Upcoming Doc Visit, Guidance Requested - PSA Rising

Meeting with Rad Onc on 5-26. (I only have Rad Onc, no Urologist or Med Onc). Those that have been down this road or familiar with path if you could please advise on what I should be discussing or treatment path opinions. Background - (Initial PSA: 7.9) (RP: 6/11- PSA Undetectable, Gleason 4+3, Contained) (PSA: 0.4 on 6/15) (38 Rad Sessions: 9/15 - PSA Undetectable) (PSA 0.1 2/17, PSA 0.1 5/17). Thank you!

24 Replies

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  • It seems like you're in a good place right now. Hopefully it stays that way. I think I'd ask the RadOnc for a MedOnc recommendation, then transfer care to the MedOnc. You will probably only need a RadOnc again IF you have a recurrence and IF it causes pain.

  • Thanks Host! Rad Onc is at Hopkins and I am going to request my 1st and 2nd choices for Med Onc. Thanks for the reply!

  • Sorry Yost, autocorrect on your name.

  • NP. Even my computer still frustratingly "corrects" it sometimes.

  • I get my care at Hopkins, too. My MedOnc is Michael Carducci. I've been seeing him for almost 10 years. Of course, they have other great MedOncs, too.

  • Yost, do you see Dr. Carducci at Sibley or Baltimore? I am in Olney, MD and have been spoiled with travel so far.

  • When I started with Dr. Carducci, I was making the trip to Baltimore. I've been seeing him at Sibley since he established the clinic there.

  • Not sure why I found that a need to know but appreciate the response. 😐

  • He just moved to the Number 1 position. I like his results😐. Thank you!

  • I don't see any reason to do anything yet. If PSA starts to increase, then act.

    Bob

  • Thanks Bob.

  • Hi- I am also g 4+3, sounds like a lot of rad sessions, can you tell what areas were radiated and basis for deciding those locations (i.e., scans), and current SEs? I suggest getting a genetic analysis of your prostate tissue, see if can determine state of your P53, PTEN, BRAC1/2, and perhaps like me ERBB2. I used Caris labs, found my PTEN brakes silenced by hyper-methylation and damage to ERBB2. My sense is keep volume Pca low and stay on top of any PSA ultra sensitive above undetectable, many like my 4+3 acts like an 8, try not to let it get away from you, especially if have fast doubling time when it takes off.

  • Just checked my record and definitely had 38 Radiation Sessions. Only the bed was radiated in the hope of killing whatever cells had returned after RP. I have copied your genetic analysis of my prostate tissue suggestion and will add that to my discussion with Rad Onc and with Med Onc when I obtain the services of one. I am concerned about the increased velocity of the doubling rate you mention. After RP it took 15 months to go to 0.1, then 12 months to 0.2 then 5.5 months to 0.3 and finally 2 months to got 0.4. Thank you very much for this information, greatly appreciated.

  • If you want to noodle around and compare some "Actuals" with "what if" scenarios concerning PSA doubling times and velocities, there are some handy PSA Calculators on-line.

    Just enter the PSA values and corresponding exact dates to display and/or calculate PSA doubling time and velocity.

    Here is one at the Memorial Sloan Kettering Cancer Center website:

    mskcc.org/nomograms/prostat...

    Here is another one: (which may use a slightly different method, using the raw data)

    doubling-time.com/compute-P...

    Charles

  • Thanks Charles!!

  • As a continuation to my previous response... I have not received any body scans the decision to radiate the prostate bed was based solely on rising PSA and results of RP being contained in the bed. I also don't know what SE's are to give you that data. I do plan on asking for future PSA tests to be Ultra-Sensitive so thank you for that info. Appreciate your help.

  • Interesting, how was determination made "being contained in bed"; i.e., that no hot spots exist elsewhere?

    Much luck

  • Just realized that I have made a rather large error in my results. My needle biopsy has 3 readings in sections 3+4, 4+3 and 3+4. I read somewhere that the larger number should be used for your Gleason Score but.... I just read my actual Pathologic Diagnosis from the removed prostate and it is 3+4 Histologic Grade Gleason Score. I apologize for that and am a little embarrassed. I don't know if this helps to understand why they radiated without scans and based their localized to the bed opinion. Sorry for the confusion.

  • Here is my profile; now with correct Gleason. Male. 59 years old. Diagnosed at 53 years old with Initial PSA 7.9. Davinci RP 6/11, Gleason 3+4, Stage pT2c, Localized, Margins Not Involved, Seminal Vesicle Invasion Not Identified, Tumor 1.5 x 1.3 cm. Post Surgery PSA <0.1. Recurrence 6/15 with 0.4 PSA 19 months after RP. 38 Radiation Session completed 9/15. Post RadiationPSA <0.1. Rising PSA 2/17 PSA 0.1

  • Get a top notch Med. Onc. I am undetectable as to PSA, and added a Top Notch Med. Onc. And I see him every 90 days, even though he has nothing to treat. This allows me to give updates to the Onc. what I am doing and researching, and the Onc. gives me updates as to my Pathology and Mutations. We communicate as co-researchers, exchanging information, since he is an integrative Onc. we can talk about supplementation as well as Medical Updates.

    Establishing a relationship is important. As if I ever do need him--we have a history, besides PSA, T, E2, DHT, blood tests. We are now going forward on a CTC Blood Test--which I recommended, to my Onc. And he still is not sure, if needed. But it is Medicare Covered, and I want to know my cancer cell count in my blood. So its is all about relationships, and getting new info, in the world of Pca research, that we do not see every day.

    Nalakrats

  • Totally agree, you have to have a MedOnc before anyone else. You really should have a Uro involved for future problems from the radiation. Actually, you won't need a RadOnc until you have future problems anyway. I'm seven + years after radiation and haven't needed my RadOnc as of yet. I'd save the co-pay if it were me.

    Joe

  • Good advice Joe, I will likely see MedOnc for regular visits once I find the right one. I was fortunate to have no ill effects yet from the Radiation Treatments. Thank you!

  • I wish you well Moe. Be aware of any peeing changes, the rad can cause your prostate to cut off your urethra, and balloon your bladder. Not good!

    Joe

  • Thank you my friend I appreciate the knowledge.

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