CSN Login
Members Online: 13

Rising and unstable PSA post RT

Osuji
Posts: 6
Joined: Dec 2010

I am a 60 year old African American male diagnosed with prostate cancer
(PSA 8.5) in October of 2002. Had RT on January 21, 2003. Gleason score was
6 (3+ 3), all margins were clear but there was Perineural invasion (PNI).
My RT side effects were brief and minimal. My PSAs were >0.1 for almost 7
years. Then rose to 0.2 in November of 2009 then went up to 0.3 in May of
2010 and down to 0.2 in August of 2010 and back up to 0.3 in November 2010.
I completed 13 of prescribed 39 sessions of Radiation today.

I read and found comments very informative (especially, Kongo's). So, I am
pleased to join forum and welcome any advice and/or comments. I wish you
all aHappy and prosperous New Year. God Bless!

Osuji.

VascodaGama's picture
VascodaGama
Posts: 1552
Joined: Nov 2010

Osugi,
Could you explain about the planned radiation treatment of 2003 and the scope of radiation you are now undergoing?
Welcome to the board.
I wish you a successful treatment this time again.
VGama

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Osuji,

Welcome to the forum and I'm sure you have many experiences to share with other readers here. I think all of us who have been treated are keen to learn of how others have fought a recurrence of prostate cancer.

I am a little confused about your post and I think Vasco is as well. Did you have your prostate removed in January 2003 or did you have radiation treatment (RT)?

The way I read your post was that you had a radical prostectomy in 03 following an elevated PSA of 8.5 and that the post-operative Gleason was 3+3 with clear margins but PNI, and that you rapidly recovered from the surgery. You had a very low PSA for several years then it started to rise in 09 until it broke 0.3 earlier this year and now you've started radiation treatment (IMRT?). Is that correct? The use of "RT" confused me but I figured that you couldn't have had clear margins without having your prostate removed. Please clarify if I've misread your information.

Best of luck as you go through your present treatment regimen. I hope that you are free of any side effects and that your PSA gets back down to where it should be.

Best,

VascodaGama's picture
VascodaGama
Posts: 1552
Joined: Nov 2010

Hi Kongo,
I thing that Osuji is mistaken the RT for RP, however, I read before that patients can have RT as prime (ig; brachy) and years later, have a “sort of SRT” directional to certain lesion, but this is rare. I wonder if Osuji is one of those patients! His schedule of 39 fractions is just too large even after 9 years of healing. Well, as you say, we like to learn.

Regards,
VGama

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

I'm sure Osuji will soon clarify his condition. I too have heard of second radiation treatments or boosts but agree with you that this doesn't seem to be that although I am still happy to learn new things about this disease almost every day.

Best,

Osuji
Posts: 6
Joined: Dec 2010

I am sorry guys. Please substitute RP for RT. The surgery was done in 2003.

Osuji

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Thanks for clarifying, Osuji. Are you having IMRT now?

K

Osuji
Posts: 6
Joined: Dec 2010

Hi Kongo,

Yes. Completed 17 of 39 sessions of IMRT today.

God Bless.

stepjnsj's picture
stepjnsj
Posts: 18
Joined: Oct 2010

Hello I wish you continued success on your radiation treatment and hope that everything goes well. I had RP last year and I am doing fine now my last PSA test was .017 and I am having another next month good luck and God Bless You and Family

Osuji
Posts: 6
Joined: Dec 2010

stepjnsj,
Thanks for your words of encouragement and prayers. I am happy to hear that your PSA came back .017 and that you're doing fine. Good luck on your next PSA test.

I need someone to give me a simple definition of PSA doubling time with some examples.

Good luck guys and God bless.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Osuji,

PSA doubling time is simply the amount of time it takes for a baseline PSA score to double. It's a prediction based on some mathematical forumulas that curve fit and is not a straight algebraic relationship. PSA doubling times are used to determine the relative risk and aggressiveness of prostate cancer and is a particularly useful tool for men who have had a RP and later see their PSA scores begin to rise. Generally, a relatively short PSA doubling time is considered dangerous while relatively long PSA doubling times are much less so or even indicative of indolent cancer.

There are several sites on the web that have free PSA doubling time calculators where you can plug in the dates and PSA scores and it automatically calculates PSA doubling time, PSA velocity, and PSA density (for men who still have prostates)

Memorial Sloan Kettering has some of the best calculators and can be found at: http://www.mskcc.org/applications/nomograms/prostate/PsaDoublingTime.aspx

The site also give a pretty good explanation of what all these scores mean and the relative risk. The more data points you have the more accurate the tool becomes because it takes into account data that doesn't fit the curve which could be an indication of a spurious reading or one that is outside the standard deviation limits and probably represents some type of lab error or other anamoly.

Hope this helps.

K

janekirstine
Posts: 24
Joined: Nov 2010

Good evening!

My husband had a radical prostatectomy in October 2001 and has been cancer free with a 0.0 PSA until November 2010 when his PSA registered at 0.56 The urologist was able to find a one centimeter mass which they could biopsy and prove cancerous.

So we are using the Calypso™ 4D Localization System with IMRT Radiation for salvage prostate treatment after a radical prostatectomy.

My husband had the Calypso Beacon Transponders implanted yesterday. The outpatient procedure when very smooth. He goes back next week for various measurements and scans that will be used when he starts radiation. He will have 35 sessions of Intensity-Modulated Radiation Therapy (IMRT).

Osuji
Posts: 6
Joined: Dec 2010

Janekirstine,

How is your husband doing? I hope he's doing fine. My prayers are with you guys. I completed my 39 sessions of IMRT today and goes back for 1st post RT PSA test. I am keeping my fingers crossed and praying, too.

Kongo,

I tried to calculate my PSA doubling time and ran into problems, I think it has to do with my fear of math. Help!

God bless.

Osuji.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Osuji,

Would be happy to calculate your PSA DT if you can email me the date/PSA reading for all the PSA tests you have had following RP. In any event, however, since you have just finished IMRT, the previous PSA DT is pretty much OBE. You want to start keeping a close record of your PSAs and the date you had them from here on out so you can see if you have anything to worry about. Hopefully, your latest treatment will eliminate this as a source of anxiety.

Best,

K

Osuji
Posts: 6
Joined: Dec 2010

Kongo,

Will do. Once again I thank you for your support.

God bless.

Osuji

janekirstine
Posts: 24
Joined: Nov 2010

Osuji,

Thank you for asking. Congratulations on finishing your sessions of IMRT!
We will pray for a non-existent 0.0 PSA reading for you.

My husband will begin his now calculated uninterrupted 38 sessions of 6 MeV each on February 22nd. Treatment will be administered at Swedish Cancer Institute in Seattle. Anxious to get it started and over with. There is so much information on this forum, and each case/patient is so unique that it is sometimes hard to comprehend it all. I cannot find any other cases like ours where there is a mass present in the prostate bed to radiate after RP.

Best of luck to everyone out there,
Jane

mrspjd
Posts: 693
Joined: Apr 2010

Hello and welcome back to the forum from one PCa wife to another. Thanks for the update on your husband. You seem quite knowledgeable and supportive of his treatment. I was curious to know how the urologist found the mass in the prostate bed. In other words, which diagnostic testing or methods were instrumental in determining the location and size of the mass found, such as a pelvic CT w/contrast, or an MRI, or an endorectal MRI, a doppler ultrasound (color or black/white) etc. If I understood your post correctly, I also wondered how the mass was biopsied in the prostate bed--was it done in the same manner that a prostate biopsy is taken or via a laparoscopic procedure, as is sometimes done to biopsy a suspicious pelvic lymph node?

Thanks for any add'l info you might be able to provide. Wishing you both all the best for a successful series of IMRT txs.

mrs pjd

janekirstine
Posts: 24
Joined: Nov 2010

Hello to you also and all of the great support on this website. I try hard to keep on top of things, but don't hold a candle to you and others posting here. I wish that I had such a forum to talk with nine years ago. Luckily, the course of treatment for this mass detected 9 years post RP has been very straightforward for us.

Thank you for asking more detailed questions of me because it made me dig deeper.

Once a rise in PSA level was detected by the primary doctor, husband was sent to urologist who could feel a small mass by digital rectal exam (DRE). Next the appointment, the urologist performed a transrectal untrasound along with a biopsy (same manner as a prostate biopsy) of the mass which was growing exactly where the diseased prostate gland was removed in 2001 (all margins were negative after RP). Three (3) biopsy cores were taken all which proved cancerous.

Transrectal ultrasound, which is performed with the patient lying on his side with his knees bent, involves using a small cylinder-shaped transducer, which is lubricated and inserted into the rectum, and a monitoring device. The transducer directs high-frequency sound waves into the body. As these sound waves are reflected back to the transducer, it records and transmits them to the monitoring device, which creates the images (sonograms).

During biopsy, transrectal ultrasound is used to help the physician properly place the needle, which is projected through the tip of a probe inserted through the rectum to the suspicious mass. The biopsy needle is used to extract a tissue sample from one or more areas of the mass.

The urologist could show my husband pictures of the three needle cores piercing the cancerous mass.

Thank you again for asking questions and best of health to all,

Jane

mrspjd
Posts: 693
Joined: Apr 2010

Jane,
How humble of you to offer thanks for my questions--you are the one to be commended for your very thorough answers. I very much appreciate that you are so open to, and encourage, questions--so will take you up on that offer with more questions ahead. Please know that my questions are by no means meant to second guess any of the choices that have already been made, but rather to understand the thinking processes involved in arriving at the decisions that were made in your husband's case. As you indicated, it does appear your husband's case is unique, since the mass was found in the prostate bed by DRE many years after the RP, in the context of a rising PSA. Perhaps the mass may have evolved/grown from a small amt of residual prostate tissue left after the RP, even if the post op path report showed negative margins. Did his post op RP pathology report (9 yrs ago) indicate a revised or confirmed pre op Gleason grade? If available, might you consider sharing the post RP path report info, including Gleason score?

In the recent biopsy taken of the prostate bed tumor mass, was the ultrasound monitor used to guide the placement of biopsy needles a black/white or color screen? In the hands of a skilled urologist/technician, some believe that a color doppler ultrasound (rather than a black/white) used to guide the needle placement can show blood flow more precisely. Since areas of tumor mass usually receive more blood flow than other areas, they may show up more clearly on a color monitor and, thereby, help in accurately guiding the placement of the biopsy needles. Either way, in your husband's case the biopsy cores were unfortunately cancerous. Did that (recurrence) biopsy report indicate the % of PCa involvement in the core samples? Since you didn't mention any other tests for staging, will assume the doctor did not order secondary tests (to the biopsy) such as bone scan, pelvic CT, or MRI to rule out local/distal metastasis. Did your husband's radiation onc recommend that the IMRT series include treatment to the local pelvic nodes in addition to the prostate bed?

Again, thanks for your time & any add'l info you might provide.
All the best.
mrs pjd

janekirstine
Posts: 24
Joined: Nov 2010

Did his post op RP pathology report (9 yrs ago) indicate a revised or confirmed pre op Gleason grade?

I do not have a revised Gleason grade now, but our current radiation oncology has the complete report from the 2001 RP done at Walter Reed Army Medical Center and I will request a copy. The doctor showed it to us, but I did not think the data would influence any treatment decisions. The hope is, as you state, that the mass is a local growth from just one cell of cancerous prostate tissue left behind, and after radiation, PSA will go to 0.0 indicating no other cells left, local or distant.

The ultrasound monitor was black and white. In my husbands case, we wished for the mass to be cancerous, and the urologist highly suspected it to be, thus the cause of the PSA rise. Silly to want it to be cancerous, but then we have a known mass to treat and not random cancerous cells.

I believe the percent Prostate Cancer involvement in the samples was 100%, but no score was given. My husband just said it was ALL cancerous. My understanding is that the IMRT will be directed only at the mass (no pelvic nodes) using the three Calypso beacons which are implanted around the mass. Pelvic CT scan has been done. Husband said they did allot of imaging tests, not sure exactly what, to get a good baseline for the future. They really seem to know what they are doing!

Have a great day!
Jane

mrspjd
Posts: 693
Joined: Apr 2010

Jane,
Really seems like both of you are on top of things. Wishing you all the best for a successful treatment outcome. Hope you continue to post with updates and share insights.
Have a Happy Valentine's Day!
mrs pjd

Subscribe with RSS
About Cancer Society

The content on this site is for informational purposes only. It is not a substitute for professional medical advice. Do not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

Copyright 2000-2014 © Cancer Survivors Network