uPSA has been right for me for since February 2016

[NanoMRI]

Quite the topic this is. Yesterday, another member awarded me Mt. Stupid standing. (okay!).

Back in 2015 I concluded this is a very challenging disease with many disparities and no easy-button; seems little has changed.

Following my Dx I took the whole of 2015 to investigate my treatment path. Consultations included: CyperKnife with Royal Marsden London, England; HIFU with Professor Emberton, University College Hospital, London; Brachytherapy with Radiotherapy Clinics of Georgia, USA; Multidisciplinary review with John’s Hopkins Urology, Baltimore, MD. Those consultations and others provided me detailed written reports. Based on imaging findings and no evidence of disease in bones or organs I settled on RP despite the awareness my cancer was likely outside the gland. Additionally, I saw benefits in having the primary tumor burden removed and I wanted the usefulness of ultrasensitive PSA testing post RP, relying on <0.010 as best indicator and dismissed the characterization “undetectable”. This 2005 study is one of several I relied on for that decision: pubmed.ncbi.nlm.nih.gov/157....

My post RP nadir was uPSA 0.051- confirmation my cancer had spread. Monthly uPSA testing tracked rise from 0.051 to 0.113 over next ten months. During that time I had more consultations. I settled on salvage RT to prostate bed, no ADT.

My post salvage RT nadir was 0.075 – cancer had spread further than thought. Over the next nine months testing tracked rise to 0.093 when I went for the Ferrotran nanoparticle MRI I share about. With the identification of multiple pelvic lymph node mets and no bone/organ mets I went for salvage extended pelvic lymph node surgery using frozen section pathology method. Six cancerous nodes removed including para-aortic.

My post ePLND nadir was <0.010, no ADT. I then did a year of bicalutamide for added insurance. After twenty-three months of frequent testing the < dropped.

For the next eight months my uPSA held in 0.01X range then rose into 0.02X range where it held for seven more months. In June 2021 my uPSA entered 0.03X range and it has been holding there since, no ADT. (Four of my last five tests have dipped into 0.02X range – but this is another discussion).

Multiple imaging methods and liquid blood biopsy testing since December 2021 to date show no indication of prostate cancer. Although I do not think I am cured I am gaining confidence I may be realizing longer-term durable ‘remission’.

Hopefully this is a useful read. All the best to all of us.

Murray

[MrProstate]

While Mt. Stupid might be a cheeky nod to the Dunning-Kruger curve that one poster on this forum seems to exclude himself from, you’ve clearly moved well past that peak. If anything, your path illustrates the “slope of enlightenment” — combining personal insight, leading-edge science, and lived experience. It’s clear you’ve been your own strongest advocate, and the results — particularly your long-term low uPSA stability without ADT — speak volumes.

Your use of Ferrotran-enhanced MRI is particularly forward-thinking. This technique, though not yet widely available, has shown superior sensitivity in detecting lymph node metastases — an area where conventional imaging often fails. That you then acted on those findings with salvage ePLND and achieved a new nadir without systemic therapy speaks to both the precision of your approach and the skill of your clinical team.

And choosing to withhold ADT despite rising PSA — a tough but defensible decision — aligns with newer thinking that emphasizes quality of life, and that not all PSA rises demand immediate systemic therapy in the absence of radiologic or clinical progression.

Wishing you continued remission and many more years of good health.

[NanoMRI in reply to MrProstate]

Thank you MrProstate. Thank you!

[ron_bucher in reply to MrProstate]

Thanks to the 0.0x sensitivity, since my original diagnosis in 2006 I've experienced ADT only one time (9 months in 2017 along with docetaxel and IMRT) and may never need ADT again. Stupidity is ignoring new treatment advancements made by the best doctors (long before results appear in studies that are not funded by pharma).

[ron_bucher]

Great to see you and your medical team believe in personalized medicine. Every case is unique and personal. And throwing ADT at every single recurrence is old school thinking.

A famous American’s advice regarding the critic:

“It is not the critic who counts: not the man who points out how the strong man stumbles or where the doer of deeds could have done better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly, who errs and comes up short again and again, because there is no effort without error or shortcoming, but who knows the great enthusiasms, the great devotions, who spends himself in a worthy cause; who, at the best, knows, in the end, the triumph of high achievement, and who, at the worst, if he fails, at least he fails while daring greatly, so that his place shall never be with those cold and timid souls who knew neither victory nor defeat.”

—Theodore Roosevelt

Speech at the Sorbonne, Paris, April 23, 1910

[NanoMRI in reply to ron_bucher]

Appreciate this, great quote and yes personalized medicine is key.

[Teufelshunde]

Very insightful. Keeping this for future reference.

[j-o-h-n]

I wish I could think of a word that means the state of understanding or awareness, often implying a sudden or profound realization of enlightenment.

Good Luck, Good Health and Good Humor.

j-o-h-n

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

How about "anxietization"? (medical term: anesecheopoesis from ανησυχιοποιηση)

[j-o-h-n]

Thank you for you response.

Meantime my dear lovely smart Filipina wife told me that sometimes my wishes are located in my wish:

I.e. I wish I could think of a word that means the state of understanding or awareness, often implying a sudden or profound realization of enlightenment.

Regards and, Με υγεία.

Good Luck, Good Health and Good Humor.

j-o-h-n