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PSA, again, STILL not under 1!

Swingshiftworker
Posts: 650
Joined: Mar 2010

Took another follow-up PSA test yesterday (21 months following CK treatment) and it came back at 1.69.

The last 3 tests over the past 6 months have been 1.81, 1.55 and now 1.69 (which I consider basically unchanged) after dropping from 3.72 and 3.56 the 6 months before that.

So, unless my PSA drops further, I think that I've reached my "nadir" at 1.55 and will just have to "hope" that it does not rise significantly from this level (or, even better, continues to drop, even if more slowly than I'd like).

These past 3 readings at just over 1.5 puts me at a slightly greater risk of PCa recurrence w/in 5-10 years based on the findings of the Zelefsky study:

http://esciencenews.com/articles/2009/12/02/psa.value.2.years.post.treatment.can.predict.long.term.survival.prostate.cancer.patients

And, if it stays at this level after the 2 year follow-up PSA test that I'll take in Sept, I'm planning to meet with my RO to discuss the need for further testing and (if that reveals any latent cancer) additional treatment.

Oh well . . .

VascodaGama's picture
VascodaGama
Posts: 1589
Joined: Nov 2010

Swing

You may be interested in deciphering the study in this link. Dr. Michael Zelefsky (MSKCC) is part of the team and his private researches/knowledge weighs a lot in the conclusions of the reported article in your link;
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891893/

This regards to the importance of MRI in defining probabilities for recurrence.
My opinion in regards to your last PSA result, which I believe to be the one at the 12-month mark, is that a nadir is not yet conclusive and that you should look into other means of diagnosis, to judge progression for your case. One should expect a bounce to occur too.

I would recommend you to research and make arrangements for image studies with the latest improvements in terms of resolution and contrast agents such as feraheme, to identify any oligometastatic cancer. With such tests you could rule out localized cancer. An increase in PSA would then rule the case as systemic which you could control with HT. In any case the value of 1.69 is low to be worried about any “fatal” spread. Hormonal is recommended at any level and many oncologists use a threshold of PSA=5 to trigger treatment in guys with recurrence from prime EBRT.

Wishing you peace of mind.

VGama

Swingshiftworker
Posts: 650
Joined: Mar 2010

Thanks for the link Vasco.

FYI, my last test result of 1.69 marks the 21st month (1 yr 9 months) following my CK treatment in Sept 2010.

Previously reported the extreme variability of my post treatment PSA scores. See:

http://csn.cancer.org/node/232974

I think the "bounce" (if any) occurred when my PSA scores went from 3.03 to 5.07 and back to 3.72 between March-June 2011.

If my 2 year PSA score in Sept 2012 (3 month from now) remains in the 1.55-1.81 range (of the last 3 tests between December 2011-June 2012, I'll be pretty certain that I've reached my nadir.

It isn't as bad as it could be but isn't as good as I would prefer. It's right at the cusp of the criteria for determining greater or lesser risk of PCa recurrence based on the Zelefsky study, which uses 1.5 as the marker. See:

http://www.ipubmd.com/users/fred@usea.com/uploads/20091222142734_Postradiotherapy%202%20year%20PSA%20NADIR%20as%20a%20predictor%202009%20%20zelefsky.pdf

If there is a signficant rise in my PSA from this level within the next 3-6 months, I will ask for a re-biopsy AND an MRI& MRSI screening to determine if there is any evidence of PCa recurrence.

The basis for the re-biopsy would be based on the results of the Crook Study, which concludes that re-biospies between 24-36 months following treatment are the most reliable (but not a perfect) predictor of PCa recurrence. See:

http://fms.kau.edu.sa/Files/140/Researches/59178_29528.pdf

The request for MRI & MRSI screening would be based on a study by the MRI/MRSI Group at UCSF that concluded that a combined MRI/MRSI screening is better in identifying the existence and location of PCa.

http://www.prostate-cancer.org/pcricms/node/169

It's good for me that the MRI/MRSI study was conducted at UCSF (where I received my CK treatment). So, it shouldn't be a problem getting this combined screening when & if necessary.

Hopefully, my PSA scores will remain stable or, even better, drop further BUT if the worst occurs, I'm prepared to request further testing and treatment, if necessary.

Ciao!

PS: Here's what I've learned from this journey.

As a PCa patient, you have to be well informed (as you can be as a layperson) about the available treatments and their possible consequences AND you have to be prepared to be your own advocate for the diagnosis and treatment of your disease at the outset (as well as in the event of a possible recurrence).

It's your life that is at stake and you can't trust anyone else to care as much about it as you do.

VascodaGama's picture
VascodaGama
Posts: 1589
Joined: Nov 2010

Swing

Your ending words are inspiring. I am glad for your positiveness in confronting the problem.
You are real the Master of your case and in complete control of the wheel. You know the details of what you can expect and nobody could judge your progress better than you.

PSA history to date:
10/12/06 -- 2.90
03/21/08 -- 3.40
01/07/10 -- 4.50
01/25/10 -- Biopsy
03/30/10 -- 29.7
04/20/10 -- 8.60
06/22/10 -- 5.90
09/22/10 -- Last of 4 CK treatments; no baseline PSA taken in 09/10
12/03/10 -- 12.30
12/15/10 -- 9.48
03/23/11 -- 3.03
06/14/11 -- 5.07
06/20/11 -- 3.72
09/12/11 -- 3.56
12/23/11 -- 1.81
March/2012 - 1.55
June/2012 - 1.69

In rechecking your PSA chronology, at first look, I see a bounce at the [3.03/5.07/3.72] period. It is consistent with the +2 theory.
The last rise, however, could be due to other causes than recurrence (falls within the 0.2 general divergence theory). After all you still got your prostate (benign cells) and any manipulation before drawing blood could alter the results.
From here, your next two (2) scheduled PSAs (Sep and Dec) may provide the evidence of any cancer activity.

The best move is to have an image study done. The combi MRI+MRSI is somehow from “the past” so you could investigate in other recent ways for higher resolutions. Take the chance and explore the C11-choline technique that is on trial (free of charge). Discuss the matter the soonest with your doctor to find out about possibilities.

In this study they conclude as follows. The low levels of PSA in detection are remarkable;

“…(11)C-choline PET/CT was able to detect recurrent disease in 28% of the patients with mild biochemical relapse characterized by very low trigger PSA levels (PSA <1.5 ng/ml). Very interestingly (11)C-choline PET/CT detected distant unexpected metastases in 21% of the patients. At multivariate statistical analysis only PSAdt and node status were shown to be significant and independent predictive factors for positive (11)C-choline PET/CT. Therefore, (11)C-choline could be suggested to be performed early during initial biochemical relapse in patients presenting with fast PSA kinetics.”
http://www.ncbi.nlm.nih.gov/pubmed/20848281

Here are links about C11;
http://www.diagnosticimaging.com/pet-ct/content/article/113619/1474149
http://askdrbarken.wordpress.com/2011/12/25/c-11-choline-petct-scan-dr-eugene-kwon-mayo-clinic/

Surely there are other ways for testing but I would go for the latest.
The importance in having proper image studies is to get a location, if any, for accessing possibilities of focal RT. Successful cases exist (20 years) in attacking oligometastatic cancer. Nevertheless I would not disregard in thinking that the last PSA is a falce positive of progress

Hope for the best.

VGama

Swingshiftworker
Posts: 650
Joined: Mar 2010

Thanks for the info about the C-11 choline trial. I'll look into it.

For now, I'm going to go to a nudist resort (where I'm a member and own site) and just lay naked in the sun to relax and soak up Vitamin D over the weekend.

Ciao!

VascodaGama's picture
VascodaGama
Posts: 1589
Joined: Nov 2010

Here is the link. Speak directly with Dr. Almeira the main responsible.

http://inclinicaltrials.com/prostate-cancer/01530269.aspx
http://inclinicaltrials.com/prostate-cancer/01304485.aspx

Eligibility:
Gender: Male
Age: 18 Years - N/A
Inclusion Criteria:
- recurrent prostate cancer (detectable PSA following radical prostatectomy or rising PSA in patients with radiation therapy as the primary treatment)
Exclusion Criteria:
- < 18 years old
- claustrophobic patients

VG

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