RP December 2018
PSA, CANCER MONITORING - 0.2 (H). 04/05/2022
PSA, CANCER MONITORING - 0.1 (H) 10/26/2021
PSA, CANCER MONITORING. - 0.1 (H). 07/19/2021
Was <.1 up until 7/19/2021
Then April 2022 cam back at .2
What do you think treatment should be, is there enough data to determine doubling? Any insight please
PSADT=8 months
The characteristics that suggest one can delay SRT are:
PSA doubling time > 1 year
Gleason score < 8
Interval to biochemical failure > 18 months
prostatecancer.news/2021/10...
With your PSADT less than a year, it's probably time to begin SRT. The nice thing about doing it now is that you can avoid adjuvant ADT and can probably do prostate bed only. I think you should talk to an RO.
Hello Plato,
I'm not an expert on any of this. My sense of it is that PSA = 0.2 after prostate removal probably indicates a recurrence, but doesn't yet prove it. Many people I've read on this forum have said that their doctors consider that the PSA must be greater than 0.2 to prove a recurrence. so if your doctor says that, he's not just trying to calm you. I think that there have been patients who got to 0.2 after surgery and then declined again. You may be one of them. Consider also the sensitivity of the test. If the test only records in tenths of a ng/ml, then your actual PSA could have been anywhere from around 1.5 to around 2.5.
I believe that the numbers you've got are not helpful for calculating doubling time, The number went down once or twice, (.2 to .1, then .1 to <.1). The change in PSA is not yet stable and the numbers are not precise enough to give you precise information. For example, "<.1" could mean .01 while ".2" could mean as much as .25. On the other hand, the change could have been from .9 to 1.5. You'll have to see clearer trends to get a doubling time.
Your doctor knows much more than I do about what to do next, but I would think that active surveillance is appropriate at this time. You could make the surveillance more active by getting a higher resolution test, i.e., more decimal points in the results, and perhaps by changing to tests every 3 months.
Perhaps the most important advice I can give you is, don't panic. It looks very likely that you will live for many years to come and, even if you have a real recurrence, there's a good chance you will make it to old age and die of something else. There are men on this forum who have lived 20 and even 30 years since diagnosis and treatment, and with the continuing cancer treatment research that we're seeing, those numbers are only going to grow.
I wish you the best of luck.
Alan
No way to calculate doubling time under the toll of the rounding error of a single decimal digit PSA reporting. Take the two extreme cases derived from the latest 3 tests:
1) First 0.1 is a rounded actual 0.101 and 3rd 0.2 is ditto 0.249. Doubling time circa 6 months.
2) First 0.1 is a rounded actual 0.149 and 3rd 0.2 is ditto 0.150. Doubling time in the decades.
As Dr Morgans (MO Northwestern and now Vandy) told me in a consult, why not kill it now while the burden is low? Direct correlation between psa at time of srt and results. And both her and my RO (U Chicago) said ADT was not necessary since psa so low. Side effects are minimal if any. I would do sulforaphane (BROQ) until you decide, to slow or stop psa progression NOW, per this study.
pubmed.ncbi.nlm.nih.gov/259...
Interesting article on sulforaphane, thanks for posting
I want to give you my own similar experience which might help you figure out what you might do. In my case I did not have RP I had RT, radiation therapy. After that my PSA fluctuated around .2 to .6 for over three years, then began climbing. My RO did not mention mPC until about 3 years after RT when the PSA began rising consistently to around the 4 level. At that point he recommended Hormone Therapy, and I chose intermittent over continuous. So, at PSA of about 8 we scheduled Lupron with Bicalutamide. Since then, I have gone through intermittent Lupron shots (3 in 90 days), three times, and then I was referred to an MO which seemed to be okay as I vacationed for four years, all the time my PSA rising until it reached 34. At that point my MO retired and the replacement MO immediately scheduled me for Lupron again and that was about 2 years ago. Since then I have been on Lupron on a continuous basis, and my PSA has flatlined at <0.1. So when I see you at 0.2 and worried it seems to me you are being too cautious. You talk about SRT which I know nothing about, but I suppose it means some kind of radiation therapy, which means you have tumor development big enough to see with scans and can zap them with radiation to reduce or control. So here I am 13 years after RT and ten years after mPC. I'm now 76 years old and although my problem is ED, hypertension, and laziness, I'm in pretty good health.
Everything I've read and experienced definitely get another PSA test (same place) and you are also now able to get a PMSA scan, lastly very early salvage is nearly = to adjuvant radiation, so if it is elevated again start radiation to prostate bed and probably pelvic lymph nodes. ~Rob
I had surgery in 2009. My PSA became detectible in 2016. in 2021 it reached 0.12, my Urologist suggested IMRT to the prostate bed and lymph nodes which was completed in August 2021, unfortunately the PSA did not go down and it is now 0.19 (7 months since RT). Now I'm on hold waiting for the PSA to rise enough so I can get the PSMA pet. I think you should wait and get the PSMA pet so you don't go thru the IMRT to the prostate bed if the cancer is already some place else at which time you need a systemic approach.
What was your experience with radiation could you still work what side affects did you have?
The first 3 weeks were very easy, so side effects. By the fourth week I had diarrhea that was controlled by meds only to cause constipation for a day or two. The worse happened when I had urgent and frequent urination in week 7 and 8. All of those subsided two weeks after the completion of radiation. Everything is back to normal now. I’m fairly active for an 80 year old man. I wish you the best
Another Greek.................. Yiasou! OPA!
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 04/07/2022 6:07 PM DST
Really good time to consult an RO to plan for Salvage RT to prostate bed and discuss including the pelvic lymph node fields. It is your best shot for a cure. Your next PSA will likely confirm BCR by the time they do the planning scans for RT. Also consider a PSMA PET which could possibly show futility if lesions seen outside the pelvis. Despite what some others say, PSMA can often be positive at PSA of only 0.2. Would also switch to ultra sensitive PSA tests during this phase. Go for a cure while you still can.
Treatment after RP with affected lymph nodes
PSA rate of decline in ADT with ductal type cancer?
PSA rise
What's Next?
Dad has PC in pelvic nodes ? Is he on correct treatment
