Next steps

fortheloveofhim
fortheloveofhim Member Posts: 5
in Prostate Cancer #1

This is my first posting, so I'll give a brief history before asking questions:   My husband was diagnosed with PC in late Feb. 2012, at 56 years old.  After a physical exam his GP referred him to a urologist, who recommended a biopsy.  His PSA was 6.  

He underwent RP on 4/9/12.  Pathology report gave Gleason score at 7 (3+4) / primary tumor staging: 3a / no lymph nodes / no distant metastasis / perineural invasion present.     PSA following Radical Prostectomy:  5/22/12 was .104  /  8/22/12 was .112   /   2/22/13 was .197   /  4/25/13 was .284.  So within the first year of RP his numbers doubled.  

From May-July 2013 he went through salvage radiation.  PSA following Salvage radiation:    8/20/13 was .186  /  11/13/13 was .119  / 2/12/14 was .1 (nadir following radiation).  7/16/14 was .108  /  12/9/14 was .2   and finally last test  2/10/15 was .2 (no change)  But once again his PSA numbers doubled within 1 year following salvage radiation

Here are my questions:  

It's our understanding that .2 means biochemical recurrance of PC, or prostate cancer is still present somewhere in his body.  Is that correct?

Everyone keeps saying that PC is so slow growing that we don't need to worry, but I'm not finding many people that have had this quick of a recurrance.  If you are out there please reply and let us know your experience.

If he still has PC, is there any other treatment that will cure him?  We understand, that to date, there is no treatment beyond salvage treatment, just ways to prolong life (which could have life-altering side effects).  Is this a correct assumption?

My husband is having pain in his hips at night that wakes him up?  He doesn't think it's related to PC...but should I be concerned?

We are in hopes that his next PSA in May will show the same or lower number, and appreciate any input from others who are in this battle.    

Comments

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,817 Member
    #2
    Sorry

    Forthelove,

    Terribly sorry that the two of you are having to deal with this.

    ".2" is the standard definition of relapse.  

    With his PSA still as very low as it is, it seems virtually impossible that metastatic disease could be in his hips; I would guess that the pain there is something else.

    I think you need to find a medical oncologist who specializes in relapse options (there are such specialists). His radiation oncologist may be a good place to get references.

    Three questions: Did you mean to say that his pathology report indicated no perineural involvement, or that there was perineural escape ?

    Were his seminal vesticles removed in surgery ? 

    Did his pathology report indicate any "positive margins?" (which is cancer touching the exterior edge of the gland).

    I hope some better news is provided to you by specialists soon,

    max

     

  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #3
    Sequentials

    Forthelove

    Welcome to the board.

    According to NCCN guide lines, recurrence in a SRT patient is confirmed after three consecutive rises from nadir PSA. These results should be at least 4 weeks apart. Consequently, your husband still needs more time to fit this protocol. In any case I think you doing well in “exploring” possibilities and facts if recurrence comes true.

    Max questions about what has been dissected in the RP, maybe he sees in the series of PSA results after SRT a sort of bounce pattern that is typical in cases of RT done as prime (with the gland in place). However, you describe his pathological stage (after RP ?) as pT3apN0pM0 signifying that the pathologist found cancer in the nerves (a traditional route of cancer escape) within the prostate but not in the seminal vesicles nor at the lymph nodes nor anywhere else, meaning that they have examined under the microscope tissue from those specimens (gland, SV, NV and LN). The missing information relates to the far metastases (at bone) that could exist but it is indicated as M0 (not identified by the pathologist). Typically positive/negative metastases (M1 or M0) are identified through image studies (PET, MRI, CT, Bone scan, etc), and I would think that any of these exams would be negative because of the low level in the histological PSA since the first one from Feb. 2012.

    I am sorry to say but the rising pattern of the PSA at the radical prostatectomy and after SRT (that typically covers only areas such as the prostate bed and its surrounding lymph nodes) seams to indicate positive metastases from cancer that escaped before the RT of 2012."Remission” after SRT should go lower than 0.05 ng/ml.

    The next step (sequential therapy) is the hormonal (ADT). This does not cure but gives control on the advancement of the cancer which may be effective during many years (some cases over 15 years). The treatment includes a series of drugs interchangeable, followed by a second line more refined class of drugs, when these firsts fail. The period of ADT may be administered together with other therapies (concurent) such as chemo, immunological therapies, etc.. These all together may give a control  until your husband turns 80th.

    I hope the PSA of May goes lower and against the odds. At least, for the time being recurrence is not declared yet.

    You can read here the meaning of “perineural invasion present”;

    http://www.cancer.org/treatment/understandingyourdiagnosis/understandingyour
    pathologyreport/prostatepathology/prostate-cancer-pathology

     

    I would recommend you to get a copy of the following book that explains well about ADT, its administration and ways to counter its effects;
     Beating Prostate Cancer: Hormonal Therapy & Diet, by Dr. Charles “Snuffy” Myers.

    Diet and a change in live tactics become important in the treatment of PCa. Physical fitness programs and proper nutrition are important when dealing with ADT. Here is a UCSF publication on Nutrition & Prostate Cancer, which copy I highly recommend you to read;

    http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

     

    Best wishes and luck in his journey.

    VGama

     

  • fortheloveofhim
    fortheloveofhim Member Posts: 5
    #4
    VascodaGama said:

    Sequentials

    Forthelove

    Welcome to the board.

    According to NCCN guide lines, recurrence in a SRT patient is confirmed after three consecutive rises from nadir PSA. These results should be at least 4 weeks apart. Consequently, your husband still needs more time to fit this protocol. In any case I think you doing well in “exploring” possibilities and facts if recurrence comes true.

    Max questions about what has been dissected in the RP, maybe he sees in the series of PSA results after SRT a sort of bounce pattern that is typical in cases of RT done as prime (with the gland in place). However, you describe his pathological stage (after RP ?) as pT3apN0pM0 signifying that the pathologist found cancer in the nerves (a traditional route of cancer escape) within the prostate but not in the seminal vesicles nor at the lymph nodes nor anywhere else, meaning that they have examined under the microscope tissue from those specimens (gland, SV, NV and LN). The missing information relates to the far metastases (at bone) that could exist but it is indicated as M0 (not identified by the pathologist). Typically positive/negative metastases (M1 or M0) are identified through image studies (PET, MRI, CT, Bone scan, etc), and I would think that any of these exams would be negative because of the low level in the histological PSA since the first one from Feb. 2012.

    I am sorry to say but the rising pattern of the PSA at the radical prostatectomy and after SRT (that typically covers only areas such as the prostate bed and its surrounding lymph nodes) seams to indicate positive metastases from cancer that escaped before the RT of 2012."Remission” after SRT should go lower than 0.05 ng/ml.

    The next step (sequential therapy) is the hormonal (ADT). This does not cure but gives control on the advancement of the cancer which may be effective during many years (some cases over 15 years). The treatment includes a series of drugs interchangeable, followed by a second line more refined class of drugs, when these firsts fail. The period of ADT may be administered together with other therapies (concurent) such as chemo, immunological therapies, etc.. These all together may give a control  until your husband turns 80th.

    I hope the PSA of May goes lower and against the odds. At least, for the time being recurrence is not declared yet.

    You can read here the meaning of “perineural invasion present”;

    http://www.cancer.org/treatment/understandingyourdiagnosis/understandingyour
    pathologyreport/prostatepathology/prostate-cancer-pathology

     

    I would recommend you to get a copy of the following book that explains well about ADT, its administration and ways to counter its effects;
     Beating Prostate Cancer: Hormonal Therapy & Diet, by Dr. Charles “Snuffy” Myers.

    Diet and a change in live tactics become important in the treatment of PCa. Physical fitness programs and proper nutrition are important when dealing with ADT. Here is a UCSF publication on Nutrition & Prostate Cancer, which copy I highly recommend you to read;

    http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

     

    Best wishes and luck in his journey.

    VGama

     

    Next steps

    Dear VGama -

    Thank you for such good reading and physical fitness recomendations.  We'll be reading these and keep praying for the best prognosis and/or quality of time and life!  These books and articles sound like a good start.

    Thanks again for your time and help!  I'm sure we'll be back on line soon to update.

  • fortheloveofhim
    fortheloveofhim Member Posts: 5
    #5
    Max Former Hodgkins Stage 3 said:

    Sorry

    Forthelove,

    Terribly sorry that the two of you are having to deal with this.

    ".2" is the standard definition of relapse.  

    With his PSA still as very low as it is, it seems virtually impossible that metastatic disease could be in his hips; I would guess that the pain there is something else.

    I think you need to find a medical oncologist who specializes in relapse options (there are such specialists). His radiation oncologist may be a good place to get references.

    Three questions: Did you mean to say that his pathology report indicated no perineural involvement, or that there was perineural escape ?

    Were his seminal vesticles removed in surgery ? 

    Did his pathology report indicate any "positive margins?" (which is cancer touching the exterior edge of the gland).

    I hope some better news is provided to you by specialists soon,

    max

     

    Next steps

    Max,

    Thank you so much for your concern.  It was our understanding that .2 was relapse as well.  

    We haven't seen the medical oncologist since radiation was completed, but if his next numbers go up I'm sure that's where we're headed.  My husband is just not sure he wants all the side effects of hormone drugs, and I want to support his decisiion if it effects quality of life, and doesn't give longevity.  But I also want to understand all that we're facing before making firm decisions.  From someone else's post it sounds like there is a possiblity of many years of life!

    His pathology report was positive for Perineural involvent.  So the cancer was outside the gland and on one side of the nerves which they took along with the prostate during surgery.  No positive margins were identified.  No seminal vesicle invasion was identified.  They took 3 lymphnodes and they were negative.  His Primary tumor staging:  pT3a.  So my understanding so far, is that there are cancer cells active in his body somewhere.  They ran all the scans and MRI's, etc. before his RP.  So we may be going through those again in the near future.

    We'll update in May after his next PSA

    It's good to talk with people who understand, and we appreciate your reply!

     

     

     

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