Ongoing BCR case. Advices are appreciated.

[MSTI]

RP 09/17/2015 GS 7(4+3), PNI,SVI, ECE, positive margins (35% right half, 15% left half (PT3b N0M0))

11/12/2015 PSA 0.06 first postop

01/13/2016 finished adjuvant RT 6600 cGy/33x to prostate bed

02/22/2016 PSA 0.03 first post RT

05/13/2019 PSA 0.11 DETECTABLE

01/29/2020 PSA 0.20 officially BCR

02/18/2021 PSA 0.23

02/04/2022 PSA 0.27

03/23/2023 PSA 0.34

Detailed PSA data in BIO.

When I was at 0.20, MO's recommendation was to wait for PSA of 0.40 an then choline and other scans. Intermittent ADT after that.

On last meeting PSA (0.34) MO opted for waiting of PSA 1.0 and then do PSMA GA68.I guess that in my country PSA has to be at least 1.0 to qualify for PSMA.

My PSADT depends on time interval selected but is 3Y9M to 4Y3M.

Closing to 70, normal active life, moderate excercise, only slight tensioning lower back to legs occacionaly.

Moderate use of supplements.

Seasonality of PSA fluctuations is prominent as Justfor noticed in one of his valuable posts.

Episode of Ramsey Hunt syndrome (2021) with prednisone use caused (probably) sharp PSA rise in a month from 0.20 to 0.34 and back to 0.22.

Episode of Covid made similar PSA spike.

Last meeting with MO was 03/23/2023 and I have got six months until next meeting. This time I decided to not monitor PSA monthly as usual. Vacations.

Today, trend is to react as soon as PSA start to rise constantly, even when numbers are below 0.1.

OK, but my doubling time is slow.

I could start with ADT in January of 2020. if I was too afraid of rising PSA. Was not, and soon will have four years free of ADT SEs.

Decision was mine (MO was against ADT but was ready to administer).

Justfor's "Bicalutamide maneuvers" are very interesting but MO probably will not risk with "soft" approach when ADT time comes.

I would like to hear your opinions and advices.

Good luck to all.

[Justfor_]

Thank you for your kind comments re my posts. Have you run your numbers through the Italian online application for an estimate of your probability to a positive PSMA detection? Ask your MO in case they were to buy a new air conditioning unit which one of the two they would selected: a) AC fixed capacity compressor with on/off room thermostat, or, DC inverter variable load compressor with proportional drive? If you are very unlucky you can get a response of the likes of: "What does this have to do with your treatment options were are discussing?". If so, time to search for a MO that doesn't leave their mind back home when practicing medicine.

[MSTI in reply to Justfor_]

Not aware of such application.

[Justfor_ in reply to MSTI]

On the road now, will post the link later.

[Justfor_ in reply to MSTI]

evidencio.com/models/show/2063

[MSTI in reply to Justfor_]

Thanks. Tipo.....sorry. Corrected.

PSMA will be scheduled when PSA is 1.0, not 0.1.

With PSA of 1.0 probability for positive PSMA scan is 20% according to application.

Max doubling time is 24 months in application. Mine is longer than that.

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

For Justfor_

You're soooooo smart.......... but just one question..... do the air conditions come in colors (maybe stripes)?

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 09/11/2023 6:34 PM DST - Remember

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

Yes, ofcourse. More buyers can be lured on appearance than efficiency.

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

SPOUSE.... good example.... eh?

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 09/12/2023 8:10 AM DST

[MSTI in reply to Justfor_]

I don't get it.

Both units will do their job, no? Yes, older technology operates with greater cost.

Was it reference to Choline vs PSMA?

Another analogy can be:

AC fixed works as intermittent ADT. Full ahead, goal reached, stop. Repeat.

DC inverter is more like ADT for life. Full ahead, then slowly adjusting to maintain the goal.

Difference ?

AC fixed has lower price because less fuel is used(ADT is halted for some time), user

feels better when temperature is temporarily rising(off ADT cycle).

There are situations when you can't choose....one must go on DC inverter here. 😉

Italian application raise the following questions:

Time to BCR is defined as less then one year or greater then one year. Is it true that there is no difference between 1,2,3,4,.... years?

Doubling time has max of 24 months. Is it true that there is no difference between 2,3,4.... years?

[Justfor_ in reply to MSTI]

You got the analogy correctly. The difference between the two is in the wear and tear of the motor plus the stressing of the power grid. In data centres they didn't spin down mechanical hard disks because they lasted longer left spinning all the time. ON-OFF transition is stressful to the body, no doubt about it. Proof of this is in abundance. Going from cold environment to an extreme hot one, or equally, from high (deep) water pressure to atmospheric, can cause sudden death (heat stroke) or paralysis (sponge divers disease).

I can't comment on the parameters of the Italian calculator. Sorry.

[MSTI in reply to Justfor_]

Parameters are mentioned as example of one size fits all philosophy (and practice) and are more retoric questions. My MO will have to answer in what part of his patients population history my case fits. Is it more typical then unusual.

[Justfor_ in reply to MSTI]

With your PSADT of 4 years +/-3 months, I doubt your MO will have any population history to match your case to. If you are not his one and only such patient, there may be another one or two, but I wouldn't expect any more. Very restricted sample count to draw any meaningful statistics out of it.

[MSTI in reply to Justfor_]

Exactly. Instead of lengthy post I had to ask if any similar case exists on forum.