Treatment after prostatectomy

[lhall2]

Psa of 0.028 after prostatectomy. What does this mean

[Tall_Allen]

It is excellent. But do you have advanced prostate cancer? Are you taking hormone therapy?

[lhall2 in reply to Tall_Allen]

Gleason score of 7 & cancer in 1 of 10 lymph nodes removed when prostatectomy 9 months ago. No further treatment at this point. Vanderbilt recommends doing hormone treatment and radiation at same time. Vanderbilt says results same doing treatment right after prostatectomy vs waiting for rising PSA. Meeting with surgeon & radiologist early March

[Tall_Allen in reply to lhall2]

That is not correct in your case. Your metastatic lymph node puts you in a different stage category (N1). You should not be waiting for PSA to rise. You already know that there are many cancer cells in your pelvic lymph nodes. You have this opportunity to maybe get them all with a combination of whole pelvic radiation and 2-3 years of ADT.

[lhall2 in reply to Tall_Allen]

My N1 status was consider by Vanderbilt in their recommendations for future treatments. Because radiation can only be done once, radiation side effects & Vanderbilt’s findings of similar results of immediate vs waiting for treatment for a person in my situation, the decision was made to allow body to recover and produce best outcome for “cure” & quality of life Thanks for the input & we will see what happens at my March appointment

[Tall_Allen in reply to lhall2]

It is just not true that there is any data showing "similar results of immediate vs waiting for treatment for a person in my situation." There is data showing similar results for early salvage when PSA rises to adjuvant treatment. But that is definitely not among men who are N1. In fact, N1 men were specifically excluded from all of those studies.

[lhall2 in reply to Tall_Allen]

You are incorrect. Check with Vanderbilt who has the study done with N1 like me

[Tall_Allen in reply to lhall2]

Could you please provide me with a link to that study? All I have seen is here:

prostatecancer.news/2017/12...

I searched pubmed and clinical trials and found no such study at Vanderbilt.

[Gemlin_ in reply to lhall2]

I think Vanderbilt is correct. Many N1 surgery patients remain free from relapse for a long time and some may be cured. There is good reason to be restrained with adjuvant radiation and hormone therapy.

[lhall2 in reply to Gemlin_]

Does restrained with adjuvant radiation and hormone therapy mean going with that treatment as soon as possible or waiting PSA increases

[Tall_Allen in reply to Gemlin_]

Do you have a reference for that?

[Gemlin_ in reply to Tall_Allen]

I think there are no randomized trials of postoperative therapy with established lymph node metastasis?Maybe this study ascopubs.org/doi/10.1200/JC... would be relevant for lhall2.

[Tall_Allen in reply to Gemlin_]

That, as well as all other studies on the subject, are linked in my article. It does suggest the opposite of what his doctors are telling him - it says there may be benefit in adjuvant RT (which was my whole point to him).

As my article shows, three researchers looked at retrospective databases and found a benefit to adjuvant RT, Abdollah, Rusthoven, and Zareba, while one found no benefit (Kaplan). The Touijer study was the highest level of evidence (3 institutions with full data) so far. All men who had RT were treated with adjuvant RT.

All of those studies primarily looked at patients treated with adjuvant RT. So your advice that "There is good reason to be restrained with adjuvant radiation and hormone therapy." is not based on any available evidence.

[Gemlin_ in reply to Tall_Allen]

Allen, I do not contradict you but do you mean that all N1 patients would benefit from aRT?Abdollah et al. wrote about patient selection in europeanurology.com/article...

...our results showed that around 25% of our population would not benefit from aRT. These consist of either patients who have locally limited disease (≤pT3a disease with negative margins and less than or equal to two positive nodes) and thus have a good disease control with surgery alone.....can be spared the side effects and the financial burden of aRT.

lhall2 might fit into that group?

[Tall_Allen in reply to Gemlin_]

I wouldn't bet on it. There is an important limitation to database analyses - selection bias and lack of full data. Those who had ≤ 2 positive nodes may have had 30 nodes removed or they may have had 5 removed. That's why the Touijer study is so important - everyone got the same treatment and diagnostics at each institution because institutional protocols were followed..

[Justfor_]

A single PSA value tells you practically nothing. Three consecutive test counts can provide just a glimpse of a trend. Since you are high risk (because of N1) a more frequent PSA testing could give you an earlier and _more_importantly_ higher confidence signal of what to expect. I for one, also high risk, 20 months post RP have in my spreadsheet 22 PSA measurements, one of which is an outlier.

[lhall2 in reply to Justfor_]

Thanks for the reply. I had 3 previous standard PSA’s that were all >.1 so I wanted the ultra sensitive PSA this time to see a finer reading. Good news that your results are great. I take it you had no further treatments? Thanks

[Justfor_ in reply to lhall2]

Unfortunately, and to rephrase your Vanderbilt doc's: "at same time", I will have to have sRT at SOME point in time. It takes a very delicate decision regarding the timing. Wait for the PSA to get higher for the PSMA PET/CT to get some better chances for a positive detection, but not long enough, because the chances of remission after sRT diminish at a rate of 2% per .1 rise in PSA. A blind irradiation is a definite NO-NO for me.

As to PSA counts, always receive them with a measurable degree of uncertainty. Allowable variance between labs is 20%. During December last I took 3 tests. My past record extrapolation indicated that my December count would had been 0.07, rising from 0.06 in November. I use, in alternation, two labs so as to get a more accurate picture of both the absolute value and the rate of PSA rise. The December test from lab A came to 0.08. It was time for a confidence check with lab B. To my great surprise, one week later, it came 0.11. I had to resolve the ambiguity. Lab C, one day later, gave 0.104 (they quote 3 decimal digits). Next week I will have my monthly test. I will see if any new surprises are looming.

[lhall2 in reply to Justfor_]

Sounds like your approach is the similar to the one I am taking. Do treatment when something shows up. You want to see something on a scan. My consideration is a raising PSA doubling time. That could result in “blind” radiation. Why have you ruled that out?

[Justfor_ in reply to lhall2]

Are you pulling my leg? How on earth can you calculate your doubling time with 3 tests <0.1 and one 0.028.

Anyway, in my case I have a multitude of calculations for reaching my PSADT. They span from -6 to +7 months, logarithmic regression. Its not forecasting a great future, but not calling for desperate measures either.

Regarding PSMA PET/CT, in spite of what silly doctors parrot, a negative detection has comparable information value to a positive one. The crucial thing here is the timing. Not too early - not too late.

[lhall2 in reply to Justfor_]

You don’t understand. Not talking about doubling time now but in the future to help as a guide to future treatments

[Magnus1964]

That is a great PSA reading. You need to watch for significant rises in your PSA. You will get small rises due do irritations or inflammations. By significant I mean 3 rises of 0.5 or more.

[j-o-h-n]

Check your PSA (btw there is no "cure" animal with cancer.... it always there... but you can live with it)

Greetings lhall2....

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j-o-h-n Tuesday 01/12/2021 5:31 PM EST