PSMA result what to do next

[old64horn]

I had my PSMA Pet scan (PSA at 0.30) on Monday and met with my MO yesterday. The test did not identify any positive location. My MO doesn’t want me start ADT yet. He wants to take another PSA test in August and see its progression. Given my age (80 yo) he wants to preserve my quality of life. In your opinion is that the right choice?

[Justfor_]

Sound but slow advice. Monthly PSA tests so that you get a more reliable and prompt PSADT.

[MJCA]

I read your history. Yes, your PSA is increasing, but the number is SO low it does not warrant any medical intervention. Keep enjoying your life and family. I would continue to monitor your PSA every 3 months.

[old64horn in reply to MJCA]

Thank you for responding. I'll probably get the PSA test done in July instead of August, in the mean time I'm hoping to enjoy few weeks of vacation and do some fishing on the gulf coast.

[MateoBeach in reply to old64horn]

Good Plan! Enjoy and catch fish. ADT can wait, you may outlive your cancer without it.

[old64horn in reply to MateoBeach]

Thanks. I plan on doing a lot of fishing with my daughter and her 3 sons without thinking about PC. Hopefully we will catch a lot of fish

[RS265 in reply to old64horn]

So I always opt for quality over duration. The researcher Michael Hoffman (Lu177) told me I may be effectively cured. In response to my raised eyebrows he simply said I may live long enough to die of something else. A get a grip moment!At 80yo and 0.3 I'd suggest you enjoy life, the side effects of any treatment are complex and always negative to QOL.

Let your psa run to 2.5 (my upper limit before (re) starting ADT), but 4 is likely also safe enough and see what the response is.

Enjoy life and don't fret prostate cancer.

Cheers

[old64horn in reply to RS265]

Thank you

[Magnus1964]

I would have the PSA test done sooner. Why wait till August? There are mild ADT drugs you could take.

[old64horn in reply to Magnus1964]

Thanks, I think he wanted me to go on my vacation without worrying about my PSA. I'll call him and get it done as soon as I get bacj in mid July.

[LearnAll]

Your MO is a smart trooper !

[Don_1213]

If I was in your situation I'd take the doctor's advice. At 80 - why give up your quality of life for what's likely to be absolutely no extension of life? ADT was tough at 73, I can't imagine how much more difficult it would be at 80.

[dac500 in reply to Don_1213]

Even at 80 one doesn't know how long he is going to live. So, treatment decision shouldn't depend on age.

[Don_1213 in reply to dac500]

Sorry - but I beg to disagree. (Respecting that since you're older than 80, you may have a contrary opinion..)

It's quite easy to find a chart of expected lifespan.. and one that correlates that to a treatment decision (MSK has them online - called "nomographs"). The fact that ADT increases the risk of cardiovascular issues means the ADT could easily shorten his lifespan to less than if he received no treatments, and men are more prone to CVT as they get older.

Treatment decisions are made all the time based on the age of the patient. One of the popular tales that urologists use to convince younger men to have an RP is "they'll live longer so the chance of secondary cancers is higher" vs radiation (which actually has not been shown to be true that I know of.)

[dac500 in reply to Don_1213]

Metastatic prostate cancer not treated properly may lead to bigger problem.

[Don_1213 in reply to dac500]

And it may not. That's why the doctor wants to monitor his PSA. Chances of it causing real problems at the levels his tests reveal are very slim. As T_A said - if the doubling time accelerates, it's probably time to consider some form of treatment, if his health allows for it.

[dac500 in reply to Don_1213]

I agree with TA watching PSADT is important. If that requires further treatment age shouldn't be the determining factor.

[Don_1213 in reply to dac500]

I'll quote the first line of my reply to him: "If I was in your situation I'd take the doctor's advice." and I'll stand by that. It's plainly stated as my opinion, and I believe that's what he was asking for (and I'm sure both he and his doctor were considering age in their opinions.)

I have a few years to go until 80, but an old friend (in his 90's now) said to me "Life is like a roll of toilet paper.. when it's new it seems as if it will last forever, when it's close to the end of the roll the sheets roll off increasingly fast.."

The question here is the usual one - quality of life vs quantity of life. When you're younger the quantity difference can be significant. As you near the end of the roll, well - quantity is reduced and to me quality becomes paramount.

[old64horn in reply to Don_1213]

thank you for both your responses. I agree with you Don I have very slow growing PC someplace in my body so small that it can't be seen on a PSMA pet scan. I also have cardio vascular disease that mat kill me before PC can. Starting ADT could worsen the situation. everyone is different. DAC500, I respect your opinion and appreciate it very much. I eventually may have to start ADT but for now. I want to keep my quality of life a little longer even if it means shorter life span.

[Tall_Allen]

3 month PSA sounds reasonable. It is slow-progressing. IF PSA doubling time accelerates, you can take action then.

[old64horn in reply to Tall_Allen]

Thank you TA. That is exactly what my MO said. August 8th is only 2 months away. I'll check the PSA and see how fast it is doubling and go from there.

[Karmaji in reply to Tall_Allen]

When on vacation with prostate in place but radiated...what doubling time to look into...Suppose one has psa <0.03...then what to look into for PSA...Is doubling time important right from beginning or after PSA hits some value. say 0.5 or 1. URO says follow PSA but did not clarify what to look

RO says it will go to 2....then worry..

What PSA doubling time span one should follow

Thanks T A

[Tall_Allen in reply to Karmaji]

There is no such thing as a validated doubling time for PSA below 0.1.

[Blackpatch in reply to Tall_Allen]

Hello TA

I’ve noticed you making this point in the past - when I was tracking my recurrent PSA at levels from .02 onwards, I came across a Finnish PhD these that examined the issue in detail, tracking men from the micro-PSA region through to beyond 0.2, and the bottom line was that trends in the micro region were highly correlated with those in the more accepted range.

Annoyingly, I didn’t download a copy and haven’t been able to find either the thesis or a conference publication that accompanied it - but it seemed to be a sound piece of work. Perhaps you are better able to track it down, since this topic comes up regularly.

Stuart

[Tall_Allen in reply to Blackpatch]

Karmaji was asking about warning signs when the prostate has had primary radiation.There is no usefulness to ultrasensitive tests in that situation, because nadir + 2.0 has been validated as the best signal for biochemical recurrence.

But you appear to be talking about the post-prostatectomy situation, which is entirely different. The reason it has never been validated is there is a great deal of data for values above 0.1 and very little data for values below that. Also, there are a lot of random fluctuations in small numbers. What we learned from RADICALS-RT is that one can wait for either a PSA of 0.1 or 3 consecutive rises in ultrasensitive PSA to have SRT:

thelancet.com/article/S0140...

[Justfor_ in reply to Blackpatch]

Is the one that uses splines on top of the usual linear regression of the log2 PSA values and also has an online application to upload your personal data? If yes, I have used the app and can "validate" the results for my N=1 case. Nice silly-less tool.

[Justfor_ in reply to Tall_Allen]

Incredibly silly rule!

Take a look at my PSA time series and tell me at what PSADT I would had arrived when I saw the 0.15 during late Feb. 2021, had I discarded all preceding PSA values inferior to 0.1.

To spare you the effort this is what the "validated" MSKCC on line calculator would had come to:

Not bad. 6.4 months instead of 9.5.

Throwing darts can be another equally "validated" way to derive PSADT.

PSADT

[Tall_Allen in reply to Justfor_]

It's not a silly rule, it's just never been validated. You can make up your own rules for an n=1 (yourself), but that has no relevance to others.

[Karmaji in reply to Tall_Allen]

many thanks

[j-o-h-n]

If I were 80 I'd say fornicate it....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 06/10/2022 7:44 PM DST

[old64horn in reply to j-o-h-n]

I like your sense of humor. Thanks

[j-o-h-n in reply to old64horn]

Thanks....But it comes natural with us guys born in the 30's...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/11/2022 1:33 PM DST