For those that still have a prostate gland and are worried about their PSA

Kentr

I don't post often but thought it would be of benefit to do so for those that elected to have brachytherapy or radiation treatment rather than removal and still have a PSA reading which concerns them.

I had brachytherapy in January 2008 (age 66 at the time) and have tracked my PSA on a fairly regular basis since then. My readings are as follows:

10/20/06 3.8
08/10/07 4.8
11/09/07 3.5
01/04/08 3.4 Brachytherapy January 10, 2008
04/10/08 1.1
07/09/08 0.4
10/07/08 0.2
01/08/09 0.4
07/08/09 0.5
12/07/09 0.8
07/14/10 1.0

The point of this post is an effort to ease concerns if you aren't in the magic "zero" club - you'll likely never get there because you still HAVE a prostate gland.

My latest reading would have caused no concern whatsoever had it been that low in 2006 and, according to my oncologist, is of no concern today. I suspect this is in no small due to the raging contoversy related to the true "value" of PSA tests.

In any event, I hope this info is of value to someone.

Hang in there my friends!

Kent

hopeful and optimistic

Some questions
Kent,

Not being knowledgeable, how does one correlate PSA's to potential cancer when one has the seed procedure.....Is it simply the size of the number; or do you have to look at the increase over time?, is there a guide line of increase similar to those who have not been treated?

Also, I heard talk about temporary seeds versus permanent seeds. Do you know much about this? Which should one choose, or is there no difference"

Ira

Kentr

hopeful and optimistic said:

Some questions
Kent,

Not being knowledgeable, how does one correlate PSA's to potential cancer when one has the seed procedure.....Is it simply the size of the number; or do you have to look at the increase over time?, is there a guide line of increase similar to those who have not been treated?

Also, I heard talk about temporary seeds versus permanent seeds. Do you know much about this? Which should one choose, or is there no difference"

Ira

PSA questions
Ira,

I'm no expert but the way I understand things, once you have the seed implants they monitor your PSA and look for trends just as they do for regular periodic physical exams.

They also look at the time it takes for your PSA to double. If you look at the stats I posted you will see my PSA doubled between July of 2009 and July of 2010. There are two oncologists involved in my case and neither of them are concerned but they do want me to retest in six months.

It seems there is a fair amount of controversy regarding what doubling really means when viewed in light of how long it takes for that to happen.

The only thing I've heard about temporary seeds is that they are much more radioactive and that's why they are temporary - kind of a "shock and awe" for the cancer cells.

Here's a link to the Sloan-Kettering Cancer Center. There are prediction tools and information regarding doubling times.

http://www.mskcc.org/applications/nomograms/prostate/PsaDoublingTime.aspx

I hope this info is sufficiently responsive to your questions.

Kent

Kongo

hopeful and optimistic said:

Some questions
Kent,

Not being knowledgeable, how does one correlate PSA's to potential cancer when one has the seed procedure.....Is it simply the size of the number; or do you have to look at the increase over time?, is there a guide line of increase similar to those who have not been treated?

Also, I heard talk about temporary seeds versus permanent seeds. Do you know much about this? Which should one choose, or is there no difference"

Ira

PSA and Seeds
Ira,

I believe the "temporary" seeding procedure you are referring to is HDR Brachtherapy. After mapping your prostate, they construct a plastic matrix for you that is attached to the perineum between the anus and scrotum. Several plastic catheters are then inserted through the matrix into the prostate and radioactive “wires” are slipped in and out of the catheters according to the radiation plan developed for the patient. These radioactive wires are much more powerful than the iodine or palladium seeds used in brachytherapy (hence HDR = High Dosage Radiation). The procedure basically has you on your back for a couple of days with your legs up in stirrups (like an OB/GYN contraption) while the radiation is administered. Two or three sessions are required. This procedure, despite the rather barbaric description of the treatment, is highly effective in treating PCa. (CyberKnife uses a process that emulates the HDR dosage and pattern with external radiation)

PSA is monitored following radiation to gauge the decline in cancer cells. It can take a couple of years for all the cells to die (the radiation interferes with the DNA that allows the cells to divide) as PCa cells have a life of about 25 months. There is frequently a phenomena known as a PSA “bounce” where the PSA declines then increase for a short period, then declines to a nadir and stays there. While they don’t fully understand everything that causes the bounce, it’s believed to be caused by the PSA thrown off by cancer cells as they die.

Since you still have a prostate after radiation (unless its salvage radiation) there will always be some residual PSA left and we know all the things that can cause PSA to be generated in the prostate besides cancer so the doctors look for a low, stable nadir that remains relatively constant over a long period of time.

Hope this helps.

hopeful and optimistic

Kentr said:

PSA questions
Ira,

I'm no expert but the way I understand things, once you have the seed implants they monitor your PSA and look for trends just as they do for regular periodic physical exams.

They also look at the time it takes for your PSA to double. If you look at the stats I posted you will see my PSA doubled between July of 2009 and July of 2010. There are two oncologists involved in my case and neither of them are concerned but they do want me to retest in six months.

It seems there is a fair amount of controversy regarding what doubling really means when viewed in light of how long it takes for that to happen.

The only thing I've heard about temporary seeds is that they are much more radioactive and that's why they are temporary - kind of a "shock and awe" for the cancer cells.

Here's a link to the Sloan-Kettering Cancer Center. There are prediction tools and information regarding doubling times.

http://www.mskcc.org/applications/nomograms/prostate/PsaDoublingTime.aspx

I hope this info is sufficiently responsive to your questions.

Kent

hoping for a great number , six months time from now
good luck

hopeful and optimistic

Kongo said:

PSA and Seeds
Ira,

I believe the "temporary" seeding procedure you are referring to is HDR Brachtherapy. After mapping your prostate, they construct a plastic matrix for you that is attached to the perineum between the anus and scrotum. Several plastic catheters are then inserted through the matrix into the prostate and radioactive “wires” are slipped in and out of the catheters according to the radiation plan developed for the patient. These radioactive wires are much more powerful than the iodine or palladium seeds used in brachytherapy (hence HDR = High Dosage Radiation). The procedure basically has you on your back for a couple of days with your legs up in stirrups (like an OB/GYN contraption) while the radiation is administered. Two or three sessions are required. This procedure, despite the rather barbaric description of the treatment, is highly effective in treating PCa. (CyberKnife uses a process that emulates the HDR dosage and pattern with external radiation)

PSA is monitored following radiation to gauge the decline in cancer cells. It can take a couple of years for all the cells to die (the radiation interferes with the DNA that allows the cells to divide) as PCa cells have a life of about 25 months. There is frequently a phenomena known as a PSA “bounce” where the PSA declines then increase for a short period, then declines to a nadir and stays there. While they don’t fully understand everything that causes the bounce, it’s believed to be caused by the PSA thrown off by cancer cells as they die.

Since you still have a prostate after radiation (unless its salvage radiation) there will always be some residual PSA left and we know all the things that can cause PSA to be generated in the prostate besides cancer so the doctors look for a low, stable nadir that remains relatively constant over a long period of time.

Hope this helps.

Yes , thank you it does help
I attended a lecture by an radiation onchologist who does the temporary seed is his privately owned facility....of course he believes this method to be better, and that is why he says he bought the temp. machine..........I think that he talked about able to control and adjust the dose.

I asked him if the average hospital does permanent or temp. seeds, and he said that the vast majority do permanent, but he believes the temp to be a better treament option....I remember asking , if this is a better treatment option, why don't more hoptipals have this...I think that he said something about funding, but that doesn't fly with me.

I'm wondering if there are any studies that measure the effectiveness of one versus the other.

Ira

mrspjd

hopeful and optimistic said:

Yes , thank you it does help
I attended a lecture by an radiation onchologist who does the temporary seed is his privately owned facility....of course he believes this method to be better, and that is why he says he bought the temp. machine..........I think that he talked about able to control and adjust the dose.

I asked him if the average hospital does permanent or temp. seeds, and he said that the vast majority do permanent, but he believes the temp to be a better treament option....I remember asking , if this is a better treatment option, why don't more hoptipals have this...I think that he said something about funding, but that doesn't fly with me.

I'm wondering if there are any studies that measure the effectiveness of one versus the other.

Ira

HDR Brachy
Kongo's description of the HDR procedure was very accurate. Brachytherapy is defined as the direct application of radiation therapy on or into tissue. High Dose Rate Brachytherapy, or "HDR Brachy" for short, can be used alone as a primary or monotherapy PCa tx or as adjuvant therapy (as a RT "boost") prior to starting an IM/IGRT scheduling plan, especially in locally advanced, non-metastases PCa (T3). This type of tx may be a viable alternative to surgery if a man chooses not to have surgery or if he is not a candidate for surgery (given certain pre-existing health concerns).

Yes, there are studies. In fact, one of the most well-known doctors and most published in the field of HDR Brachy has recently been recruited by the UCLA Radiation Oncology Dept. He is considered by many to be one of only a few experts in this field. I don't believe in publicly posting names of doctors, but if you'd like his name, please email me via the CSN network, and I would be happy to give it to you. Or, anyone can go to the UCLA Dept of Radiation Oncology website to search out the info.
mrs pjd

hopeful and optimistic

mrspjd said:

HDR Brachy
Kongo's description of the HDR procedure was very accurate. Brachytherapy is defined as the direct application of radiation therapy on or into tissue. High Dose Rate Brachytherapy, or "HDR Brachy" for short, can be used alone as a primary or monotherapy PCa tx or as adjuvant therapy (as a RT "boost") prior to starting an IM/IGRT scheduling plan, especially in locally advanced, non-metastases PCa (T3). This type of tx may be a viable alternative to surgery if a man chooses not to have surgery or if he is not a candidate for surgery (given certain pre-existing health concerns).

Yes, there are studies. In fact, one of the most well-known doctors and most published in the field of HDR Brachy has recently been recruited by the UCLA Radiation Oncology Dept. He is considered by many to be one of only a few experts in this field. I don't believe in publicly posting names of doctors, but if you'd like his name, please email me via the CSN network, and I would be happy to give it to you. Or, anyone can go to the UCLA Dept of Radiation Oncology website to search out the info.
mrs pjd

Hi mrspjd
Thanks for the information. I've heard about this doctor. At UCLA where I am a patient , there are lectures from time to time by various docs which I attend occasionally....I hope to attend a lecture by this doc at some time , if in fact he does present. You might be interested as well.

I remember that you mentioned that you are somewhat north of LA. and have some knowledge of support groups. I attend support groups in the general area where I live, Los Alamitos,
so if thereis a subject that I am interested in I attend in long beach, fullerton, newport beach, or orange.

Now, I am interested in finding a support group near UCLA westwood so I can speak with men who are patients at ucla.......I wonder can you direct me to one.

ira

mrspjd

hopeful and optimistic said:

Hi mrspjd
Thanks for the information. I've heard about this doctor. At UCLA where I am a patient , there are lectures from time to time by various docs which I attend occasionally....I hope to attend a lecture by this doc at some time , if in fact he does present. You might be interested as well.

I remember that you mentioned that you are somewhat north of LA. and have some knowledge of support groups. I attend support groups in the general area where I live, Los Alamitos,
so if thereis a subject that I am interested in I attend in long beach, fullerton, newport beach, or orange.

Now, I am interested in finding a support group near UCLA westwood so I can speak with men who are patients at ucla.......I wonder can you direct me to one.

ira

local resources
Hi Ira,
Happy to share any local info that might be helpful. Will email you via the CSN network.
Best,
mrs pjd