What next?

[Toyota1904]

Oct 2009 psa was 39. Put on Casodex for 3 yrs. 2010 gold seeds implanted and radiology every day for 7 weeks. after this psa was less than 0.1 but as slowly risen to 0.77 in oct 2017. Due next obs in July. Sex is out, but otherwise things seem a feel "normal".

[Tjc1]

Hi 1904, if you still have your postrate that number is not to alarming actually. You will need to keep an eye on it for sure. The psa doubling time will be more important than the number itself. Whats next might be Xtandi or zytiga. But i dont know all that much. LOL. Good luck and keep us posted.

Thomas

[Hidden]

Hi:

If you have 3 increasing consecutive values of the PSA that will indicate a recurrence of the PC. May be it will be convenient to measure the PSA more frequently than every 9 months. Do you have more values that were not posted.?

Perhaps a Gallium 68 PSMA PET/CT may be indicated to determine the extension of the disease. There are clinical trials for this study. Please search in clinicaltrials.gov for Ga 68 PSMA and prostate cancer. UCLA and UCSF have trials I believe you could qualify.

I f there are metastasis the most probable treatment will be ADT (lupron or similar) associated with abiraterone (Zytiga). Some metastasis may be susceptible of treatment with radiation. Talk with your doctor about possible avenues of study and treatment before July.

Best wishes

Raul

[Tall_Allen in reply to Hidden]

"3 consecutive increases" was abandoned by ASTRO as a definition of biochemical recurrence in 2005. The reason was because it did a very poor job of predicting actual recurrence, and needlessly worried people.

[Hidden in reply to Tall_Allen]

I quote for this article from 2013:

ncbi.nlm.nih.gov/pmc/articl...

"The definition of BCR following RT is more problematic. The AUA panel found 99 different definitions of BCR following RT, among which the American Society of

Therapeutic Radiology and Oncology (ASTRO) definition was the most common. This was defined as the mid-point between PSA nadir and the first of 3 consecutive rises in PSA.9

Although the AUA recommends that the ASTRO definition be adopted, it has several weaknesses, including failure to use the PSA level at nadir as a risk factor and the requirement to backdate the time of biochemical recurrence.

An alternative definition of “nadir +2 ng/mL” (Phoenix definition) has shown improved accuracy over ASTRO in predicting clinical failures.12-14

However, the nadir-based definition results in substantially lower estimates of BCR at 5 years, and substantially higher estimates of BCR at 10 years than the ASTRO definition.6

Pending more information on development of distant metastases and prostate-specific mortality, the AUA continues to recommend the ASTRO definition of BCR following RT.

[Tall_Allen in reply to Hidden]

You misunderstood what the authors wrote. The "AUA panel" that they are referring to published in 2007 (not 2013) after reviewed definitions used from 1991 to 2004. None of what they say is important because it was before the Phoenix definition was adopted in 2005.

jurology.com/article/S0022-...

I assure you that ASTRO has by consensus thoroughly abandoned the "3 consecutive rises" definition in favor of nadir + 2.. Here is what they say about it:

redjournal.org/article/S036...

"In 1996 the American Society for Therapeutic Radiology and Oncology (ASTRO) sponsored a Consensus Conference to establish a definition of biochemical failure after external beam radiotherapy (EBRT). The ASTRO definition defined prostate specific antigen (PSA) failure as occurring after three consecutive PSA rises after a nadir with the date of failure as the point halfway between the nadir date and the first rise or any rise great enough to provoke initiation of therapy. This definition was not linked to clinical progression or survival; it performed poorly in patients undergoing hormonal therapy (HT), and backdating biased the Kaplan-Meier estimates of event-free survival.

A second Consensus Conference was sponsored by ASTRO and the Radiation Therapy Oncology Group in Phoenix, Arizona, on January 21, 2005, to revise the ASTRO definition. The panel recommended:

(1) a rise by 2 ng/mL or more above the nadir PSA be considered the standard definition for biochemical failure after EBRT with or without HT;

(2) the date of failure be determined "at call" (not backdated). They recommended that investigators be allowed to use the ASTRO Consensus Definition after EBRT alone (no hormonal therapy) with strict adherence to guidelines as to "adequate follow-up." To avoid the artifacts resulting from short follow-up, the reported date of control should be listed as 2 years short of the median follow-up. For example, if the median follow-up is 5 years, control rates at 3 years should be cited. Retaining a strict version of the ASTRO definition would allow comparisons with a large existing body of literature.

[Hidden in reply to Tall_Allen]

I just quoted an article published in 2013:

Clin Adv Hematol Oncol. 2013 Jan; 11(1): 14–23.

you are quoting older articles.

The AUA uses both definitions (2013) article written by Dr. Carroll

auanet.org/guidelines/prost...

[Tall_Allen in reply to Hidden]

Raul-

One of the dangers of getting all of your information from google searches is that you don't understand the context. I don't wish to discourage you, but it may take a bit more effort on your part to understand what you are reading. You will see if you look again at the 2013 article you were quoting (and misinterpreting), that the authors were referring (footnote #9) to a 2007 AUA article that looked at BCR definitions in use from "1991-through early 2004." Here is the study that the footnote #9 links to:

jurology.com/article/S0022-...

What the article you cited is saying is that the "3 consecutive rises definition" - called the "ASTRO Definition" - is flawed, and was replaced by the "Phoenix definition" of nadir+2 in 2005.

At any rate, it is not AUA that matters. ASTRO guidelines for radiation oncologists is what matters, and they endorse the nadir +2 definition. I should add that no definition of biochemical recurrence is perfect and should be revisited as more data accumulate (which is the point of the article you cited).

I hope that clears it up for you.

[Daddysdaughter in reply to Hidden]

How are you doing?

[Tall_Allen]

You have nothing to worry about until his PSA reaches 2.1, which is the definition of biochemical recurrence. PSA will fluctuate from time to time because he does have an intact prostate.

Your next step is to get another PSA in 6 months.

[frannebrant in reply to Tall_Allen]

If waits 6 months for another psa test, he is a fool looking for trouble. Please quit posting information that can be harmful.

[Tall_Allen in reply to frannebrant]

Perhaps you have seen better information than I have? If so, let's look at it together. I am only quoting ASTRo's position about this. Perhaps you disagree with the organization that sets the guidelines for all radiation oncologists in the US. I think your misinformed opinion will only result in needless anxiety. Posters on these sites know that none of us is a doctor, and often spout misinformation as you just have.

[Hidden]

Hey Toyota 1904, seeds every day for seven weeks , that sounds terrible. I had gold markers put in to target Radiation. Sex? What’s that? I’ve almost forgotten that pleasure. Otherwise you sound good. Our paths are all somewhat different but truely we all have the same nemesis. Weve got to find happiness wherever we can. Take care and good luck!