on Friday!

    MF
    Last edited by Michael F; 05-21-2019 at 09:07 PM.
    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 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. 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 c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: 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 91 Months Post Op: Mean = 0.022 (22x uPSAs: Range 0.017 - 0.032) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  6. #6
    Steve, sorry to hear. Would be good to have the full PSA data. Judging from post PSADT seems worrisome. Hope the metastases can be located and are few enough to be treated.

  7. #7
    I view PCa like silt in the river. PCa in an area of very low blood flow has expanded into an area with good blood flow. Thus more PCa is being transported downstream.
    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 with Intraductal Carcinoma
    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.

    PSA 3/27/19 03 (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)
    9/10/2019. <.02. (198 days)

    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. #8
    Quote Originally Posted by Duck2 View Post
    I view PCa like silt in the river. PCa in an area of very low blood flow has expanded into an area with good blood flow. Thus more PCa is being transported downstream.
    Silt never mutates into killer silt, though. What I find most frightening how PSADT halves with each treatment attempt.

  9. #9
    Senior User
    Join Date
    Mar 2017
    Posts
    111
    Quote Originally Posted by Michael F View Post
    Hi steve135! The very 1st action step to take is to Rule Out Error. Error is reality and there is an incidence of occurrence though fortunately small. There have been at least 3 incidents of error involving post RP uPSA results in the past few years. So, at this moment, you simply can not accept the 0.235 ng/ml as being a correct result.

    Have the uPSA repeated asap and the result ready in time for your MD appointment on Friday. I go to a "local" LabCorp phlebotomy clinic. The sample is sent to a LabCorp main facility in Birmingham, AL and the result is available (to my URO MD) the next AM and then posted on my portal 48 hours later.

    In your previous Thread: https://www.cancerforums.net/threads...-Blood-Testing ; you have expressed uncertainty with the results based on having multiple account #s within the LabCorp System.

    First & foremost, you must obtain, print and digitally save the PDF of the Original Lab Report for each uPSA. Examine each to check that your name, Acct #, Date & Time of collection are all correct. If no one can provide you with this essential info, you might want to think about throwing them all into the trash and starting over. If LabCorp won't provide the Original Lab Reports, then have someone at your MDs office call and request them.

    This may seem like pulling at thin strings (and it is) but accuracy of your latest result must be confirmed or denied. Going from 0.03 to 0.235 in 3 months at this point on your multiple treatments timeline is highly baffling. May the 0.235 be 100% wrong!

    Certainly line up your questions for Friday and insist on good answers! You have been through so much and deserve to be putting your PCa into the rear view mirror.

    4 items that I would ask your MD on Friday are:

    - WTF is possibly going on?

    - What are the chances that there is now lymph node involvement?

    - Why would/could SRT miss lymph nodes?

    - If I am in fact recurrent, I want to know EXACTLY the location(s) of PCa. Where can I get a Gallium-68 PSMA PET/CT scan? At what PSA level should I get such a scan?


    Other FBs have had these scans as part of a clinical trial. There are several trials available to look into:

    https://www.cancer.gov/about-cancer/...abeled-psma-11

    You've been through a lot Steve and certainly do not need a rising PSA added to your Signature. Let's determine your current uPSA level with a repeat test. If the result stands, then its time to pinpoint locate the site of remant/recurrent PSA and eradicate it!

    Stay Strong & remain Optimistic!

    Good luck gaining better clarity on Friday!

    MF
    If you look back when I had the first reccurence my PSA was going up .1 every 11 to 13 days ended up at .6 before I got the Axumin Pet Scan! Which located the tumor.
    Oh and by the way my wife and I are a hot mess there isn't any strenght left...
    Last edited by steve135; 05-30-2019 at 01:10 AM.
    Diag. 56 DOB 2/59 PSA 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    Pet Scan & Biopsy of rib Neg
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, Perineural invasion identified ,Multicentricity multifocal
    Margins Not present on inked margins lymph nodes five negative pT3a,N0
    PSA 10/16 .1 1yr PSA 02/7/17 .4 PSA 02/15/17 .5
    Pet Scan 2//17 Neg PSA 03/17 .6 03/17 Axumin trial 17.4mm recurrence rt. semi vascular bed 03/17 Casodex + Trelstar 2yrs
    04/17 SRT (42)
    08/17 PSA <.1 Last 6 uPSA <.006 uPSA 2/19 <.030 2nd BCR 5/19 <.235 5/19 <3.2 6/19 <.34 7/19 <.06 8/19 <.08 9/19<.056
    7/19 Trelstar, Xtandi, Zoledronic Acid

  10. #10
    Senior User
    Join Date
    Mar 2017
    Posts
    111
    Met with URO, why do they look surprized when PSA goes up again? He gave me a script for a Pet/Ct Scan with Axumin (fluciclovine ) , have a delay with insurance issue! I knew I was going to have an issue with Pet Scan as I had issues before with them about coverage and payments! Issue is the injection, its a $4500.00 cost to the Radiology people. They submitted to wrong insurance dept. at BC&BS Only BC&BS FEP covers Axumin trace? I needed to get them on board. I preplaned this time and set up first available Appt. at University of Penn. Penn. Medicine Radology before calling local Pet Scan. I also set up with a Penn Medicine MO two days after there Scan. This will either be a second opinion or they may be first, with local MO being second. I have a Local Medical Oncologist Appt. tomorrow. I am hoping my local MO can call Penn. and get me in sooner. Since I have no referal Doctor, they placed me base on Medical interview. They did say it's being reviewed for urgency? uPSA re tested 7days later from <.235 to <.258
    Last edited by steve135; 05-30-2019 at 01:13 AM.
    Diag. 56 DOB 2/59 PSA 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    Pet Scan & Biopsy of rib Neg
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, Perineural invasion identified ,Multicentricity multifocal
    Margins Not present on inked margins lymph nodes five negative pT3a,N0
    PSA 10/16 .1 1yr PSA 02/7/17 .4 PSA 02/15/17 .5
    Pet Scan 2//17 Neg PSA 03/17 .6 03/17 Axumin trial 17.4mm recurrence rt. semi vascular bed 03/17 Casodex + Trelstar 2yrs
    04/17 SRT (42)
    08/17 PSA <.1 Last 6 uPSA <.006 uPSA 2/19 <.030 2nd BCR 5/19 <.235 5/19 <3.2 6/19 <.34 7/19 <.06 8/19 <.08 9/19<.056
    7/19 Trelstar, Xtandi, Zoledronic Acid

 

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