84 month check up

shadowman

was diagnosed with prostate cancer in november 2011    gleason 9    had radiation and hormone treatments  

 

since then my psa has gradually risen to now being 2.49

<0.05 0.31 0.63 0.79 1.00    5/23/13  to 2/3 15

1.36 1.89 1.52 1.62 1.88 1.90 2.49 from 12/1 15 to 10/1/2018

 

how concerned should I be

 

VascodaGama

Long PSAdt

Shadow,

From your shared PSA histology, using the PSA result of 0.79 in Oct 2014 to today's PSA=2.49 Oct 2018 we can calculate your doubling time as being approximately 29 months. This regards an indolent slow growing bandit. However, we know that you were diagnosed with a Gs9 and that your treatment involved adjuvant ADT, which influence should be firstly checked to verify if your testosterone has returned to normal levels by 2014. Have you done any testosterone test?

Though, if we use your following result of 1.36 in your second lot of results (thinking that it is from Apr 2015) then the PSAdt becomes longer at 49 months which makes me think that you can wait a little longer till the PSA reaches 5.0 ng/ml which is a threshold used in IADT approaches for restarting hormonal treatment. You should get the opinion from your doctor who is following your PCa case considering any other illness you may have and your present age (75 ?).

Here is the link to your story;

https://csn.cancer.org/node/232055

Best,

VG

shadowman

VascodaGama said:

Long PSAdt

Shadow,

From your shared PSA histology, using the PSA result of 0.79 in Oct 2014 to today's PSA=2.49 Oct 2018 we can calculate your doubling time as being approximately 29 months. This regards an indolent slow growing bandit. However, we know that you were diagnosed with a Gs9 and that your treatment involved adjuvant ADT, which influence should be firstly checked to verify if your testosterone has returned to normal levels by 2014. Have you done any testosterone test?

Though, if we use your following result of 1.36 in your second lot of results (thinking that it is from Apr 2015) then the PSAdt becomes longer at 49 months which makes me think that you can wait a little longer till the PSA reaches 5.0 ng/ml which is a threshold used in IADT approaches for restarting hormonal treatment. You should get the opinion from your doctor who is following your PCa case considering any other illness you may have and your present age (75 ?).

Here is the link to your story;

https://csn.cancer.org/node/232055

Best,

VG

thak you

thanks for the info

Old Salt

Thanks Vasco

For providing the link to patient's prior history. Now that I have read that, I second the idea of restarting hormone therapy and suggest that shadowman has a serious discussion with his medical team and family (if appropriate) about when to start such therapy. 

shadowman

current status

since I was last on I have my psa has continued to rise    here is list

5/23/16  1.89

9/13/16  1.52

12/21/16  1.62

6/7/17   1.88

12/1/17  1.90

10/1/18   2.49

6/21/19   3.95
 
1/17/20   4.76

7/17/20   7.80

9/30/20   8.43

when it was 3.95 i had scans done and results were negative    discussed doing hormone treatments again but decided to wait   havve appt on oct 19th with uroligist   what have members experiences been when there psa has continued to rise   ShouldI do another scan now or just resolve myself to go back on hormone treatment( which I really didnt like before)    I also should add That I recently had a heart attack and had to have 3 stents placed in my main artery I am feeling good now with no other symptoms of any issues

Georges Calvez

Spot treatment

Hi there,

If I were in your shoes I would go for the possibility of a scan and maybe spot treatment if they can find a localised tumour.
ADT is almost always a holding operation and you will be on ADT or intermittent ADT for life.
At least it seems to be moving fairly slowly so it is not an immediate risk.

Best wishes,

Georges

Clevelandguy

Data points

Hi Shadow,

You have enough data points to indicate that something is going on.  If it was me I would talk to your Oncologist and start putting a plan together( PET or MRI scans) to find the bandit first and then treat it.  If you can't find it then figure out some type of systemic treatment plan.  Good advice from the gentleman above.

Dave 3+4

VascodaGama

Some action is required

Shadow,

I agree with the opinions of above survivors. You can try locating the bandit and treat it with intent of cure using spot radiation (if it lies at appropriate place) or you can opt for a systemic approach. Surely your choices depend on any other health issues you may have and age (77 years old).

In systemic treatment you have chemotherapy, immunotherapy and hormonal therapy (ADT). They all have side effects attached but ADT is the common preference.

If you decide in spot radiation then you should request a PET scan that is more specific in identifying cancer in bone and soft tissues. CT and Bone scan are not reliable enough for such diagnosis. Your PSA is close to 10.0 ng/ml so this is the timing to make a decision.

Best

VG

 

 

hopeful and optimistic

tests

data have suggested PSMA-PET is a superior imaging modality for prostate cancer relative to current standards. There are various contrasts that are considered investigational but superior. These PSMA's are game changers. The PSMA using GA68 is currently in submission for FDA approval, and many docs are hopeful that it will be approved in the next few months. UCLA and UCSF are using this contrast. Currenty there is a patient charge of about 2700. There are alos other teaching institutions  that use other contrasts that may be as effective.

The dection rate by PSA is as follows:

less than 0.5 psa , detection 36.2---sample size 69: 0.5 to 1.0 psa, detection 51.4---sample size 37; 1.0 to 2.0psa, detection 66.7----sample size 33: 2.0 to 5.0psa, detctection 84.8---samle size 33; equal to or greater than 5.0 PSA, detection 96.7---sample size 30   source: Michael J. Morris, MD

So this test is the best, much better than Axium currently medicare covered.

.................................................

Also, 

The U.S. Food and Drug Administration (FDA) has approved FoundationOne Liquid CDx, a blood test that can be used to identify cancer patients who may benefit from certain targeted therapies, including the FDA-approved prostate cancer therapy Rubraca (rucaparib). The test became commercially available on Aug. 28, and is covered by Medicare and Medicare Advantage for qualifying individuals across all solid tumors. "We believe that cancer patients and their physicians deserve the highest quality genomic testing to make informed decisions about personalized treatment," Brian Alexander, MD, chief medical officer at Foundation Medicine, which developed the test, said in a press release. Understanding the genetic profile of a tumor can provide useful data about prognoses, as well as indicate what treatments may or may not be appropriate. For instance, Rubraca is specifically approved for the treatment of

 

 

More information:

 

  NCCN Guidelines: Prostate Cancer Version 2.2020

 

 • Olaparib is a treatment option for patients with mCRPC and a pathogenic mutation (germline and/or somatic) in a HRR gene (BRCA1, BRCA2, ATM, BARD1, BRIP1, CDK12, CHEK1, CHEK2, FANCL, PALB2, RAD51B, RAD51D, RAD54L), who have been treated with AR-directed therapy.

 – Patients with PPP2R2A mutations in the PROfound trial experienced and unfavorable risk-benefit profile. Therefore, olaparib is not recommended for patients with a PPP2R2A mutation

 

. • Rucaparib is a treatment option for patients with mCRPC and a pathogenic BRCA1 or BRCA2 mutation (germline and/or somatic) who have been treated with AR-directed therapy and a taxane-based chemotherapy

. – If the patient is not fit for chemotherapy, rucaparib can be considered even if taxane-based therapy has not been given. NCCN.   

.......................................................

 

 

 

shadowman

thanks everyone for the

thanks everyone for the advice   will update once I see doctor on 19th

Old Salt

MRI as the next step

I had Gleason 9 prostate cancer as well and underwent radiation therapy + ADT. When, after a few years, my PSA went up, my rad oncologist advised me to have an MRI (with a 3T machine and contrast). I suggest that you discuss doing that first.