PSA CONCERN

Kongo said:

Cure?
Hopeful,

Forgive me if I have misremembered but I seem to recall that you were initially diagnosed with a Gleason 9 with no evidence of metastasis and your medical team launched you on a course of hormone therapy coupled with IMRT. Wasn't your original PSA reading in the 50s? Now, about 18 months later, your PSA is down to 0.28 and still dropping. I am assuming you are still receiving the Firmagon shots.

Setting aside the apparent bluntness of this particular PA it seems to me the gist of your question is whether or not a "cure" is in the offing. There have been many discussions in this forum on whether or not there is truly a cure for prostate cancer or any cancer that is inherently metastatic for that matter. It seems that a "cure" is in the eye of the beholder.

From what I have read in many cases that an early stage prostate cancer completely contained within the prostate gland and treated with either surgery or radiation that there is an excellent chance that the cancer will not manifest itself again. Historically, both surgery and radiation show about a 30-35% chance of biochemical recurrence characterized by rising PSA scores some time after treatment. While some of the more modern forms of radiation (such as what you received) seem to have a much lower recurrence rate in the near term, we won't know for several years whether this trend will continue at the 10 and 15 year points.

Prostate cancers diagnosed in the intermediate and advanced stages have higher rates of recurrence. A Gleason 9, as you well know, is a dangerous cancer. Although there may not be any immediate evidence of metastasis there is a high likelihood that a Gleason 9 patient will see tumors that have spread outside the prostate via the blood or lymph systems even though they might be microscopic and otherwise undetectable. Your treatment course, which i personally think was very wise on your part, went after the cancer in an aggressive way. The radiation attacked the prostate cancer cells within the target area of the IMRT and the Firmagon works to curb cell growth in those areas that were not radiated.

The fact that your PSA continues to drop is a good sign in my lay opinion. It suggests to me that your treatment is working as intended. What i suspect that the PA was trying to say is that the Firmagon (or any hormone therapy drug) should knock the PSA levels down to near zero levels regardless of whether or not any other treatment has occurred. I'm certainly no expert on hormone therapy and I don't know what the normal range of expected PSA scores should be given your Gleason 9 starting point. I would request an email exchange or arrange for a telephone chat with your lead physician and ask him what his opinion of a PSA = 0.28 after being on Firmagon for a year really means for a Gleason 9 patient and whether this is within a normal range or not.

You really won't get a feel for the effectiveness of the radiation treatment until you have stopped hormone therapy and your testosterone leeks return to normal. This could take several months after you stop taking shots.

Men who retain their prostates will never see a zero PSA score. (Although HT skews this data) Their PSA will decline until a nadir, or low point, is reached, and then stays at that level. If PSA results raise more than 2.0 ng/ml above the nadir it is usually considered a recurrence.

One phenomena associated with radiation treatment is the PSA bounce effect where the PSA declines after treatment then inexplicably increases and then continues a decline toward nadir. Perhaps your reading was somewhere during the bounce phase? I would also query your doctor about his thoughts on PSA bounce.

In any event your PSA continues to decline and that is a very good thing from my perspective. Whether or not there is a "cure" seems off point to me. What I think you should be asking is: Is this cancer going to progress to a terminal late stage that kills you? I think its way, way to early to draw that conclusion on that and the PA should have made that clear to you. I wish your PA had taken the time to put all of these numbers and nuances in perspective for you and I hope you seek further clarification with the doctor in person.

Best to you.

K

Samsungtech1 said:

Doctors
You need to get another doctor. They should call you in for consultation. .1 is not bad. Lots of guys would love that reading. I would start looking for another DR. And understand that different labs get differwnt results. Do not be alarmed or excited until you get two tests.

Good luck

Mike

petrogc said:

Correction
Thank you so much for your response. After sending the last message about his psa being elevated, we found that his psa had not changed any from a 0 psa to a .10 post lupron shot.

Is having a psa of .10 mean that the cancer is undetectible or is the lupron shot just a "bandaid" for the actual results in future testing? His gleason score is a 9 and with that score we are concerned about the aggression of the cancer. Do you think that we should feel hopeful that the cancer was removed during radical prostetecomy even though the pathology report says that the margins were very close and the cancer might have spread past the capsule? The other question is now that the lupron shot is at its 6 month duration, when do we think about radiation or another form of treatment before the psa rises back to a 4 like it was prior to prostatectomy?

Bunch of questions I know.. but seems like we get more informative information from this discussion board than what we do paying hundreds of dollars for an "i dont know" from his urologist.