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Differences of Opinion

Laskey
Posts: 1
Joined: May 2011

Age at diagnosis 64
PSA 30
RP (robotic) Jan 09
Pathology Report
Gleason 4+4, (pre-path. disease in 2 cores)
Tumor 3.4 x 1.3 x 1.2 = 5.5 cm3
Predom. left and right anterior apex-mid prostate
Tumor focally involves capsule – 0 extension
PT2cN0MX, Stage II
Neg seminal vesicle, lymph nodes and margins
Perineural invasion present
PSA
3/09 .04
5/09 .02
9/09 .<01
9/09 .05 (outside lab)
1/10 .01
4/10 .02
9/10 .03
12/10 .04
3/11 .05
4/11 .067 (outside lab)
4/11 .05
5/11 .07
_______________

3/11 Referred to radiation oncologist who believes this is recurrent cancer and recommended immediate radiation.
4/11 Outside opinion said there is still a possibility this is residual benign tissue, but considers .1 recurrence and would recommend salvage radiation at that time.
4/11 Tumor board voted to wait (not unanimous)for a clearer trend to avoid over-treatment.

Latest reading as of 2 days ago shows a 20% increase in one month, but have not had the opportunity to speak with my urologist/surgeon.

Any comments, suggestions?

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

Hi, Laskey and welcome to the forum. It's not at all unusual for experts to have differing perspectives regarding potential recurrence and the online literature is full of conflicting opinions. Most (but not all) urologists feel that a PSA of 0.2 ng/ml following RP and rising is evidence of BCR. This factor is most likely what is driving the tumor board to vote the way they did.

On the other hand, your post RP pathology of 4+4 suggests a high likelihood of eventual recurrence. Your slow but certain rise in PSA readings, in my lay opinion, is indicative that BCR is indeed occurring and does not seem consistent with the PSA which might be produced by the remaining small amount of prostatic tissue left behind.

Studies suggest that the earlier salvage radiation starts the more successful it will be. If I were in your shoes, I would find a radiological team I was comfortable with and go with their recommendations. At the end of the day this choice is yours, not the board at your medical center.

Best of luck to you and please keep us appraised of your decisions and progress.

Beau2
Posts: 239
Joined: Sep 2010

Hey Laskey,

I have a good friend whose PSA went up to 0.1 after surgery. He was scheduled for SRT; but went for a second opinion at the University of Colorado. They thought it could be prostate tissue left behind.

University Hospital put him on Avodart and his PSA has stayed below 0.1 for the last two years. I would point out that his Gleason was 3 + 3 before surgery and the cancer was apparently confined to the prostate.

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