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PSA Still Not Below 1

Swingshiftworker
Posts: 626
Joined: Mar 2010

Well, it's been a year & 1/2 since my CK treatment in Sept 2010 and, after some irregular readings, the PSA is trending down but is still NOT below 1.

Last reading yesterday was 1.55. Still waiting to break the 1 barrier. Oh well . . . at least it's still heading in the "right" direction.

Hopefully, next time.

VascodaGama's picture
VascodaGama
Posts: 1528
Joined: Nov 2010

It will reach the levels you are hopping. Just give it a chance.
The next will be a Zero.
VG

mrspjd
Posts: 688
Joined: Apr 2010

VdG

While I understand the power of positive thinking and your comment may be correct, curious as to how you can state, with absolute certainty, that: “The next [PSA] reading will be a Zero.” Do you have (or is there) some post RT trending formula that can predict the next PSA value/trend for post-RT PCa tx? Don’t forget that SSW’s only primary tx was SBRT/CK, a focal RT tx (& no tx to the bed or nodes); therefore the prostate is intact (vs surgically removed). Doesn’t an RT treated prostate still continue to generate some levels of PSA? Is it realistic or reasonable to expect (predict?) that the next PSA trend in this specific case will reach (or even stay at) an =/< undetectable nadir of zero PSA value given the SBRT/CK focally treated prostate?

Thx in advance for sharing your perspective.

M

Swingshiftworker
Posts: 626
Joined: Mar 2010

I'm just hoping to reach PSA 1 which seems to be considered the primary marker between failure or remission for PCa radiation treatment.

My RO keeps trying to reassure me that I'm on course and that my post-tx history is not unusual but, after hearing from others whose PSA dropped below 1 within months after receiving CK , as I did, it's disconcerting to be a 18 months out and still not be there yet.

Oh well . . . I have no choice to be patient and, if the trend continues, I'll get there eventually, but as Mrs.PJD points out, it's unlikely that I'll ever get to zero.

Ciao!

mrspjd
Posts: 688
Joined: Apr 2010

You may have misinterpreted what I wrote. Please re-read my previous post. I never stated or "pointed out" that “…it's unlikely that [you’ll] ever get to zero.” I did, however, question how one could predict with any certainty, that “the next [PSA reading] will be a Zero,” especially in the context of an intact prostate treated focally with SBRT/CK for low risk/low volume PCa.

Swingshiftworker
Posts: 626
Joined: Mar 2010

Mrs. PJD:

I understand the point you were making, but thought it presumed a distinction between the probable PSA outcomes of surgery vs. radiotherapy. Since you object to the attribution, I'll retract it.

Instead, just let me say that, since my prostate is still intact and has only been treated w/CK, I believe that the likelihood of my PSA ever reaching ZERO is highly unlikely since it will continue to produce some prostate specific antigens (while a fully removed prostate should not).

From what I've consistently read and heard since I got into this mess, the perceived measure for "success" following treatment seems to be a PSA level of less than 1 for radiotherapy and less than 0.1 (which is considered "zero") for surgery.

So, again, I'll just be happy if my PSA eventually falls and stays below 1.

Ciao!

mrspjd
Posts: 688
Joined: Apr 2010

In other words, there are no “Wrongs” or “Rights” in PCa...only shades of blue and what is best for each patient, his lifestyle, maturity level, and his “shade” of PCa.

mrspjd
Posts: 688
Joined: Apr 2010

Appreciate the retraction although, it wasn’t necessary. (Maybe the “Huh back at you” is, but that’s another matter.) After reading your post, I wanted to make sure that there was no misunderstanding about what I wrote and felt a clarification was in order. On a number of previous threads, you’ve actually asked for clarification or explanation regarding something I wrote. This time, I wanted to be sure that I was clear and we were both on the same page.

We know several men who have been treated with IG/IMRT as their sole primary PCa tx and who have reached an undetectable PSA nadir using the ultrasensitive assay. Whether it’s likely or unlikely for YOU, I would never say or predict (my crystal ball is on the fritz). Certainly one can hope. Perhaps that’s what VdG had in mind when he wrote “The next will be a Zero.” Maybe VdG will consider posting on this thread again to share his thoughts re PSA trend and nadir for men tx’d with any form of RT as a primary tx, including those who have used ADT as short term neo-adjuvant tx with RT. I, for one, would be interested in reading his and other members' perspectives on this topic.

Arrivederci,

M

76joann51034
Posts: 5
Joined: Mar 2012

I went for my three month checkup after 40 radiation treatments and my PSA tested 1.7, the Doctor was very comfortable with that and I stated I wanted it zero. He told me that it is not good to be at zero as I would not have any strength. So I decided to be happy with the 1.7.

You might ask your doctor about this. I know all doctors have a different opinion sometimes.

Good Lucj to you

rch
Posts: 78
Joined: Nov 2011

My understanding is that as long as there is some semen production, the PSA will never be zero.It will always be a positive number and that it might take as long as 2-3 yrs post-RT to achieve a nadir ( below 1.0). I think you are on the right track.

Swingshiftworker
Posts: 626
Joined: Mar 2010

Never expected my PSA to go to "zero" but kept hearing from post-CK patients here and elsewhere that their PSA dropped below 1 only 3-6 months following their treatment.

It's already been 18 months since my CK treatment and I'm only at 1.55. Questioned my RO about it before and he also said that it might take 2-3 years to get to or below 1, but I've also read a recent study that said that failure to reach 1.50 or below w/in 2 years post radiation treatment could be a possible indicator of treatment failure.

I'm right at the borderline of that indicator now. No reason to panic yet. I'll just have to be "patient" and hope that my PSA drops below 1.5 by the end of Sept 2012 (which is the 2 year anniversary date for my treatment)) and below 1 sometime after (if not before) that.

Thanks!

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

Swing, my understanding of "failure" after any radiation treatment is a PSA rise of 2 ng/ml over successive PSA tests above nadir. I have not heard of the metric that suggests a PSA of greater than 1.5 after two years to be a predictor of failure although it makes sense that a higher nadir might be more indicative of potential failure than a lower nadir.

I certainly appreciate your angst regarding the slow drop in PSA scores but to me the very positive things is that they are continuing to drop which is an indication that you have not yet reached nadir. There may be other things going on that are affecting your PSA too including the bounce effect. For all we know, you could have had a bounce in between readings and the timing of the tests are such that it looks like a slow drop when in fact it's coming off a bounce. Who knows? I think that as you suggested in your original post, as long as it's dropping it is a good thing.

Best,

K

Swingshiftworker
Posts: 626
Joined: Mar 2010

Kongo:

Here's the link to the study that found that a nadir level of PSA 1.5 within two years following treatment w/EBRT was associated with a higher risk of distant metastases (DM) 5 and 10 years following treatment.

Those with a PSA nadir of 1.5 or less had DM rates of 2.4% and 7.9%, 5 and 10 years following treatment, respectively. Those with a PSA nadir greater than 1.5 had DM rates of 10.3% and 17.5%, 5 and 10 years following treatment, respectively. So, there's apparently greater risk of cancer metastases if your PSA nadir within 2 years following treatment is greater than 1.5.

My PSA nadir is currently 1.55, 18 months following treatment but I'm hopeful that it will drop below 1.5 in one of the next 2 quarterly PSA tests.

See: http://www.redjournal.org/article/S0360-3016(09)00045-5/abstract

Vasco previously gave me link to another study which suggested that a longer period to PSA nadir may be associated with a better possibility of successful treatment (defined as "biochemical disease free survival" or BDFS -- 4 years following treatment as opposed to "biochemical failure" which is defined as 3 successively increasing PSA scores regardless of amount) BUT that study was NOT reassuring to me.

The results of the study as reported in the abstract are a bit confusing but here's what they found:

1) The overall 4 year BDFS for the study group treated w/EBRT was 42%. This was surprising low to me.

2) A PSA nadir of 1 or less within two years following treatment (the study follow-up period) offers a very high probability of 4 year BDFS -- 70% for a PSA nadir of 1 or less vs 12% for PSA nadir over 1.

3) A PSA nadir achieved w/in 1 year (regardless of PSA level) resulted in a 4 year BDFS rate of 28%, while a PSA nadir (regardless of level) achieved between 1-2 years resulted in a 4 year BDFS rate of 58%.

4) For those patients with a PSA nadir of 1 or less, those who achieved the PSA nadir in 1-2 years had a 4 year BDFS rate of 75% vs. 61% for those who achieved the PSA nadir in 1 year of less.

While the findings suggest that a longer to nadir period may be associated with a better rate of 4 year BDFS, the study also finds that a PSA nadir of 1 or less w/in 2 years following treatment is the strongest predictor of success.

It's still possible that my PSA level will drop below 1 by September but, given the erratic and agonizingly slow rate of decline, there's no guarantee that it will either.

See: http://www.thegreenjournal.com/article/S0167-8140(98)00061-9/abstract

I hope you and others find these studies of interest.

hopeful and opt...
Posts: 1293
Joined: Apr 2009

by don fuller, md

In the video there is discussion about bounce among other cyberknife and general prostate cancer topics.

Since no two patients are the same, there is a differences in the rate of PSA drop, and bounce,however after two years, the average PSA is 0.25 (I think for his patients).

He also states that the second most impressive drop is between 18 months and 24 months. (REPEAT: second most impressive drop is between 18 months and 24 months)

The presentation is a pretty good one, and gives a lot of information to a novice such as myself

http://link.brightcove.com/services/player/bcpid1311218266001?bckey=AQ~~,AAABMTO41yk~,0BDF4jnPRYk18rLHqrcfnGVhJxC-Y8Rm&bctid=1349680876001

VascodaGama's picture
VascodaGama
Posts: 1528
Joined: Nov 2010

Ira

Thanks for the link. This got loads of information in all the fields from top specialists. The facts presented are own opinions from each doctor/presenter which could be biased through their speciality, but the content is “precious”.
Dr. Leibowitz in particular presents his newer protocols.

Regards.
VGama

Swingshiftworker
Posts: 626
Joined: Mar 2010

Thanks for the link to Dr. Fuller's presentation on CK. He's very active on the Patient Forum on Accuray's website and you can chat w/him directly there.

First time I've seen this video. Nothing really new in it but it provides a pretty comprehensive overview of the different radiotherapies generally and CK specifically.

It would have been nice to have seen it before I decided to go w/CK, but it's definitely something that everyone who's considering any form of treatment should see, even though it's a bit dated (3 years old) now.

The video confirmed that I am WAY behind the curve in terms of my PSA scores. Dr. Fuller reported the following PSA data following his treatment of a group of 42 patients:

12 months - 1.1
18 months - 0.67 (39.1% drop from 12 months)
24 months - 0.25 (62.7% drop from 18 months)

Here's my data:

12 months - 3.58 (70.9% drop from 3 months)
18 months - 1.55 (56.7% drop from 12 months)
24 months - Pending Sept 2012

So, I'm no where near where I "should" be in terms of my post-treatment PSA.

The only comforting thing that Dr. Fuller said in the video was that, even though a lower PSA is associated w/the greater probability of a "cure", there is no "magic number" that is absolutely predictive of a cure; ie., a cure could come at PSA 0.25 but also at 1 or above.

As for failure, there are currently 2 commonly accepted indicators of PCa treatment failure:

1) 3 successive rises in PSA beyond nadir and/or
2) a 2 ng/ml rise above the nadir PSA

I've already had more than a +2 ng/ml rise in March 2011 (3.03 to 5.07 six months following treatment) but it wasn't the nadir since the PSA scores fell back down after that. That "may" have been my post-treatment "bounce". It was the only rise in PSA post-treatment, but the 1st (3 month) post-treatment PSA reading started at a VERY high level (at 12.30). In any event, there is no firm indication of failure yet in my case.

If indeed there is a further drop off between 18-24 months, it should occur in my next 2 PSA tests. I doubt that my PSA will drop to 0.25 at 24 months (the average reported by Fuller) but, if I can get at least a 40% drop by Sept 2012, that'll take me to 0.93 after 2 years and I'd be MORE than happy with that because it will be below 1 (the generally accepted indicator of success (even if it's not a guarantee of a) cure 2 years following treatment).

We'll see . . .

hopeful and opt...
Posts: 1293
Joined: Apr 2009

In my eyes you are an expert about cyberknife. You studied the procedure, way more than me. I am not an expert; in fact I am a novice.

Of course one worries when they feel threatened, however, it is my opinion, which I feel is more objective than yours since I am not the one who is undergoing the situation; that iniitally your numbers were low ( and I thought that you would be a candidate for AS), that your PSA is trending down, that your percent drop in PSA 18/12 is significantly higher than the average patient that Dr. Fuller studied; that Dr. Fuller reports significant drops in PSA among his patients between 18 and 24 months.

I really believe that you will see another drop of your PSA during the next six months I also tend to believe that this drop will be significant.

We are rooting for you

Swingshiftworker
Posts: 626
Joined: Mar 2010

Thanks, we'll see . . .

mrspjd
Posts: 688
Joined: Apr 2010

.

rlbusche
Posts: 2
Joined: Apr 2012

I wonder if you would care to share what your PSA readings were before treatment, although I have yet to start treatment I thought what better place to get answers than a survivors network, by the way my PSA is 8.5

hopeful and opt...
Posts: 1293
Joined: Apr 2009

however the biopsy is the critical evidence that generates treatment. ONe generally looks at the rate of increase of the PSA, however this is not appropriated in your case. I wonder, did you have a digital rectal exam, what did this show? Also what prompted you to have a PSA at this time.

P.S. there is a relationship between prostate size and PSA, those who have large prostates secrete larger amounts, Do you know your prostate size?

Swingshiftworker
Posts: 626
Joined: Mar 2010

If so, you can find my entire PSA history in the thread entitled "Hooray! -- My PSA Is Finally Dropping" posted on 12/28/11: http://csn.cancer.org/node/232974.

The last reading that I posted at the top of this thread was 1.55 on 3/26/12.

Of course, all of this data is specific only to me and will probably not be the same for you regardless of the form of treatment you choose.

Ciao!

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