En route to Nadir

[Northcaptain]

As you can see from the lab report, PSA has begin to fall after the RP on February 28th, but three (3) months is the medical reference for the final reading after an RP. For whatever reasons the oncologist asked for a 1 month PSA then another PSA as month 2. I have read in medical documentation that a PSA that fall too fast can be an indicator of a resurgence later.

So i went from .36 to .18 and i don't know if its the nadir yet... The calculation based on PSA half life is no longer relevant, so the guess is that there was some normal prostate cells remaining on the nerves that have been saved (negative margin) and they are dying by themselves...

Out of the 25 nodes removed 3 were positives but God only know if there is another one that has been invaded. Maybe none. Maybe it was just the starting of invasion, i have asked for detailed pathology report but they don't do cell count or grading of the nodes like they do on the prostate so no way to know if the node has been invaded for 2 years or for 2 days.

I'm seeing the doctor next week, he will probably want to wait for another month before indicating an adjuvant treatment if any. He already told me his first move would be a PSMA imaging but i guess if i stay under 0.2 or even go below 0.1, imaging could be irrelevant.

Tall_Allen already wrote about that:

pcnrv.blogspot.com/2016/12/...

Knowing or not knowing, that is the impermanence of life, we should stay in the absolute present, and use it rather than being used by the time.

Take care guys

[Northcaptain]

I am completely in line with your thinking Nalakrats ! Even if the Touijer study europeanurology.com/article... talks of increase of cancer survival with a massive ADT+RT attack its not without a huge impact on the day to day thinking, the quality of life, and many other factors not described in the study. After all there are still a lot (35 % if i remember) who goes without recurence in the study. Mass of people purchase lottery tickets with 0.00000001 % of chance of winning... with 35 % of chance of winning all the USA would go to purchase tickets and the whole country would be locked out for all the week

I know that many men here had a very rough ride with adjuvant treatment and i want to praise their courage and i'm not bragging against anyone. I have complete admiration for all the fighters here, and everybody choose the tactic he is inspired from.

Personnaly, I like to have my head not always trying to compute statistic of survival and when i will die or of what. I agree though that if and when PSA come back, a target will materialize somehow and from there the action might be more relevant

[tango65]

Nobody wants to have radiotherapy after a prostatectomy. With your PSA level the chance that residual cancer is detected by a PSMA PET/CT scan is extremely low. Perhaps this info about ultrasensitive PSA tests, PSA levels at nadir and BCR incidences could be of some help.

hopkinsmedicine.org/brady-u...

quanterix.com/resources/pre...

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

euoncology.europeanurology....

[Northcaptain in reply to tango65]

Very interesting Tango65. I noted in the NCBI link :

" Naturally, the success of post-operative RT depends on whether biochemical relapse is due to local vs. distant disease. Biochemical failure precedes distant metastasis by about eight years [7] ...."

My local laboratory measured 0.175 ng/mL i wonder what kind of technology they are using but i will ask which is the last significative number. Maybe they can measure down to 0.01 with precision.

Thanks !

[tango65 in reply to Northcaptain]

This other article could be of interest:

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

[Northcaptain in reply to tango65]

The study I was referring to! Indeed the next months will be key.

Thanks I had lost it

[Hidden]

Stay on your heading Captain . Great news .

[Jbooml]

It stands to reason that any detectable PSA after whatever the treatment at nadir is a risk....the big question is what cancer phenotype at what point of nadir will result in stable disease....if such an animal really exists.

[j-o-h-n]

To Nalakrats:

A present for your birthday:

A linguistics professor says during a lecture that, "In English, a double negative forms a positive. But in some languages, such as Russian, a double negative is still a negative. However, in no language in the world can a double positive form a negative." But then a voice from the back of the room piped up, "Yeah, right."

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 04/29/2019 11:16 PM DST

[Northcaptain]

My last PSA test of today shows 0.09 so still going down 5 months after RARP. To celebrate this i'm going to spend 6 weeks on my sailboat in Eastern Canada provinces. Fresh air and dazzling stars at night + an attitude of zenitude will be the best of all drug for me. Inspiring summer to everyone !