Time between Radical Prostatectomy and Metastatis

[Mish80]

Hi there,

As my dad is about to start treatment (Radiation and hormone therapy) I’m feeling anxious and sad. He has no outward signs of being ill and it’s surreal that a psa score and scan showing one spot on his spine now has him at stage 4 and about to put his body through treatments that will make him sick.

I guess I’m after a positive boost based on his current stats. He was first diagnosed as Gleason 7 9 years ago and has had no treatment since his prostate removal then. A PSMA scan in sept last year was clear. His psa is now 1.4 and he has the single bone met.

Does this information point towards his pca being more slow growing and less aggressive? Or do we really have no idea and just have to wait and see?

I feel so helpless.

[beta321]

You don't state his age but the protocol is standard. The fact of no outward sign bodes well. His numbers and treatment plan mirrors my experience. There were no outward signs and the bone scan was clean. However, the choline PET-CT showed more activity. My docs decided to move forward with hormone treatment and allowed me to make the call. My health in all other areas was good. I have no regrets. My advice is whatever your Dad is doing to function at a high level to keep it up along with a positive attitude. As to whether the low PSA is evidence of slow growth is hard to say. You may want to get a reading between the last reading and the date treatment starts. it may give some indication of a rate of growth. I am not sure there is any mechanism to predict the rate of growth once meds start because there are varied responses. Don't despair. The recent developments in treatment protocol open a myriad of options. I am sure the docs will let him make the call to delay, particular if he has no outward signs. From my understanding, the earlier the intervention, the more successful the treatment. Good luck to your Dad.

[Mish80 in reply to beta321]

Thank you for replying. Dad is 68, RP 9 years ago and no treatment since. He is relatively fit - eats well and regularly exercises which he is keen to increase. Just this week he had his first shot of Lupron and started radiation on his spine met and on the prostate bed.

[tango65]

PSA dynamics after recurrence has predictive value. PSADT (psa double time) is useful to estimate survival, progression to metastases etc. You could calculate PSDAT using the MSKCC nomogram:

mskcc.org/nomograms/prostat...

The risk of mortality by prostate cancer after recurrence could be calculated here:

mskcc.org/nomograms/prostat...

He seems to be oligometastatic. The metastasis could be treated with SABRT and that could stop progression of the cancer for a while:

ncbi.nlm.nih.gov/pubmed/305...

ncbi.nlm.nih.gov/pubmed/292...

[Mish80 in reply to tango65]

Thanks so much - that is very helpful. I need to chase some info to be able to complete the calculations properly. Being the “child” I’m often not privy to first hand information.

[klaas40]

A current PSMA scan “sees” metastases much earlier than the up-to-date scans of two years ago. So, your dad should be in no hurry to rush into treatment.

[Mish80 in reply to klaas40]

I did find out that the psma PET scan only came to Australia in 2016... I’m guessing that this will change prognosis stats big time and allow for this advanced stage to be stretched out...

[dmt1121]

To follow-up on what has already been said, I think educating yourself about PCa in general but most importantly, your father's specific condition and medical history. Be sure to seek second opinions when making a major treatment decision or diagnosis so you have both a broader perspective and confidence in the basis for decision making as you move ahead. As predictive matrices, their are the Partin charts and Sloan Kettering in New York also has an online categorization of disease based on information you provide. Johns Hopkins is where the Partin charts were developed.

The broadly recognized markers for assessing the aggressiveness and mortality rates for PCa are post-RP Gleason score , using the tumor pathology sample (note: you can get a second opinion on the Gleason score from Johns Hopkins via mail between pathology labs); then the time to recurrence of the disease after initial treatment (RP) (measured by rising PSA levels over the course of 3-5 blood tests after reaching the nadir) and finally the doubling time of the PSA. You can investigate how these are interpreted online using reputable sources. Keep in mind that continuing ADT after the initial treatment will not allow for the PSA testing for either recurrence or doubling time. Doubling time can still be determined if stopping ADT for long enough that it clears his system and then beginning testing. The trade off is that you are releasing the PCa to rise unchecked. This is definitely a personal choice.

Hope that helps. Good luck.

[Mish80 in reply to dmt1121]

Thank you for taking the time to reply. I am always learning new things about this crappy disease. I need to get more info - like I don’t know what dads post RP Gleason score was 9 years ago. He is 68 now, no previous treatment at all apart from the RP to remove the “confined Gleason 7 T2” so I guess we still have an armour of treatment options available..?

[dmt1121 in reply to Mish80]

There are usually more "arrow in the quiver" but I think it's important to weigh the real tangible benefits versus quality of life. I have found that often when I do research on a new 'silver bullet", the overall lifespan and mortality rates are virtually the same but teh side effects may be terrible. I recommend doing your homework and making informed decisions based on a love of your dad and quality of time he has remaining.

Good luck.

[j-o-h-n]

I feel so helpless.

Well you've come to the right place for help.

Please tell us more about your dad. Age, location, prior treatments and current one, treatment center, doctor's name(s). All info voluntary but it helps us help you and helps us too. If you will reply please do so in a future post and NOT to me. Thank you.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 04/15/2019 7:14 PM DST (Uncle Sam's Birthday)

[tallguy2]

Thank you for posting and supporting your father.

I'm not hearing you say that there was a "positive margin" after the RP. Good for him!

With one bone met and a relatively low PSA 9 years later you may wish to meet with a radiation oncologist and discuss options. But as you will read on this forum there are no scientific data showing a longevity benefit to doing this. Nonetheless, I am also oligometastatic and chose another course of radiation to try to keep the beast in check for a while.

It would be interesting if you father can have a blood test for "Circulating Tumor Cells." This can be expensive but can also guide your treatment decision-making.

Best wishes and please keep us posted!