Post Radiation PSA Questions

[jdayoc]

I have asked questions before, but to reintroduce: radical prostatectomy 3/31/17. Post surgery pathology report: Gleason score 9, Primary tumor pT3a, margin free of tumor, lymphovascular invasion present pN1 (2 of 16 nodes positive), Distant metastasis Unknown, extraprostatic extension of one lymphatic in the adipose tissue of base of prostate. Post op PSAs: .09 on 6/6 and 0.155 on 9/21. Referred to radiation oncologist. Had 8 weeks radiation therapy ending 3/30/18.

Just got first post radiation PSA of <0.13, which doctor said was “lowest” his test would go. Have you all heard of a PSA test where <.013 is the “lowest” measurement?

Also, I have been on hormone therapy (Bicalutamide/casodex) for the past 6 months. Radiation oncologist said there were no studies for Bicalutamide for less than 2 years. When I told doc that I want to quit the Bicalutamide, he responded that was up to me as a “quality of life” decision. So, as per doctor, Bicalutamide suppresses PSA, would it be logical to quit the Bicalutamide in order to determine if I still have cancer; that is, if cancer cells still present, PSA would go up? If PSA doesn’t go up, then I’m good?

One more question: I am also taking Tamoxifen to counter Bicalutamide breast side effects. If I stop taking Bicalutamide, should I stop Tamoxifen at same time or keep taking for awhile...and, if so, for how long?

Thanks in advance for your enlightened responses.

Joe

[spinosa]

Just got first post-radiation PSA of <0.13, which doctor said was “lowest” his test would go. Have you all heard of a PSA test where <.013 is the “lowest” measurement?

wait - which is it? less than .13? Or, less than .013? If the latter, that's pretty sensitive, and great news - most assays will only indicate, less then .04.

If .13... then, one must consider the length of time from radiation to nadir - which my RO tells me is between 6 months and two years. Did he talk to you about that? Or, are you talking only to your urologist? If the latter, get thee to thy RO.

I don't know if there's a way to avoid the gynecomastia with Casodex - did Casodex in fall of 2002... still there.

[jdayoc in reply to spinosa]

Thank you very much for your reply! Yes, my PSA was “less than” 0.13.

[jdayoc]

Thank you very much! Joe

[Tall_Allen]

Conventional PSA tests have a lower limit of 0.1. And considering you are on hormone therapy, there is really no value to an ultrasensitive PSA test at this point.

I hope you will reconsider your decision to stop Casodex now. Casodex is a very weak hormone therapy (Lupron is more effective), so 18 months is typical. And we know that LN mets respond to hormone therapy. You only get the one chance at using hormone therapy for "clean up." Stopping and re-starting later has the same effect as stopping and restarting antibiotics - causing resistant cells to take over.

[jdayoc in reply to Tall_Allen]

Allen- Thank you very much for your advice. I could switch to Lupron. That, also, is up to me. What do you think of changing “type” of hormone therapy? And if I switch, how long on Lupron considering I’ve been on Bicalutamide for 6 months? And why is the hormone therapy protocol for so long AFTER radiation? Thanks again! Joe

[Tall_Allen in reply to jdayoc]

There are basically two jobs for hormone therapy when used ADJUVANT to radiation: (1) to radio-sensitize the cancer so that radiation has more cancer-killing power. This phase starts a few months before SRT and continues through it; and (2) to continue to kill whatever hormone-sensitive cancer cells may be floating around systemically after SRT. This may take some time - just how much time is a subject of debate. Data suggests a couple of things for node positive patients

• At LEAST 6 months of ADT (and not just Casodex) improves SRT outcomes, and most likely 12 months is necessary:

pcnrv.blogspot.com/2016/08/...

• When positive pelvic LNs have been discovered, the combination of ADT and whole pelvic SRT gives better outcomes:

pcnrv.blogspot.com/2017/12/...

[jdayoc in reply to Tall_Allen]

Allen- Just read both reports. I agree that greater than 12 total months of hormone therapy should significantly enhance survival chances. I greatly appreciate YOU, Allen. Joe

[WayneSC in reply to Tall_Allen]

My urologist stated that casodex improved the lupron results by 3-5%.

[jdayoc in reply to WayneSC]

Thank you Wayne! Joe

[Break60]

My RO insisted on 13 months of ADT3 : triple blockade. No recurrence after IMRT to all LN s

What not use all available ammo? You only get one shot.

Bob

[jdayoc in reply to Break60]

Thanks, Bob!

[Break60 in reply to jdayoc]

Note that no cancerous LNs were found during LN dissection at RP. Mets surfaced about two years later and were minor ( two iliac nodes) . But ALL pelvic lymph nodes were radiated just in case.

Bob

[jdayoc in reply to Break60]

Thanks, Bob! Joe

[bldn10]

A few comments. First, I'm surprised they put you on only bicalutamide; I was on adjuvant ADT3, which got my PSA almost to undetectable before RT even began. I got my PSAs at Labcorp and their sensitivity was down to <.015. FWIW my rad-onc told me that the RT had done what it was going to do shortly after I finished it. I then let my 3-mo. Lupron shot run out and stopped bicalutamide and Avodart when those bottles were empty. I too wanted to know if the RT had been effective. I still have undetectable PSA 22 mos. post RT. But my PCa was just 2 spots in the bed, as revealed by C11 Acetate PET.

[jdayoc in reply to bldn10]

So no lymph node involvement?

[bldn10 in reply to jdayoc]

No.

[abmicro]

Quest Diagnostics offers a super sensitive PSA test that can go down to 0.02. This is normally offered after successful surgery. You can demand it and it is covered. You may have to educate and argue with the Quest people if they cant find that super sensitive test or dont know how to do it. I had <0.02 after radiation and Provence and thought I was cured, but it came back after a year. I am gleason 8.

[jdayoc in reply to abmicro]

Thank you. And God Bless You! Joe

[Emak1]

Wrapping up salvage radiation. was GL7, 0.27 right before ADT. I am on 7 shots of Firmagon (28 days each), so about 6.5 months

[jdayoc]

Thank you. Joe

[larry_dammit]

Glad your doctor talks about you being cancer free 😀😀😀. As for me. Stage 4 with Mets in spine,ribs and lymph nodes I do what the doctor says and know as he says I will die with prostate cancer. When you self diagnose you are playing with dynamite.

[jdayoc in reply to larry_dammit]

Thank you Larry! Joe

[zenbee13]

Hi jdayoc,

I was diagnosed in 2009 Gleason was a composite 9+

I was clean of a readable PSA for 2 full years after 13 weeks R/T. The R/T was done a year after the Da Vinci removal when detectable PSA returned. I agree with others, see your Doc get more opinions. We may have learned a lot, but we are still lay people.

Peace be the journey brother

[jdayoc in reply to zenbee13]

Thank you very much! Joe

[j-o-h-n]

Hey Joe, Where are you located and where are you getting treated?

Good Luck and Good Health.

j-o-h-n Friday 06/01/2018 2:45 PM EDT

[jdayoc in reply to j-o-h-n]

My prostatectomy was by Dr Brian Miles at Houston Methodist. My radiation oncologist was at the south Austin Texas Oncology facility.

[jdayoc in reply to jdayoc]

God Bless YOU!

[j-o-h-n in reply to jdayoc]

In the meantime get yourself a good Oncologist that specializes in Pca.

Good Luck and Good Health.

j-o-h-n Saturday 06/02/2018 10:25 AM EDT

[Costarica1961]

Hey Joe, I know enough to be dangerous. But what I do know your numbers and journey sounds very close to mine. I am currently on lupron every 3 months. And for the last month zytiga and predisone. I have no Mets the psa is down from 0.39 to 0.07 happy to be on this combo minimal side effects. Always consult with your oncologist about stopping meds. Rik

[jdayoc in reply to Costarica1961]

Thank you. How long will you be on hormone therapy?

[Costarica1961 in reply to jdayoc]

I started with eleguard around July 2016. And the only time I stopped was for two months after radiation sessions a year ago. My psa rose up and went back on this time lupron ever since. I am considered non curative, all treatments have in theory failed, although I'm optimistic zytiga and p will give me good longevity until the next hot drug comes along. I had a Gleason 9 with a focal 5 4 + 5 a psa of 12.4. Started with rad prostectomy then 37 sessions radiation while on hormone therapy now zytiga and predisone and lupron. And the best goes on. Rik.

[jdayoc in reply to Costarica1961]

Thank you for sharing, Rik. God Bless You. Joe

[Papillon2]

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