Adjunctive vs Salvage Radiation? - Advanced Prostate...

Advanced Prostate Cancer
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Adjunctive vs Salvage Radiation?

kpminn
kpminn

10 weeks post op uPSA, <.006

What factors should I consider in deciding to have adjunctive vs waiting for salvage radiation?

Keith, age 71, Agent Orange exposure 1967-68

PCa DX Biopsy 10/3/18, PSA 12.7

RALP 12/18/18

TUMOR Acinar adenocarcinoma

Gleason Pattern 8, (4+4)

Tertiary Pattern 5

Intraductal Carcinoma (IDC) Present

Extraprostatic Extension (EPE)Present, nonfocal

Seminal Vesicle Invasion Present, right

Perineural Invasion Present

Margins Uninvolved by invasive carcinoma

Lymph nodes Uninvolved by invasive carcinoma

Pathologic stage classification

Primary tumor pT3B

Regional lymph Nodes pN0

Additional Findings High-grade prostatic intraepithelial neoplasia (PIN)

Decipher genomic test. .73

10 Replies
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On the one hand, your pathology and genomics are quite poor; on the other hand, your 10-week uPSA is very encouraging. If you decide to wait, you may want to have monthly uPSAs and jump on it as soon as your uPSA exceeds 0.03.

BTW - Did Genome Dx give you a PORTOS score along with the Decipher score?

kpminn
kpminn in reply to Tall_Allen

Thanks for your comment! I did not get a PORTOS score. Does my urologist have to request that or can I?

Tall_Allen
Tall_Allen in reply to kpminn

You can call them. They were doing it last year - they may have stopped.

farmanerd
farmanerd in reply to Tall_Allen

They don't currently include a PORTOS score in the Decipher biopsy report, but they do include a "Post-Op Radiation response" score in the GRID report which has a footnote that states "Model retrained and varies from the published version". This info is from my Decipher reports from October 2018. Perhaps they used to call this PORTOS?

From GenomeDX with a 2016 date: "The PORTOS signature is currently available on the Research Use Only GRID Tumor RNA Expression Profile, which is available to physicians who have ordered the Decipher Prostate Cancer Classifier test."

Tall_Allen
Tall_Allen in reply to farmanerd

PORTOS stands for "Post Operative Radiation Therapy Outcomes Score"

pcnrv.blogspot.com/2016/11/...

I did not post on this but did respond to someone else on a similar question, last month.

Your Ultra PSA score is just phenomenal! Seminal Vesicle, Perineural, EPE, may very well indicate, we cannot for certain know where any undetectables might be. I call the ones we cannot see the undetectables, because our most sensitive Blood tests, and scans cannot determine a location. You may have micro-metastasis---> escape into the blood. or they may be in your nether regions. There is every reason to be suspicious, and for you to be active in your surveillance, from here on out. You did not have a good biopsy report/analysis. You chose poorly one might say. It read a bit like mine from 40 months ago. Except, my classification determination, was Ductal Cribriform.

But I have gathered enough evidence, thru recent research papers, that when your PSA has reached a Level of <0.03, and by doing monthly PSA's. Not 6 month PSA's, that there is a determined series of tests that are very predictive. Here is the Gist of the research: That when having a PSA of <0.03, regardless for how many months or years--> that when you have a recorded number, such as 0.03, and in following months, it then goes to 0.04, and then to 0.05. This series of test events, will almost without fail predict that you are going to have a Bio-Chemical Recurrence. Some MO's will actually on their visit notes call this situation as a BCR. Even though <0.1 is considered undetectable by many institutions such as John Hopkins--the more sensitive scans now offer future predictability.

But tell me where the recurrence is occurring, since we cannot detect its position? In my case, the best prediction, is escape into the blood. The new evidence for those of us with Ductal aggressive Pca, is that escape may have occurred over 6 months or more before a DX.

{So I cannot recommend anything for you to do} But my position, is towards, surveillance and wait. Yes, probably 8 out of 10 cases, anything left is in the Bed area. You can wait some would argue to a PSA of 0.2 before deciding on radiation.

Just a true case--->same as yours, except his Gleason was a 9. Interestingly he was a Prostate Cancer Researcher for Bayer. He took a similar route that I have taken, and after being <0.03 for 3 + years, he had a PSA return. It got all the way up to 0.3---> some would start panicking---he did not. It is now 8 years later, and his PSA is still 0.3. I do not enjoy having lunch with him, as he is so dry. He never it seems got out of having a Lab Personality. He is a strong advocate of Alternatives, which is interesting for someone who worked on developing drugs for Pca.

In all you are doing great.

Nalakrats.

j-o-h-n
j-o-h-n in reply to Nalakrats

I betcha he really gets along with Laboratory mice...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 03/05/2019 11:13 AM EST

Nalakrats
Nalakrats in reply to j-o-h-n

Been retired a long time--no need to chase those mammals.

Nalakrats

I received my GRID report and have only started to digest the information. My Post-Op Radiation response is “61”. My predictive ADT response was “17” and my 5 year risk metastasis is “39”.

I have an appointment with RO next week to discuss options for adjuvant or salvage radiation.

I met with the RO at the VA yesterday. It has been recommended that I have adjuvant RT. Based on my adverse pathology and decipher scores the probability not a BCR is very probable. Rather than waiting for a rise in PSA I believe that the best outcome will be to have the aRT sooner than later. Waiting until the 5-½ to 6 month post op will allow maximum recovery from the RP. I will continue to have monthly uPSA's and would start at the slightest increase in PSA. I am meeting with my urologist/surgeon on Monday and if he concurs I will start sometime in June.

I can't tell you how much I appreciate the input and thoughts you have all given me. The depth of knowledge and peer support on this forum is overwhelming!

Yesterday I went to the Twins home opener with 2 lifelong buddies and after the game we went to a downtown restaurant/bar for some food. We had a table full of appetizers and beverages and the waitress came to the table and said everything we had ordered to that point had been paid for. She wouldn't disclose who but about 15 minutes later a guy who had been sitting at the bar came up and said, "Thank you for your service". I was wearing a Vietnam Veterans hat and was totally amazed by his act of kindness. I was overwhelmed by his sincerity and asked him if he knew that today was National Vietnam Veterans day. He thanked me for telling him and said he was going to call his father immediately. A real touching moment.

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