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Thread: Bio chemical reoccurrence

  1. #11
    Quote Originally Posted by PeterG View Post
    My oncologist says I can do the radiation or not and wait . She also said that I have gone from “ cured “ to “ Cancer Management “

    Of course the radiologist wants me to have the treatment.

    I’m tending to lean torwards my oncologist recommend.

    There has been no movement in my psa since the .2 for 4 months .

    Thoughts ?

    Your age and co-morbidities are factors. If you will never see your 60's again, or have heart or other medical problems to deal with, the oncologist suggestion makes more sense. If you are younger, its more worthwhile considering the salvage radiation if you think there is a good plan to perhaps get it all.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  2. #12
    Peter, its a tough decision, always. In my case, also a g7(3+4) i was told to wait by my surgeon, who was following me at the time. I consulted with 2 top RO's at MSKCC and Cleveland Clinic and when i was at .06, they both told me to treat, reason being that recent studies have shown that earlier is better. I assume you had negative margins, if so, then what was different than my case was in my case, i had a positive margin, which was seen DURING the surgery, which prompted the surgeon to cut additional tissue and obtain a negative "Final" margin. Both RO's told me it was 80% chance it was in the prostate bed. at the time i was just about 3 years out of surgery. So far so good but its too early to tell.

    Its a really tough decision whether to treat what you cant see. The problem is, at .2, if you wait you risk possible distant mets, which you may or may NOT have now. Consult with a top RO at a major cancer hospital. Then make your decision, its partly a matter of asking yourself "how lucky do you feel". Not an ideal situation but it is what it is.
    Diagnosed at age 64 (in November, 2014), PSA 4.3
    Nov 2014 BX 3 of 12 cores positive original pathology G8. Johns Hopkins second opinion, G6
    Surgery with Dr Ash Tewari Jan 6, 2015
    Post surgical pathology, stage T2c, bilateral disease, upstaged to G7(3+4)
    5% of Prostate involved in Tumor. Organ confined, Margins, SV, lymph nodes (9) all negative, PNI positive
    PSA <.02 until (uh-oh), 2/17 .02. Then 5/17-.033, 8/17-.033, 11/17-.046, 4/18-.060, 6/18-.068, 7/18- .082, 8/18-. 078.
    Decipher score low risk, .37
    ADT/Firmagon started August 2018. SRT SEPT 2018. Finished SRT November 2018, Finished ADT Feb 2019
    T=7, PSA <.05, 5/19 T=48 PSA <.05, 10/19 T=97 PSA=<.05

  3. #13
    A look at the longer PSA history for estimating PSADT might be helpful. Well possible one doesn't see much change in 4 month is measurement precision is low.

    There are logarithmic graphing tools out there for the purpose. Google "Simple recording of your own medical history including graphical presentation of PSA-evolution and other values.".

  4. #14
    Regular User
    Join Date
    Dec 2013
    Posts
    49
    Again, thanks everyone for you thoughts.

    Diagnosed at 48. Surgery at 50. Tested monthly, then every 3 months for 5 years. Then went 6 months to find the 0.2 My results prior to July 2019 were given as 0.0 undetectable . I am currently 56. The CT was with contrast . From lower lung to pelvis. The PET was called a nm body pet with sodium fluoride, from skull to knees. .

    I am otherwise healthy . No family history of prostate cancer. My oncologist said that at 5 years I was considered cured and the reoccurrence means I am now in cancer management.

    There has been only one movement in my psa over a 10 month period from 0.0 to 0.2.

    The radiologist even mentioned I could do a lupron injection after the radiation treatment.

    My primary oncologist says I can do the radiation or wait and said radiation with the Liupron is a aggressive treatment , again, I could do it or not. She is telling me I am not in danger and itís my choice to seek treatment or wait.

    I was thinking that meant I may never need treatment . From many of your comments Iím thinking my choice is do it now or do it later and doing it at 0.2 is better than doing it at 0.4.

    I have a consult with her on the 25th to discuss further options.

    Thanks again for all your thoughts.

    Peter

  5. #15
    I think you would want to retest your PSA with better precision by asking to have blood sent to a better lab and then get some tangible evidence on your PSA development.

    Imo the often held opinion 6 month delay make no difference statistically looking for first treatment, like RP, holds much more plausibly after a 5 year period post RP. I side with your primary oncologist.

  6. #16
    Regular User
    Join Date
    Dec 2013
    Posts
    49
    Quote Originally Posted by Pratoman View Post
    Peter, its a tough decision, always. In my case, also a g7(3+4) i was told to wait by my surgeon, who was following me at the time. I consulted with 2 top RO's at MSKCC and Cleveland Clinic and when i was at .06, they both told me to treat, reason being that recent studies have shown that earlier is better. I assume you had negative margins, if so, then what was different than my case was in my case, i had a positive margin, which was seen DURING the surgery, which prompted the surgeon to cut additional tissue and obtain a negative "Final" margin. Both RO's told me it was 80% chance it was in the prostate bed. at the time i was just about 3 years out of surgery. So far so good but its too early to tell.

    Its a really tough decision whether to treat what you cant see. The problem is, at .2, if you wait you risk possible distant mets, which you may or may NOT have now. Consult with a top RO at a major cancer hospital. Then make your decision, its partly a matter of asking yourself "how lucky do you feel". Not an ideal situation but it is what it is.
    Sorry, I didnít answer youíre question , I tried to shotgun them all. Yes I had clear margins.

    I will send my oncologist a email and ask if my tests go out to the next decimal .

    Thank you.

    Peter

  7. #17
    I noticed you put clear margins. But was your final path stage? Did you have any adverse findings on your path report? I noticed from old post that tumor had left prostate. Is it possible healthy tissue was left behind!?
    Last edited by Honeybun078; 11-15-2019 at 01:26 AM.

  8. #18
    Peter,Sorry to hear about the BCR, I'm at the second BCR at 4 years out. I would keep a good eye on the PSA as anything over .5 is never good! My Pet scan showed (6/19) nothing conclusive. But showed the first BCR was cleared with Radiation so something to thing about. Its never an easy choice. Keep a open mind!
    steve
    Diag. 56 DOB 2/59 PSA 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    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, PNI ,Multicentricity multifocal
    Margins Not present lymph nodes 5 neg pT3a,N0
    PSA 10/16 0.1 1yr PSA 02/7/17 0.4 PSA 02/15/17 0.5
    Pet Scan 2//17 Neg PSA 03/17 0.6 03/17 Axumin trial 17.4mm BCR rt. SVB 03/17 Casodex + Trelstar
    04/17 SRT (42)
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/19 03.2 6/19 0.34 7/19 0.06 8/19 0.08 9/19 0.056
    10/190 0.08 11/19 0.07 12/19 0.07
    7/19 Trelstar, Xtandi, Zoledronic Acid

  9. #19
    Top User
    Join Date
    Aug 2016
    Posts
    1,930
    For others, using more sensitive testing would have given you time to see this coming sooner. For example, a lower limit of <0.02 test may have raised the yellow flag a few years earlier and given you data on velocity. It may or may not still be in the prostate bed area, but it's a better chance it is the earliar it is detected.

    Still the earlier the detection the more likely it will be for early treatment to have a higher chance of being useful.

    Your young. I'd throw the kitchen sink at it myself with both hormone and radiation. If you're shooting in the dark go big. First I'd get another opinion from a cancer center. I'm not impressed with your doctor's ambivalent advice unless its you projecting it. This is another critical juncture for you and shouldn't be left to you too choose without a complete professional opinion including risk numbers.

    Then again, if you're a low acceptance profile patient I can understand a doctor's ambivalence and leaving the ultimate responsibility in your hands. What's the point of ongoing testing if your not going to do anything about it?

    I'm not convinced by the healthy tissue left behind theory. A continuing rising PSA will ultimately be followed by cancer detected somewhere, imo. There is a belief in circulating tumor cells being present when cancer is present and they may land and take hold somewhere or not.

    Another eventual level of treatment is holding this at bay with hormone therapy if and until it stops working. I have a friend in this situation on hormone therapy. He's not a happy camper about it, but he's alive and enjoying life. If radiation has a chance of keeping that level of therapy at bay a little longer I'd take it.

    It's not too late for treatment to make a difference now. We all will tell you we don't want to be where you are, but yours is a better situation than most. I understand the longer the time to BCR the better, but if you don't treat then what's the point.

    Early detection early treatment all the way down. You've missed the early detection early treatment in all phases. It's not working for you. Don't miss the treatment even if its late.

    I'll finish with recognizing some aspects of your signature. A first PSA of 10. You were on AS for two years with a stable PSA of 10? A pathology with no adverse conditions. Follow up PSA 6 years later at 0.2. There's so much missing here.
    Last edited by Another; 11-15-2019 at 02:35 PM.

  10. #20
    Hi PeterG! Thank you for filling in the details.

    You were diagnosed and treated at a very 'young' age and are still young! My opinion is: If possible, see if the site of recurrence can be pinpoint located prior to treatment. Check out the link in Post # 10. You may qualify for an advanced scan that will achieve this. My "guess" is RT is in the near future. The key issue is: You want to be certain that your site(s) of remnant/recurrent PCa are fully eradicated by RT. We have a few Forum Brothers who have had a subsequent recurrence following SRT. The usual culprit is PCa "hiding" in a lymph node (LN) that did not get fully eradicated by RT.

    IMO, 100% Cure should still be a high possibility. To achieve this, all remnant PCa must be eradicated.

    Again, make a list of questions & issues to discuss with the Oncologist at your upcoming appointment.

    Good luck on the 25th! May this be the next and final step to achieving CURE!

    MF

 

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