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Thread: Radiation Therapy is Inevitable - so why Wait?

  1. #21
    Quote Originally Posted by garyi View Post
    But it wasn't inevitable, you chose treatment. Death on the other hand, as ASA pointed out so eloquently, is.

    OTS has the right to chose his course of action, which seems quite reasonable to me. The opinion of his impressive MO, that he already has recurrent PCa, is not so logical, IMO. His MO is probably exhausted from all of OTS's statistical analysis.

    Just this morning I received my LabCorp results, and my PSA has leveled off at 0.074. There is little reason to believe further treatment is inevitable for me either.
    Congrats, garyi. That's very good news which just happens to bolster my argument

  2. #22
    Top User garyi's Avatar
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    Quote Originally Posted by Another View Post
    Your PSA has not leveled off. It is inconsistently rising. With your inconsistency you need a few more tests to confirm such a statement.
    Thanks for that ray of sunshine.
    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
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19
    We'll see....what is not known dwarfs what is thought to be fact

  3. #23
    About garyi:

    Quote Originally Posted by Another View Post
    Your PSA has not leveled off. It is inconsistently rising. With your inconsistency you need a few more tests to confirm such a statement.
    What's the saying "One swallow does not a summer make" ? I think that sums up the story about interpreting low readings on uPSA tests. On the other hand we can't say that garyi's PSA hasn't leveled off. There are so many intrinsic and extrinsic factors that are most likely in play with uPSA and low PSA that some inconsistency may be normal for some of us. Let's say "may be leveling off."

  4. #24
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    Quote Originally Posted by garyi View Post
    Thanks for that ray of sunshine.
    I corrected it. Sorry. You are post SRT and that changes the interpretation of your numbers.

  5. #25
    Top User garyi's Avatar
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    Quote Originally Posted by Another View Post
    I corrected it. Sorry. You are post SRT and that changes the interpretation of your numbers.
    Of course, no worries and thanks.

    To be more precise Djin, I'll call it 'leveling off for the time being', which I find most encouraging
    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
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19, .081 9/19
    We'll see....what is not known dwarfs what is thought to be fact

  6. #26
    Quote Originally Posted by garyi View Post
    .....Just this morning I received my LabCorp results, and my PSA has leveled off at 0.074. There is little reason to believe further treatment is inevitable for me either.
    Congrats garyi! You are one brave hombre => flying your F-4 levelled off at ground level!!!

    https://www.youtube.com/watch?v=Tz1hhx8yxyU

    MF

  7. #27
    Another,

    Thank you for your response to my post concerning life expectancy. As always, your post was thoughtful, reasonable, and very well written.

    I can't help but comment that you should consider changing your screen name to better reflect your obvious and strong advocacy against denial and delay in treating PCa.

    Maybe TakeAction, NoDenial, WhyWait...you get the idea. IMHO, that would fit you better than just "another" screen name.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
    Hopefully, I can remain untreated. So far, so good.

  8. #28
    Quote Originally Posted by ASAdvocate View Post
    Another,

    Thank you for your response to my post concerning life expectancy. As always, your post was thoughtful, reasonable, and very well written.

    I can't help but comment that you should consider changing your screen name to better reflect your obvious and strong advocacy against denial and delay in treating PCa.

    Maybe TakeAction, NoDenial, WhyWait...you get the idea. IMHO, that would fit you better than just "another" screen name.
    I can see the newbies' confusion when he ends his posts with:

    TakeActionNow, previously known by Another name

  9. #29
    What a collection of well thought out, carefully reasoned, and well expressed responses! Thanks to everyone for taking the time.

    I suspect my MO is as ambivalent as this group of responses. He strongly suggested I would benefit from a 2nd opinion, other than the RO he referred me to, from a Center of Excellence such as Mayo (Jacksonville, FL 300-miles from here or MD Anderson in Texas, which is a ways from here). I spoke to Mayo yesterday and they would make it very easy to drive over and get a carefully considered 2nd opinion. But, Moffitt Cancer Center is just up the road 115-miles and would be much more convenient. My Pickleball partner was treated there for Ewing's Sarcoma and has nothing but great things to say about Moffit.

    Here are a couple responses and my thoughts:

    I am in great physical condition and all the more sophisticated life expectancy calculators give me another 25 or more years. My father, even after two battles with a very rare cancer of the blood, and two knee replacements was still taking long walks and playing daily golf at age 92. I plan on having another 10 to 15-years of active athletic endeavors such as my current obssession with pickleball (3-hours/day 5-days a week) and long distance bicycle riding.

    My thinking about "delay" or "post-RP active surveillance" is based on the risk/reward analysis from delaying RT until PSA is > 0.06.
    REWARD :
    - continuation of my very active athletic life with NO RT side effects for at least several years
    - possibility of PSA stabilizing at some value < 0.1, thus never any need for RT
    - if I am lucky and PSA increase remains very slow- I might, in 5 to 10 years, see a major breakthrough in post-RP/recurrent PCa treatment

    RISK
    - Metastatic Prostate Disease with clinical symptoms in five to 10-years

    I feel that I can quantify the RISK with a Decipher test and a CTC analysis. My current thinking is that the recent research I posted here shows that with my CAPRA-S score and pathology report I have:
    -5-year metastisis probability<1% & 10-year ~ 2% with a Decipher <= 0.2 if I wait to begin Adjuvant Radiation Therapy at some PSA value < 0.1
    -5-year metastisis probability ~2% & 10-year is 5% with Decipher =0.4.

    I am certainly willing to risk a 1 in 50 chance of metastisis in 10-years to avoid RT until (IF) my PSA is > 0.05 and showing a continual rising trend. I would probably be willing to take the same risk with a Decipher of ~0.4, giving me a 1 in 20 chance of 10-year metastisis.

    The problem I see with that logic is that 10-year risk/probability only gets me less than half way to my expected death but we don't have any data that predicts PCa specific death beyond about 15-year. But, MSK nomogram gives me less than a 1% probability of PCa specific mortality at 15-years if I receive RT with a post-RP PSA < 0.2. That says to me, that WAITING a number or years to observe my PSA and to defer initiation of RT does not diminish my long term PCa specific survival.

    If the Circulating Tumor Cell analysis finds only 1 or 2 cells then another recent research article indicates a very low probability of future metastisis.

    SO - my current thought is to ask the RO I will meet next week a lot of questions. If he (20+ years practice after a 4-year Radiation Therapy fellowship at University of Michigan) is ambivalent about the need for prompt RT, (i.e. before my next 3-month PSA test), I will delay any further decisions until November 2019 at the earliest. And, I think I will plan on getting that 2nd opinion from Moffit or Mayo after I get the results of my October 2019 µPSA test.

    Thanks for taking the time to read this and respond. It is a enormous help with my decision making and forces me to think carefully and critically as I write this stuff and then carefully consider all your replies.

    AND - I DO NOT regret my decision 2010 - 2018 to postpone treatment for my rising PSA! I experienced nine wonderful years of sailing and mountain bike riding all through the US West with none of the side effects I would have experienced with either RT or RP at some point during that timeframe.

    I made the decision, I understand the consequences, and I feel, that for ME, the price I am paying now was worth the nine-years of freedom I enjoyed.
    Last edited by OldTiredSailor; 07-11-2019 at 08:39 PM.
    DOB: July 1947
    PSA: 2.0/2004 4.0/2010 5.8/2010 4.5/2012 5.6/2013 Normal DRE
    5/18 PSA: 9.2
    6/18 PSA: 10.2 & 8.4% Free
    6/28 3T mpMRI PIRADS 3
    18 cc gland=PSD 0.57 ng/cc
    0.32 cc lesion in apical PZ with subtle T2 signal hypointensity
    mild restricted diffusion of contrast into lesion prostate unremarkable intact capsule
    7/18 4KScore 34% Probability Gleason =>7

    8/03/18 Bx: Adenocarcinoma 6 of 13 cores ONLY L lobe
    T1c / Grade II / unfavorable intermediate
    extent of G3-G4 tissue far greater than indicated by MRI
    G6 (3+3) 70% LL Base 50% L Lateral Mid 20% L Base
    G7 (3 +4) 100% LL Apex 20% L Mid 60% L Apex
    8/15/18 Clear CT scan and Bone Scan
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported

    PSA
    10/3/18 0.021
    01/4/19 0.018
    04/03/19 0.022
    06/26/19 0.028
    10/1/19 0.035

  10. #30
    I was going to ask what you gain by delaying Salvage Radiation Therapy (SRT)

    SouthSider said you delay side-effects and cost. Both of those statements are true. However, delaying cost does not seem like much of an issue IF the SRT is inevitable. Pay me now, pay me later, what's the difference except that it will cost more later.

    Delaying the side-effects is also true but for me, the side-effects have so far been about non-existent. It might increase ED if that is a concern but if it is, get an implant and turn the clock back 50 years. I guess it could increase the risk of colon cancer in 5 or 6 years but I would probably rather attack the cancer I know I have than worry about the one I might someday get. You have a chance to slap this cancer down before it gets back up. I think that would be my choice.
    History: age 53 It took 3 biopsies (34 cores) to find 2 cores 4+4 Gleason 8
    Lap RP at MSKCC Apr 2004, age 54 All neg margins, nodes & structures. (T2a).
    Post RP PSA: <.1 until Feb, 08 (46 mos) PSA 0.1 - I then got sensitive tests -> 2008: Feb 0.06,
    May-08 0.09 - Jun-08 0.10, - Aug-08 0.10, - Nov-08 0.15
    SRT Dec-2008 ---Post SRT PSA 2009, Feb-09 0.10, May-09 0.09, Aug-09 0.06, Dec-09 .04, - 2010 Mar-09 0.04, 2011 .02, 2012 .02,
    STARTED UP Feb 2014-0.06, Jul-2015 0.10, Oct-2015 0.10, Feb-2016 0.15, Jun-2016 0.17, Dec-2016 0.25, Jan-2019 0.74, Jun -2019 0.72
    Aug 2018 Auximin scan - nothing
    Had an inflatable penile implant 2018 for ED. Best decision ever https://www.peyroniesforum.net/index...oard,56.0.html

 

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