Any advice, opinion or insight would be greatly appreciated
Questions regarding the when(s), how and where(s) of SRT as my uPSA levels have started to rise post-op RP after 2 years.
A big issue is finding the right health insurance plan in case I need treatment in the coming year which is the issue for guys under 65 and medicare. This means I need to know a few options going forward and if the health insurance plan covers them. Hoping for no treatment in the coming year.
A friend of mine just got treated at Stanford with ADT then SRT with a post-op RP uPSA level of 0.05 after 4 years. Blind shotgun prostate bed and lymph node radiation since nothing showed on MRI imaging.
Is blind shotgun radiation preferred over waiting for higher PSA levels, positive imaging locations and targeted radiation?
My uPSA was first detectable at 17 months (with b vitamin supplements being used).
These b vitamin supplements were subsequently eliminated with uPSA being detected again at 26 months post-op RP
I am 60 years old
Ultrasensitive PSA test results - 17 months clean post op RP until positive at 22 months
Radical Prostatectomy 11/19/2015 with Gleason 3+4 at age 56
uPSA test result history
12/27/19 12/20/19 12/13/19 12/6/19 12/4/19 7/15/19
0.011 0.010 0.012 0.011 0.011 <0.006
4/3/19 11/29/18 11/16/18 9/21/18 7/16/18 4/30/18
0.008 0.007 0.009 0.007 0.007 <0.006
2/24/18 1/8/18 11/14/17 10/11/17 9/16/17 9/15/17
<0.006 0.008 <0.006 <0.006 0.009 0.010
6/5/17 3/3/17 12/1/16 8/29/16 5/4/16 1/14/16
<0.006 <0.015 <0.015 <0.015 <0.015 <0.02
my medical history is as follows
Genomic Health Decipher test score 0.22 below-average risk, 0 to 1 scale
Genomic Health Decipher test predicts metastasis risk and longevity for 5, 7 and 10 years out.
11/19/2015 Radical Prostatectomy UCSF Dr Peter Carroll da Vinci robotic surgery
Synoptic Comment for Prostate Tumors
- Type of tumor: Small acinar adenocarcinoma.
- Location of tumor: Single tumor. Left posterolateral midgland and base (1.2 cc; slides B10-12).
- Estimated volume of tumor: 1.2 cc.
- Gleason score: 3+4=7; primary pattern 3, secondary pattern 4.
- Estimated volume > Gleason pattern 3: 10%.
- Involvement of capsule: Tumor invades capsule: left posterior midgland (slides B10, B11).
- Extraprostatic extension: None.
- Margin status for tumor: No tumor at ink, but tumor into capsule is less than 0.1 mm from ink; slide B11.
- Margin status for benign prostate glands: No benign glands present at inked excision margins.
- High-grade prostatic intraepithelial neoplasia (HGPIN): Present, extensive.
- Tumor involvement of seminal vesicle: No tumor.
- Perineural infiltration: Present.
- Lymphovascular invasion: None.
- Lymph node status: Negative; total number of nodes examined: 1.
- AJCC/UICC stage: pT2aN0.
Johns Hopkins (Epstein) pathology 10/13/2015
Gleason Score: 3+4=7
2 cores (60% + 20%) (30% Gleason pattern 4)
Kaiser pathology, 9/1/2015
Gleason Score: 3+4=7
NUMBER CORES INVOLVED/TOTAL NUMBER CORES: 2 / 14
TOTAL CARCINOMA LENGTH: 10 mm
PSA 3.2 6/10/2014
PSA 4.8 6/8/2015
PSA 4.4 8/10/2015 (free PSA 7%)
PSA 5.0 9/28/2015 (free PSA 8%)
A) PROSTATE, RIGHT APEX, NEEDLE BIOPSY
-- ATYPICAL SMALL ACINAR PROLIFERATION
-- TOTAL SPECIMEN LENGTH, 44 MM
B) PROSTATE, RIGHT MID, NEEDLE BIOPSY
-- FOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL
-- TOTAL SPECIMEN LENGTH, 30 MM
C) PROSTATE, RIGHT BASE, NEEDLE BIOPSY
-- FOCAL HIGH GRADE PROSTATIC INTRAEPITHELIAL NEOPLASIA
-- TOTAL SPECIMEN LENGTH, 23 MM
D) PROSTATE, LEFT APEX, NEEDLE BIOPSY
-- BENIGN PROSTATIC GLANDS AND STROMA, 43 MM
E) PROSTATE, LEFT MID, NEEDLE BIOPSY
-- BENIGN PROSTATIC GLANDS AND STROMA, 22 MM
F) PROSTATE, LEFT BASE
ADENOCARCINOMA, GLEASON GRADE 3+4 = 7
ADENOCARCINOMA INVOLVES 2 OF 2 CORES AND 10 MM OF 30 MM
The first involved core from the left base contains 3 mm of Gleason grade 3+3=6 adenocarcinoma and the adenocarcinoma is located 6 mm from the presumed peripheral edge (see note).
The total core length is 17 mm.
The second involved core from the left base contains 7 mm of adenocarcinoma. Greater than 6 mm of the adenocarcinoma is Gleason grade 3 and less than 1 mm is Gleason grade 4. The Gleason grade 4
adenocarcinoma is located approximately 2 mm from the presumed peripheral edge (see note).
The total core length is 13 mm.
NO PERINEURAL INVASION IDENTIFIED