RRP followed by PSA Rise

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Comments

  • Old Salt
    Old Salt Member Posts: 952 Member
    Could be the motto of this forum...

    I believed in the doctor blindly. He was my god and savior from a death that did not exist.

     

    Thanks Vasco!

  • hewhositsoncushions
    hewhositsoncushions Member Posts: 409 Member

    First test 0.16

    Second test a week later 0.17

    **** furious and scared at the same time.

  • lighterwood67
    lighterwood67 Member Posts: 329 Member
    03/20/2018 RP

    Thanks for posting your experiences.  I go for my RP 03/20/2018.  I have been posting on the goings on with me on this site.  Will post on mine when they get done.

  • hewhositsoncushions
    hewhositsoncushions Member Posts: 409 Member

    03/20/2018 RP

    Thanks for posting your experiences.  I go for my RP 03/20/2018.  I have been posting on the goings on with me on this site.  Will post on mine when they get done.

    Good luck, mate.

    Good luck, mate.

    I hope it goes well.

    Be kind to yourself when you get out of hospital and do not overdo it!

    C

  • VascodaGama
    VascodaGama Member Posts: 3,526 Member
    The previous result was confirmed but you need a third one

    Cushions,

    I cannot see a reason to be furious with the results but I understand the worries. Being scared is natural as you are dealing with the unknown. The second test confirms the previous result but you should wait for a third one in three months time to assure recurrence.

    My suggestion is for you not rushing believing that by doing so you solve the problem. Get second opinions and advance with something solid that you trust. You may try to go private for a consultation with a medical oncologist specialized in PCa cases. You can also request the urologist you are seeing for referrals to get a second opinion from other oncologist, within the NHS.

    The traditional next step will be based on the exchanged conversations above.

    Best,

    VG

     

  • hewhositsoncushions
    hewhositsoncushions Member Posts: 409 Member
    edited March 2018 #87
    Vasco

    Vasco

    Cheers!

    Voice of reason as always.

    My concern waiting three months to get a better idea of PCADT is that I am 0.17 with some potentially agressive PCa elements and an initial doubling somewhere between 7 and 9 months post op.

    I understand that this places me in a grey area for good long term survivability and also that salvage done under 0.2 stands a far better chance than over.

    If I wait three months for another test it may rocket and I could be stuffed.

    Thoughts?

    C

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,752 Member
    Numbers

    Hewho,

    Your PCa was relatively mild/indolent before, so (if you have PCa at all now) it should still be the same: relatively indolent (Pathology post-op:  G7, minimal volume, no positive margins, no nodular involvement).

    I have read that the high-end threshold for successful start of curative RT following relapse after RP is around .5, and it seems you are far, far from that.  Results from salvage RT post-RP are described as "poor" if a PSA of 2.0 is reached before starting salvage RT. ( Dr Peter Scardino's Prostate Book, p. 450, in Chapter 20: "Rising PSA After Surgery, Radiation, or Other Therapy"  Dr. Scardino is Chairman, Department of Surgery, at Sloan Kettering Cancer Center, NYC.  I recommend that you get his book, a regular stock item at Amazon and Barnes and Noble)

    Do as Vasco suggests, and do not become frantic. Remain systematic and methodological instead.  It seems thinking in great detail is an attribute you possess; use that, not fear.

    max

  • hewhositsoncushions
    hewhositsoncushions Member Posts: 409 Member
    MAx

    MAx

    You and Vasco are right - get over the panic and learn.

    The whole threshold thing like many things seems to have lots of different opinions so I will see what my consultant says and share it.

    One thing I need to do is get my head around the various forms of salvage as I am a little confused with some of the abbreviations.

    Here goes:

    ADT - I understand to be Androgen Deprivation Therapy, medications to reduce T to starve cancer cells. Makes sense

    ART - Adjuvant Radiotherapy - I assume to be salvage RT but...

    ESRT - Early Salvage Radiotherapy also exists. What is the difference? Also I assume SRT is just the generic term.

    What other forms of salvage are there?

    I also understand that the above can be applied in various combiations of sequence or parallel for different reasons / effects. Is that true?

    Cheers

    C

  • Grinder
    Grinder Member Posts: 487 Member
    Prostate Cancer Androgen Receptor Pathway

    I posted this diagram showing the whole pituitary-testes-pituitary-testes-adrenals androgen process but it is copyrighted, so the best i can do is post the link...

    http://clincancerres.aacrjournals.org/content/clincanres/17/7/1649/F1.large.jpg

    It helps me when i see the whole process diagrammed. Thought it might help when considering ADT treatment.

  • Grinder
    Grinder Member Posts: 487 Member
    another link

    Here is another link to a diagram that shows the pituitary - testes - adrenals - hormonal link and the resulting androgen stimulation of PSA production, growth, and survival of the cancerous cell.

    https://d9aqs07uebq07.cloudfront.net/content/clinchem/57/10/1366/F2.large.jpg

  • Grinder
    Grinder Member Posts: 487 Member
    first one

    I posted this link showing a diagram of the whole hormonal androgen process, but it got pulled for some reason... trying again...

    http://clincancerres.aacrjournals.org/content/clincanres/17/7/1649/F1.large.jpg

  • hewhositsoncushions
    hewhositsoncushions Member Posts: 409 Member
    Cheers for that, Grinder!

    Cheers for that, Grinder!

  • hewhositsoncushions
    hewhositsoncushions Member Posts: 409 Member
    Aww rats.

    Aww rats.

    Consult on Tuesday and my head is playing really stupid games with life expectancy and what ifs ("wjy did I not have ART?") and fretting that T2c is the end of the world.

    It is stupid because the logical half of me knows I have to wait and see. The monkey brain in me is sitting in a tree hooting and throwing panic poop at my logical part :)

    Waiting sucks ....

  • hewhositsoncushions
    hewhositsoncushions Member Posts: 409 Member
    Hi all

    Hi all

    I updated the master subject to be a bit clearer and more sensible :)

    So I saw the urologist consultant today - she was a bit apologetic that I had had the rise (0.05 - 0.16) but seemed to want to reassure me than only a percentage of these are due to BCR and only a percentage of those become an issue - the usual numbers game.

    I have a referall to a urology consultant to discuss options - either watch and wait or SRT/SHT. I favour the latter out of the box but my OH is Mrs. Cautious and is reluctant for me to dive in. I need to make sure I listen to her but do what is right for me as I need to be here for them as long as possible.

    Only downside as they could not fit me in today it will take several weeks to get to see the onco. I'm hoping I don't get a bigger rise inbetween.

    C

     

  • contento
    contento Member Posts: 75
    Hey Cushins, it's normal to

    Hey Cushins, it's normal to be worried . I would be too but I doubt very much your psa would skyrocket in a couple of weeks or so. My Gleason 8 took over 6 months to go from

    .1 to .2. What does your OH want to wait for ? I assume it's a specific psa threshold ? I don't think it's a bad strategy to wait a bit.

    I'll propose 3 reasons

    1). A slightly higher psa ( say .2 ng/ml ) is still very manageable

    2). It would definately confirm reoccurance

    3). Perhaps most importantly, there's a better shot that an mri could locate the cancer. I know from conversations with my radiation oncologist who told me that the success rate of salvage is much higher when they know where the cancer is located. Keep in mind that salvage radiation  would still be givin even if they can't locate the cancer but they have to cover a wider area which would be exposed to more rads than if they knew where the cancer was located ( they could focus a little more ).

    also, which of course is not good, if the cancer is located in a distant location other than the pelvis area then you would most likely not receive any radiation but begin HT. I hope this is not your situation.

    I know there's mental anguish and I'm sorry for that but I agree with your OH , I would wait a wee bit longer if my doc also agreed.

  • hewhositsoncushions
    hewhositsoncushions Member Posts: 409 Member
    contento said:

    Hey Cushins, it's normal to

    Hey Cushins, it's normal to be worried . I would be too but I doubt very much your psa would skyrocket in a couple of weeks or so. My Gleason 8 took over 6 months to go from

    .1 to .2. What does your OH want to wait for ? I assume it's a specific psa threshold ? I don't think it's a bad strategy to wait a bit.

    I'll propose 3 reasons

    1). A slightly higher psa ( say .2 ng/ml ) is still very manageable

    2). It would definately confirm reoccurance

    3). Perhaps most importantly, there's a better shot that an mri could locate the cancer. I know from conversations with my radiation oncologist who told me that the success rate of salvage is much higher when they know where the cancer is located. Keep in mind that salvage radiation  would still be givin even if they can't locate the cancer but they have to cover a wider area which would be exposed to more rads than if they knew where the cancer was located ( they could focus a little more ).

    also, which of course is not good, if the cancer is located in a distant location other than the pelvis area then you would most likely not receive any radiation but begin HT. I hope this is not your situation.

    I know there's mental anguish and I'm sorry for that but I agree with your OH , I would wait a wee bit longer if my doc also agreed.

    Hi Contento

    Hi Contento

    I should have clarified - OH is Other Half, i.e. wifey. She is a cautious person whereas I am a boots first into the landing zone typer person. She thinks I should wait and see.

    I am divided because as you say waiting means more chance to spot tumours but interventkion below 0.2 is supposed to give better long term outcome.

    Best approach os to get to the onco asap and see what they say.

    Cheers

    C

  • hewhositsoncushions
    hewhositsoncushions Member Posts: 409 Member
    Hi Vasco

    Hi Vasco

    "End of story" sounds so cheerful :)

    I have so much conflicting information - the reason I had HT then RT suggested elsewhere as a standard is that it allows for tumour reduction making the RT more effective.

    Also the consultant said that 30% of people get a rise after RP but a smaller percentage get full on BCR.

    I am having to step back from the what ifs and life expectancy head games, cocentrate on facts and get to the onco.

    C

  • VascodaGama
    VascodaGama Member Posts: 3,526 Member
    Playing Russian Rolette

    In my opinion, after failed RP, the only existing "salvage treatment" is radiotherapy. Hormonal treatments in this aspect are sequential therapies and do not salvage anything. To this extent I agree with Contento's opinions. Without a gland in place or a definite target, the benefit in a salvage radiation would depend on luck alone. One can guess but no assurances are given that it will work.

    Your wife may be right in regards to the % of the goodies in an earlier attack but does she know what would be the results if the treatment is done at a PSA of 0.4 ng/ml?
    "Earlier" is not based on a PSA level but on the diagnosis of recurrence. In such regard the NCCN guidelines (followed worldwide) recommends to use the threshold of 0.2 ng/ml to indicate BCR and intervention at a PSA of 0.4 ng/ml. These thresholds were obtained from past experiences from a huge number of cases. Both judgments (Earlier or Thresholds) are used in salvage therapies but none of them can prove to be better than the other.

    You need to confirm recurrence even if the increase is most certain indicating the end of the story. WW may not be your best choice due to the Gleason rate 4 found initially. HT would just postpone an intervention or accelerate refractory, apart from providing you an overload of symptoms. Surely you may gain time and the opportunity for other therapies to popup (now on the drawing boards). LU177 is doing wonders but got its own pitfalls too.

    Let's have a beer. You get a bitter and I a lager.

    Best,

    VG 

     

  • VascodaGama
    VascodaGama Member Posts: 3,526 Member
    You got many years ahead to enjoy life and see man on Mars

    Sometimes I do not understand your reasoning. You had RP not RT.

    This time you are looking for a salvage therapy not a prime combi of HT+RT. You have no prostate in place in need of reduction. HT will sensitize the cells to turn them more susceptive in absorbing radiation (a better killing) but it also masks the PSA extending the period post treatment without knowing the final results. Some guys prefer to have these in sequential. First RT to be followed by HT if the former fails.

    After RP nobody is supposed to get a rise in PSA. No gland in place no prostatic cells to make the serum. In fact it takes just ten days for the body to clean floating PSA in the blood. The first PSA after op should be less than 0.06 ng/ml indicating success. This was your case.

    I hope you find answers to your doubts and get peace of mind.

    Where do you live?

    Best

    VG

  • hewhositsoncushions
    hewhositsoncushions Member Posts: 409 Member
    Vasco

    Vasco

    That was badly worded - I meant "had HT and RT (as a discussion point in the previous post I made)" not "had HT and Rt (to start with)". I hope that clarifies things.

    Yes, I had RP and the initial results were promising (0.05 with the cancer allegedly contained) BUT as you know, 8 months later it rose (0.16/0.17).

    I have been referred to a urology oncologist because I am nearning the 0.2 mark and am still awaiting on an appointment (which I no doubt will have to expedite).

    The specific reason I mentioned HT as a precursor to RT as a combined salvage therapy was that lay experts in McMillan and Prostate Cancer (similar folks to you) suggest that in the UK they are now starting to apply HT for up to six months BEFORE RT as there is trial evidence that it increases the success rate. I am guessing the theory is that the HT shrinks / kills tumour which makes the RT more effective over potentially a small application area.

    You are right in that there is a risk the cancer becomes refractory early which is why I am trying to see it from all sides to make a risk aware choice.

    Hope that makes sense.

    Thanks again for the advice and support.

    C