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Thread: Next uPSA?

  1. #11
    Quote Originally Posted by Trex Dino View Post
    Exactly what my wife and I were thinking when we went to my 30-day post RT appt with my RO. Actually, I would rather not have any extra appts if not needed.
    I certainly needed appointments within 30 days of ART and there was no charge to me or the insurance.

    Post 30 days I am sure the insurance is paying and after Dec 31 I’d be paying my share of the visit.
    Last edited by Duck2; 11-17-2019 at 03:47 AM.
    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)

  2. #12
    Senior User
    Join Date
    Apr 2019
    Posts
    104
    For those that asked, no, there is no ADT with his radiation. Decipher showed his cancer is missing all the androgen receptors they measure, so ADT is unlikely to help.

    It's unclear at this point how long the RO will continue to follow up beyond the initial 3 month test. As his post-surgery PSA was very low, we haven't yet consulted an MO. His surgeon at CC is done with him, and we don't have a local urologist.
    Wife Posting, Husband D.O.B. 1975
    2/2018 - routine physical PSA 15
    3/2018 - PSA 13
    4/2018 - PSA down to 11.6, free PSA, 18%
    6/2018 - PSA 10, free PSA 20%
    7/2018 - mp- MRI done, prostate volume =22cc, "inflammation consistent with prostititis"
    11/2018 - PSA 14, free PSA 11%,
    3/2019 - PSA 12, free PSA 17%, 2nd opinion on MRI = PI RADs 3 lesion
    4/2019 - Cognitive Fusion Biopsy
    5/12 cores positive
    4 Gleason 3+3
    1 Gleason 3+4 5% (Where PIRADs 3 lesion IDd)
    Decipher Biopsy score: .07 very low risk

    Bone scan negative
    MRI 6/19 said PIRADS 4 lesion, no definite EPE

    RRP 7/19 Final Path: pT3a
    G6 - 75-90%
    G7 (3+4) - 11-25%
    24mm tumor, 30% of prostate
    EPE+, BNI+, SM + (at bladder neck), LVI-, SVI -, PNI-, Nodes -
    Decipher Post RP score: .78, high risk
    6 week PSA = .015 (ultra-sensitive Labcorp)
    12 week PSA = .014
    ART underway (no ADT)

  3. #13
    Top User
    Join Date
    Aug 2016
    Posts
    1,937
    Quote Originally Posted by AceVA View Post
    For those that asked, no, there is no ADT with his radiation. Decipher showed his cancer is missing all the androgen receptors they measure, so ADT is unlikely to help.
    I am unfamiliar with this. Does this mean ADT will never be possible for you as a management tool?

    Does this mean testing can determine cancer resistant to this therapy?

    Is this condition common?

  4. #14
    Senior User
    Join Date
    Apr 2019
    Posts
    104
    Quote Originally Posted by Another View Post
    I am unfamiliar with this. Does this mean ADT will never be possible for you as a management tool?

    Does this mean testing can determine cancer resistant to this therapy?

    Is this condition common?
    No, it is not common, but it's still relatively early days for these things being known ahead of time. I believe it's called "AR null Phenotype."

    ADT may or may not work for a brief time, but the cancer would likely proceed to castration resistance either immediately or much faster than normal. (This is per the Hopkins researcher at the PCA conference we attended a few weeks ago, as well as the partner of the RO directing radiation currently).

    Also according to decipher his cancer is also completely unresponsive to Taxatore. Said Hopkins researcher actually recommended another genetic test that is apparently more sophisticated than Decipher as well.
    Wife Posting, Husband D.O.B. 1975
    2/2018 - routine physical PSA 15
    3/2018 - PSA 13
    4/2018 - PSA down to 11.6, free PSA, 18%
    6/2018 - PSA 10, free PSA 20%
    7/2018 - mp- MRI done, prostate volume =22cc, "inflammation consistent with prostititis"
    11/2018 - PSA 14, free PSA 11%,
    3/2019 - PSA 12, free PSA 17%, 2nd opinion on MRI = PI RADs 3 lesion
    4/2019 - Cognitive Fusion Biopsy
    5/12 cores positive
    4 Gleason 3+3
    1 Gleason 3+4 5% (Where PIRADs 3 lesion IDd)
    Decipher Biopsy score: .07 very low risk

    Bone scan negative
    MRI 6/19 said PIRADS 4 lesion, no definite EPE

    RRP 7/19 Final Path: pT3a
    G6 - 75-90%
    G7 (3+4) - 11-25%
    24mm tumor, 30% of prostate
    EPE+, BNI+, SM + (at bladder neck), LVI-, SVI -, PNI-, Nodes -
    Decipher Post RP score: .78, high risk
    6 week PSA = .015 (ultra-sensitive Labcorp)
    12 week PSA = .014
    ART underway (no ADT)

  5. #15
    I think you mean testosterone naive. Keep in mind Decipher is a statistical analysis and beyond ranking aggressiveness the test has not been validated.

    The Foundation One test is a better test for treatment choices.
    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)

  6. #16
    Top User
    Join Date
    Aug 2016
    Posts
    1,937
    Quote Originally Posted by Duck2 View Post
    I think you mean testosterone naive. Keep in mind Decipher is a statistical analysis and beyond ranking aggressiveness the test has not been validated.

    The Foundation One test is a better test for treatment choices.
    I found information on AR null Phenotype.

    What do you mean by testosterone naive and prostate cancer?

  7. #17
    Quote Originally Posted by AceVA View Post
    For those that asked, no, there is no ADT with his radiation. Decipher showed his cancer is missing all the androgen receptors they measure, so ADT is unlikely to help.

    It's unclear at this point how long the RO will continue to follow up beyond the initial 3 month test. As his post-surgery PSA was very low, we haven't yet consulted an MO. His surgeon at CC is done with him, and we don't have a local urologist.
    Hi AceVA! I also went out of state for RARP. My last meeting with the URO Surgeon was at the 6 month post RP check up. He then turned my care back over to Dr Mann, my hometown URO MD. Dr Mann is very conservative and vigilant! We get a uPSA every 4 months and I suspect it may remain that way until we hit the 10 year anniversary and then move to annual uPSA testing. I pick up the LabCorp test requisition form from his office and take it to the nearest LabCorp facility. LabCorp faxes the result to Dr Mann within 24 hours. Usually I will get the result soon after from the local hospital's patient portal posted by Dr Mann's RN. LabCorp waits 4 days to post the result on the LabCorp Patient Portal. One can also download and save the full LabCorp lab report PDF. Our health insurance is good. Each time I have a uPSA, I am billed $13 OOP.

    Your RO will require PSA monitoring for several years ahead. If you do not have a local URO MD, your PCP can order the PSA testing. Be sure to provide the PCP with the exact test #, otherwise it will be a standard PSA assay.

    BTW, I do not see ART listed in your Signature. This omission may cause confusion to those who are not familiar with your case history.

    Let us know what your RO's advice is & to whom you are referred moving forward.

    Glad that you are now across 2 major hurdles in your quest to Cure! May the rest of the journey remain hurdle-free.

    MF
    Last edited by Michael F; 11-18-2019 at 08:54 PM.

  8. #18
    Quote Originally Posted by Another View Post
    I found information on AR null Phenotype.

    What do you mean by testosterone naive and prostate cancer?
    Hormone naive is the proper term.
    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)

 

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