On_A_Journey's journey

On_A_Journey

I hear you but can't completely agree. DT is a more vital metric than PSA itself in my case. Should I really be happier with a DT of 16m vs. 41m just because my PSA is rising in a linear fashion now? I think not!

centralPA

https://csn.cancer.org/discussion/comment/1724815#Comment_1724815

Well, it’s just a math thing.

What doubling time refers to is exponential growth. With exponential growth your PSA should be going up, but also the rate of your PSA going up should be going up. In your case, all of your PSA readings are 0.11 apart (or so). This points to non-exponential growth.

You get exponential growth when you have one cell dividing into two cells and then four cells and then eight cells, etc. That is a runaway process. If you see an increase in the rate of increase, the signal for growth.

If it stays on this linear growth pattern, then you’re doubling time will be continually increasing. That is of course, a good thing. Fingers crossed for you.

VascodaGama

Hi again,

Thanks for the update.

I recall, back in 2002, Dr Slovin of SMKCC telling me that PSA thresholds trigger treatments based on the aggressiveness of each case. Higher Gleasons tend to "get" higher thresholds not because they need lesser urgency for intervention but because the PSA tend to increase faster reaching the "mark" at the same time as a lower aggressiveness case would.

In a previous post of yours you wrote that your oncologist suggested a PSA threshold of 10 which could mean that he/she considers you holding an aggressive case. I think that you should clarify the issue before deciding on your next step. Your PSA histology doesn't show aggressiveness. It is hard to belive that at this moment you have far metastasis that could be diagnosed in a PSMA PET exam. Localized recurrence seems most probable.

In 2002, I had an evident failed surgery in need of a salvage treatment but I was recommended WW (watchful waiting) because of the diagnosed Gleason score 5 (2+3) which had been confirmed through the prostate specimen I took to JH laboratory. The aim was also trying locating the bandit to discard any possibility in having a systemic issue.

Let me note that since 2006 that lower Gleason rates become classified as 3 therefore Gleason score 6 being the lowest nowadays.

In your investigations I would suggest you to check also the risks involving the treatment. ADT in long periods may lead to cardiovascular issues and kidney deterioration, RT can cause fistulas and bowel issues but well directional manages to kill the bandit.

We all need luck in this "adventure".

Best wishes

VG

On_A_Journey

Hi @VascodaGama, nice to hear from you again.

The way it has always been explained to me, is the three simple factors required to determine future treatment. Original Gleason, instantaneous PSA, and DT.

I'm happy that I was diagnosed on the low side of intermediate way back then (3+4). Now, I couldn't care less if my PSA was 100 if it was 'only' 99 a few months ago. But, my DT is now the shortest it has ever been since recurrence.

My oncologist has made it clear that he is in the 'late treatment' camp, i.e. he won't treat me medically until it is apparent that the horse has bolted. This is in conflict with my personal belief that the priority should be to delay progression, especially while I am comparatively young, fit and strong.

@centralPA, I agree that it is a math thing. Lies, damn lies, and statistics lol! But DT is relevant regardless of exponential growth or not. Sure, if my PSA only increases by 0.11 every three months forever and a day it will eventually result in a slowing of DT, but that's not a reason to discontinue monitoring it. I'd still rather be in the position I was in 12 months ago!

centralPA

Oh for sure keep monitoring!

I'm in the same boat watching my PSA go up linearly, and have been for three years. So it's a topic near and dear to my heart (and prostate).

swl1956

Waiting for a PSA of 10 seems too risky to me.

This video might have some applicability to your situation?

https://www.youtube.com/watch?v=teCDcRXctR8

VascodaGama

Hi again,

Like you, PSADT has been important in my judgment when evaluating the progress of my PCa case. Apart from the three parameters you use (original Gleason, instantaneous PSA, and DT) I add the aggressiveness "value" of my case at its diagnosed periods. That is: the PSA pre op (24.2 ng/ml), and the pathological stage post op (pT3apN0M0).

In my times the PSADT of 24 months was the breacking boundary, being the ">24" more for concern.

In any case, I always tended to follow Dr "Snuffy" Myers suggestions who considered a PSADT of 14 months as the boundery marker to ADT recommendation.

My real experience was a PSADT of 18 months since RP(2000) to SRT(2006) and a PSADT of 12 months since SRT to ADT(2010).

The hormonal treatment was intermittent mono eligard in a period of 18 month, that allowed me to be 10 years free of drugs since stopping. The trigger to restart ADT should have been a PSA of 2.5 but a newer urologist delayed it so I had a PSADT of 12 months by the time I restarted the Eligard shot.

I believe that the PSADT would become of lesser than 9 months (aggressive progression) if I had delayed the restart of ADT.

I think that your trigger parameters (1 and 2) to ADT or RT spot radiation is a good choice as it may assure you delaying cancer progression or eliminating it for good. However, it may prejudice your intent of advancing a treatment while you are "young, fit and strong".

We can't compare our cases but I hope that my story helps in your concerns.

Best wishes for peace of mind.

VG

On_A_Journey

Thanks all.

Myself, my RO and my 'new' MO who I recently had a meet-and-greet with, agree that the first step will be to get another PSMA PET scan when my PSA reaches 2.0 and some sort of RT will be had if the cells are located. But I have made it clear to both of these fine people that (a) if the scan is negative, or (b) if my DT falls below 12 months before my PSA reaches 2.0, I will immediately insist on a course of ADT to punch the bandit in the nose while I'm still comparatively young and strong and hopefully enjoy a lengthy 'hormone therapy holiday' after that. There's not a snowflake's chance in hell that I will wait for my PSA to reach 10 before starting ADT!