Recurrence after lymph node dissectio... - Advanced Prostate...

Advanced Prostate Cancer
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Recurrence after lymph node dissection / How best to stall PSA progression

Hi, I am new to this forum and looking for Tall Allen's (thanks for your past help Allen) or anybody else's thoughts.

I have been treated since 2011 when I got diagnosed with a PSA of 65, Gleason 4+3=7 and seminal vesicle involvement. I had brachytherapy, IMRT and 2 years of hormone therapy done at the time.

My PSA remained fairly stable at .3 till it progressively rose to 2.94. Last year in July 2017 I had a lymph node dissection done by Jeffrey Karnes (who is a truly wonderful doctor) at the Mayo as a Gallium scan I had done via clinical trial at UCSF revealed several active nodes.

After the dissection my PSA dropped to a new low of .08, suggesting I had active cancer in those nodes all along.

My PSA is now at .13 after two successive rises.

Though I am not actively seeking treatment yet, the trend is suggestive and I am trying to be as prepared and proactive as possible.

My question is, "What are the most proven practices that I can do to slow PSA progression?"

I have read many things throughout the years of dietary impact on PSA progression, some from clinical trials. Eggs, meat, milk, sugars, corn, on and on. If you search enough, you can probably find drinking water is f-c-i-g PSA progressive. Haha!

What is real and what is not? What dietary or behavior practices are REALLY proven to help stall PSA?

Thanks,

Michael

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You still have a prostate that can generate PSA, and your PSA is still VERY low. PSA output will fluctuate, perhaps due to some residual prostatitis. Biochemical recurrence after radiation is set at nadir+2.0 for this reason. Just keep monitoring it every 6 months or so and see what happens.

Did the external beam radiation include your whole pelvis? Recently they've found that the treatment field is often not wide enough. ePLND can only remove the lymph nodes they are able to find - Karnes is among the best at finding them.

The evidence quality is very poor for dietary interventions. Perhaps over a lifetime it makes a difference. The only supplement I've found that still looks interesting is sulforaphane.

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Tall Allen - Does the after radiation nadir +2.0 BCR definition only apply if you still have a prostate? Many of us don’t have a prostate as well been through SRT. What would you define BCR in the above case? Thanks

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A confirmed PSA ≥ 0.2 is the standard definition of BCR after prostatectomy, no matter what adjuvant therapies are given.

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Yes, I had the whole pelvis radiated during my initial treatment though it looks like I received a lighter dosage than perhaps optimal as my Nadir dropped to .08 after the lymph nodes (26 in total) were removed. Previous my nadir was roughly .3. Between the brachytherapy and heavy radiation I received (I did have 80% involvement) I don't think I have much viable prostate tissue what so ever honestly. My psa dropping to .08 minus hormone therapy convinces me to that my new nadir is .08. Is that possibly wrong?

I have had 3 progressively rising psa readings. Isn't that considered recurrence?

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No, 3 consecutive rises is not considered a biochemical recurrence (BCR) since 2005. So, for you, PSA would have to reach 2.1 before anyone would call it a BCR. Even 20% of the prostate is still a lot of prostate tissue that can put out PSA. More to the point, most oncologists would not start you on lifelong ADT without some better indication.

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After my brachytherapy in 2011, my PSA went down to 0.1 rose to 0.2 and then fell back to 0.1. After that it started rising to 0.2, 0.3, 0.4 over two years. Then it jumped to 1.5 during the next one year. Recurrence discovered in an extraprostatic mass. I had ADT for nine months and cyberknife. My PSA fell to undetectable within 3 months of cyberknife. Then from April to August I had rapid rise of PSA from 0.2 to 1.3. My question is what should I consider PSA nadir for me? My URO wants to start ADT. He has given me a prescription for Axumin PET scan. What should I do if the scan result is negative? I will have another PSA test in two days time. I have made an appointment with a MO.

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Your nadir is 0.1 or 0.2 (if you want to start at recurrence after SBRT). Can you get an Axumin scan before your PSA hits 2.1? If it is negative, considering your rapid PSA doubling time, I would think you would want to start on intermittent ADT.

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I know the nadir + 2.0 benchmark for BCR is the acceptable standard for recurrence after radiation therapy as primary treatment. However, there are exceptions. Take my case, 5 years after my brachytherapy recurrence in extraprostatic mass was discovered when my PSA was 1.4 above the nadir of 0.1. The mass was rather large implying that the recurrence was there even when the PSA was around 0.4. Detectable at that point? Perhaps yes.

My URO thinks you can have Axumin scan when your PSA reaches 1.4. I am thinking my PSA test tomorrow will return a value around 1.7 or 1.8. If it is lower than that, I might rethink about the Axumin scan. In that case, would it serve any purpose seeing a MO?

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If your insurance will cover it, of course, go for it.

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Hi Allen,

I am not convinced I am recurrent, just wanting to be as proactive as I can in case I am going forward. The trend of rising numbers does have me concerned though of course.

I will look into sulphorafane. I never heard of it. Thanks.

I am a believer in the relationship between stress and prostate cancer growth. I was quite stable PSA wise for quite a while then my mother passed away and it immediately took off on me. I was under high stress and depression at the time and the timing was definitely remarkable.

I am curious, has there ever been any clinical trials involving anti anxiety or anti despressant medication and the reduction of PSA doubling time?

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Not to my knowledge.

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futurity.org/antidepressant...

I found this article.

I have it in my head that prostate cancer cells feeds off of anxiety (or MAO-A) as well as testosterone. My life prior to contracting prostate cancer was a very anxious one, running my own business and stressing over a million details. My post diagnosis life has been more stable but my more profound PSA rises do seem to coincide with stressful periods to some degree.

If my PSA does elevate yet again I am leaning towards a three month period (until my next reading) of anti depressant use just to see if there is a decline in PSA. I think I need to satisfy the question.

As meditation, yoga and prayer (all of which mediate anxiety) appear to help manage prostate cancer cell growth there is a bit of logic to this.

??

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Hey Michael, I recommend primaldietition.com. She has helped several with diets on this forum .

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