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Thread: What do do from here with Prostate Cancer?

  1. #1
    Regular User
    Join Date
    Oct 2017
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    What do do from here with Prostate Cancer?

    I've placed my "bio" below. The highlights are the following: PSA prior to biopsy was 7.6; Gleason of 3+4, extracapsular involvement, 50% involvement on right side; Radical Prostatectomy on 12/2016; PSA on 2/2017 was undetectable; PSA 8/2017 .1; PSA 12/2017 .1; PSA 6/2018 .2 Urologist determined doubling time to be six months and recommended Lupron and Casodex which I took from 8/2018-2/2019; From 8/2018 - 10/31/2018 I had 39 radiations; PSA, upon finishing radiation was .1; PSA 6/2019 was undetectable (MY TESTOSTERONE WAS BACK TO NORMAL) or less than .1; and most recent PSA in November 2019 was .1

    I'm not sure what that means. AM I going backwards? Any feedback would be appreciated. Thanks so much.

    David



    PSA prior to surgery was 7.6
    11/14/2016 biopsy showing Gleason 3+4 disease
    12/2016 Radical Prostatectomy showing Extracapsular extension right side; final staging— pT3a; negative margins, no lymph node involved
    PSA 2/17 undetectable
    PSA 8/17 .1
    PSA 12/17 .1
    PSA 6/2018 .2
    8/2018-2/2019—Lupron and Casodex (hormone suppressors)
    8/31/2018-10/31/2018, 39 Radiations
    PSA 10/31/2018 .1
    PSA 6/19 <.1 or undetectable with NORMAL TESTOSTERONE
    11/19 .1

  2. #2
    David, there are some really reputable cancer centers that use .1 as their lower limit for PSA testing, but it makes it difficult to determine what’s happening.

    You need a retest to confirm the latest result.
    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)

  3. #3
    Hi David -- Even if you confirm that your current PSA is 0.1, and assuming the previous was correct at <0.1, that would still give you almost no insight into what your PSA is doing. Assuming for the moment these readings were correct, your 6/19 PSA could have been 0.099, which is recorded as <0.1, or "undetectable" on your test. So an increase as small as 0.001 could have taken you to your current 0.01. OR your previous actual PSA could have been much lower than 0.099 and your current could be as high as 0.149, which would also round to the reported 0.1. You have no way of knowing.

    There are 2- and 3-decimal tests specifically designed for post-RP men, especially if they are high risk, like you and me. In the U.S., Quest and Labcorp have such tests, for example. I strongly suggest you switch and start monitoring with at least a 2-decimal test to better track your PSA trend. Different 2-decimal tests have different lower limits, e.g. 0.05 and 0.02, but any 2-decimal test would be a big improvement in your case. There is rounding/uncertainty in the right-most digit of any test -- if the result has only one significant digit...well, you get the picture.

    IMO, a PSA test that has a lowest detectable level of 0.1 should be used only for low-risk men (e.g. Gleason 6), who had no adverse findings on their RP pathology report.

    An unexpected rise in PSA should be confirmed by a repeat test, but using a finer-grained test, it's easier to spot potential outliers from your trend.

    Djin
    Last edited by DjinTonic; 11-11-2019 at 03:24 AM.
    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(5L, 11R): 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 retest)
    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

  4. #4
    Hello David: If I am reading this correctly, your psa in Aug. of 2017 was .1, this was 9 months post surgery. Your urologist then did nothing with a increase to .2 over the next year? you did not start HT until a year from when the .1 came about? Forgive me, this is why I hate some doctors. If all this is true, I think u need to find another doctor to head your care. This is just wrong...what was he waiting for? you were a pt3a on pathology...You need to go to a major cancer center and see what is going on. It might be nothing, but those numbers would concern me for someone who has had 3 treatment modalities. please keep us posted, and do not sit on this for another second..Best, 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
    Top User
    Join Date
    Aug 2016
    Posts
    1,932
    What MichiganMan16 said. You're not going backwards. You're not going forward fast enough. You've missed several opportunities to get ahead of this. If it's the doctor, then yes a new doctor and preferably a cancer center. If you've been self directing then stop and get yourself to a cancer center.
    Born 1953
    family w/PCa; grandfather, 3 brothers
    07-12-04 PSA 1.90
    07-10-06 PSA 2.02
    08-30-07 PSA 3.20
    12-01-11 PSA 5.69 Internist recommends urologist, I say no
    05-16-12 PSA 4.76 manipulate w/diet & supplements
    12-11-12 PSA 5.20, Health system changes to 3 years on testing
    03-07-16 PSA 7.20 Internist adamant on urologist
    DRE smooth, enlarged
    03-14-16 TRUS biopsy-prostatic adenocarcinoma 1%-60% across 8 of 12 samples, Gleason 3+3=6
    03-31-16 MRI pelvis w/o dye
    05-04-16 DaVinci prostatectomy, nerve sparing, Dr. Kent Adkins - recommend
    Final Path; weight 65g, lymph nodes, seminal vesicles, capsule, margin all negative, Gleason 3+4=7, Tumor volume 35%, +pT2c
    Catheter out - 16 days
    Incontinence at 6mos is minimal – no pad
    Cialis 3x/wk & Viagra on occasion
    Begin self-injection needle therapy for erections, stop after 6 due to onset of Peyronie’s
    Erections 100% - 14 months
    5-21-19 PSA <0.02, Zero Club 3.5 years

  6. #6
    Hi David53! Ditto to DjinTonic's Post #3!

    IMO, you should monitor at least every 3-4 months until it is determined if your PSA is either:

    - dropping
    - stable
    - rising

    Let's see what your next result is in Jan or Feb. Hopefully the "<" symbol will appear in front of the next result and stay there permanently!

    MF
    Last edited by Michael F; 11-12-2019 at 12:12 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

  7. #7
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    Oct 2017
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    what to do from here?

    Thanks so much for getting back to me. I'll look for a cancer center. I live in CT so I'll look at Yale. Thanks so much!!!!

  8. #8
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    Oct 2017
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    Thanks so much Duck2. Wow, you guys know so much about this!!!

  9. #9
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    Thanks so much. Maybe it's time to find a cancer center. I'll try Yale since I live in CT. Thanks again.

  10. #10
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    Thanks so much Michael. Hope you continue to enjoy good health!!!!

 

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