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Thread: Next uPSA?

  1. #1
    Senior User
    Join Date
    Apr 2019
    Posts
    104

    Next uPSA?

    The radiation oncologist that is directing his current radiation won't be ordering a PSA test (of unknown sensitivity) until 3 months post treatment. This means there will be 6 months between tests, which I think is too long. I know a lot of other guys here seem to order their own tests too? Doesn't it make sense to stay on the every 3 months schedule even through radiation?

    I'm frustrated that we haven't yet found a doctor that wants to take this as seriously as I do. We have very good insurance, I can't see any harm in him ordering the test for our piece of mind right at the end of radiation. And even then I don't know that he'll order the labcorp uPSA. It seems we're doomed to shell out $109 4 times a year for the next 10 years.
    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)

  2. #2
    Senior User
    Join Date
    Feb 2019
    Posts
    285
    AceVA ...I too have very good insurance and came across similar hurdles though not as high as yours. Fortunately (as fortunate can be) I was doing both RT and HT, as such, my MO was ordering my uPSA every time just before I got my Lupron injection during my RT sessions. And I requested an early MO appt at the end of September (with just one more week of RT sessions) for a followup and uPSA before I headed off overseas for a vacation. On Nov 6th I had my 30 day post-RT appt with my RO at which time he would normally order my first uPSA ... however, since I just had a uPSA at the end of Sept, and will have another one on Nov 22nd (due for another Lupron injection) my RO decided not to do his uPSA and will use the uPSA results from my MO. Makes sense to me at this time. In the future, my uPSA will be with my MO every three months.

    I see nothing wrong coming out and requesting that your RO do the uPSA test whether he feels it is necessary or not. If for some reason you and your husband decide to use another doctor for additional uPSA test make sure it will be tested at the same lab as this is important for comparison accuracy.
    Last edited by Trex Dino; 11-16-2019 at 04:04 PM. Reason: grammar
    Age DX 63 dob 1955
    8/11/16 CT scan (blood/sand in urine). Prostate norm w/cent calcification.
    11/6/18 GP freq urine/retro ejact. PSA 7.1 (RX Proscar/Flomax)
    12/18 PSA 4.1 14.8% Free Proscar? MRI Lesion 1.6cm. Lymph nodes sim to 2016 CT, prostate norm size. Stage 3. PIRADS 4
    1/19 Biopsy 2/5/19 DX
    2/19 Bone/CT scans: No evid met chest/abd/pelvis
    3/2019 RALP Cath out/post-op path rpt week later:
    G9 (4+5) (65-70% + 15-20%)
    Dominant tumor: 4.3 cm apex to base, bilat.
    LNI+ (4 of 12 on R, largest 4mm, 1 of 8 on L, 9 mm)
    EPE+ (right lat., post. and L lat. aspects apex to base and at ant. mid aspect)
    Intaraductal component+, BNI-, SVI+, LVI+
    SM+ (carcinoma unifocally extends to ant. mid margin area of EPE (2mm)
    Prostate fat: neg. pT3b pN1
    5/2019 Casodex 2-weeks. uPSA 0.11
    5/24 uPSA 0.11 Lupron injection
    6/19 uPSA .02
    8/7 began 39 sessions RT 70.2 Gy (last session 10/1)
    8/23 uPSA .01 Lupron injection
    9/27 uPSA <0.01
    10/22 uPSA <0.01

  3. #3
    Quote Originally Posted by AceVA View Post
    The radiation oncologist that is directing his current radiation won't be ordering a PSA test (of unknown sensitivity) until 3 months post treatment. This means there will be 6 months between tests, which I think is too long. I know a lot of other guys here seem to order their own tests too? Doesn't it make sense to stay on the every 3 months schedule even through radiation?

    I'm frustrated that we haven't yet found a doctor that wants to take this as seriously as I do. We have very good insurance, I can't see any harm in him ordering the test for our piece of mind right at the end of radiation. And even then I don't know that he'll order the labcorp uPSA. It seems we're doomed to shell out $109 4 times a year for the next 10 years.
    I guess everyone’s treatment is different, but 30 days post ART I am done with my RO for treatment and follow up. My MO is now calling the plays and we test every 90 days. On top of that, I still have lab orders from Cleveland at my local lab I can use.
    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)

  4. #4
    Experienced User
    Join Date
    Sep 2017
    Posts
    89
    Your Signature does not whether or not ADT was part of the regimen so likely there was no ADT

    Getting a PSA now makes little sense. You say "there will be 6 months between tests." The reality is there was 2 months of radiation in this 6 month period and the Oncologist will order a PSA at 3 months following completion of radiation. You can order the test but there will be no useful information and nothing gained.

    Why do you assume that you will be paying out of pocket for 4 PSAs per year? The Oncologist will order a PSA test at least every 6 months.

    You are still very good for wanting to know.

    Good luck
    Last edited by Semiramide; 11-18-2019 at 06:41 PM.

  5. #5
    My understanding is that the PSA level following RT slowly declines for some rather long period. Here is a statement from a paper describing post-RT treatment options when the PSA level either does not go low enough or begines to increase after reaching a "good" low level:

    Both benign and malignant prostatic glandular epithelia are injured by radiation therapy, which ultimately results in clearance of damaged cells through the process of programmed cell death. This process may take many months following the completion of therapy, and so diagnostic tests, including serum PSA and prostate needle biopsy, must be interpreted with caution. In particular, serum PSA levels decline slowly over 6–18 months after radiation, with a nadir value often reached as late as 33 months.
    I highlighted what I think is important in your situation.

    I find nothing that indicates post-SRT PSA levels are different from when RT is the primary treatment.
    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

    Decipher RP = 0.47 Average Risk

  6. #6
    Quote Originally Posted by AceVA View Post
    Doesn't it make sense to stay on the every 3 months schedule even through radiation?


    Maybe , maybe not. It does take a certain amount of time for the radiation therapy for its work to be reflected in your PSA scores.

    I'm sure that the doctor takes his work very seriously, he just might not think that taking another test would make any difference in the treatment plan before 3 months after treatment.

    Definitely give him a call on Monday morning and ask him about it. He has his reasons, for sure.
    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

  7. #7
    Senior User
    Join Date
    Feb 2019
    Posts
    285
    Quote Originally Posted by Duck2 View Post
    I guess everyone’s treatment is different, but 30 days post ART I am done with my RO for treatment and follow up. My MO is now calling the plays and we test every 90 days. On top of that, I still have lab orders from Cleveland at my local lab I can use.
    Agree, everyone's treatment is different ... my RO is still planning on following up with me once every 6 months to stay up on any possible RT complications, and my MO has the helm for the rest of my treatment(s).
    Age DX 63 dob 1955
    8/11/16 CT scan (blood/sand in urine). Prostate norm w/cent calcification.
    11/6/18 GP freq urine/retro ejact. PSA 7.1 (RX Proscar/Flomax)
    12/18 PSA 4.1 14.8% Free Proscar? MRI Lesion 1.6cm. Lymph nodes sim to 2016 CT, prostate norm size. Stage 3. PIRADS 4
    1/19 Biopsy 2/5/19 DX
    2/19 Bone/CT scans: No evid met chest/abd/pelvis
    3/2019 RALP Cath out/post-op path rpt week later:
    G9 (4+5) (65-70% + 15-20%)
    Dominant tumor: 4.3 cm apex to base, bilat.
    LNI+ (4 of 12 on R, largest 4mm, 1 of 8 on L, 9 mm)
    EPE+ (right lat., post. and L lat. aspects apex to base and at ant. mid aspect)
    Intaraductal component+, BNI-, SVI+, LVI+
    SM+ (carcinoma unifocally extends to ant. mid margin area of EPE (2mm)
    Prostate fat: neg. pT3b pN1
    5/2019 Casodex 2-weeks. uPSA 0.11
    5/24 uPSA 0.11 Lupron injection
    6/19 uPSA .02
    8/7 began 39 sessions RT 70.2 Gy (last session 10/1)
    8/23 uPSA .01 Lupron injection
    9/27 uPSA <0.01
    10/22 uPSA <0.01

  8. #8
    Quote Originally Posted by Trex Dino View Post
    Agree, everyone's treatment is different ... my RO is still planning on following up with me once every 6 months to stay up on any possible RT complications, and my MO has the helm for the rest of my treatment(s).
    That sounds like an added profit program to me, but what do I know. My post ART visits were with a NP.
    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)

  9. #9
    Experienced User
    Join Date
    Nov 2017
    Posts
    99
    Hi,

    I went back through your older threads, and could not figure out if ADT therapy was part of your husband’s treatment plan. If you husband was administered ADT as part of the ART protocol, there is very little reason to schedule the Psa test any sooner.
    Eric

  10. #10
    Senior User
    Join Date
    Feb 2019
    Posts
    285
    Quote Originally Posted by Duck2 View Post
    That sounds like an added profit program to me, but what do I know. My post ART visits were with a NP.
    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.
    Age DX 63 dob 1955
    8/11/16 CT scan (blood/sand in urine). Prostate norm w/cent calcification.
    11/6/18 GP freq urine/retro ejact. PSA 7.1 (RX Proscar/Flomax)
    12/18 PSA 4.1 14.8% Free Proscar? MRI Lesion 1.6cm. Lymph nodes sim to 2016 CT, prostate norm size. Stage 3. PIRADS 4
    1/19 Biopsy 2/5/19 DX
    2/19 Bone/CT scans: No evid met chest/abd/pelvis
    3/2019 RALP Cath out/post-op path rpt week later:
    G9 (4+5) (65-70% + 15-20%)
    Dominant tumor: 4.3 cm apex to base, bilat.
    LNI+ (4 of 12 on R, largest 4mm, 1 of 8 on L, 9 mm)
    EPE+ (right lat., post. and L lat. aspects apex to base and at ant. mid aspect)
    Intaraductal component+, BNI-, SVI+, LVI+
    SM+ (carcinoma unifocally extends to ant. mid margin area of EPE (2mm)
    Prostate fat: neg. pT3b pN1
    5/2019 Casodex 2-weeks. uPSA 0.11
    5/24 uPSA 0.11 Lupron injection
    6/19 uPSA .02
    8/7 began 39 sessions RT 70.2 Gy (last session 10/1)
    8/23 uPSA .01 Lupron injection
    9/27 uPSA <0.01
    10/22 uPSA <0.01

 

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