PSA keeps rising

First, you came to the right place! There is a wealth of first-hand experience here that folks are ready to share. I have three stories: mine, my older brother's, and a close friend of mine that may be of interest since we all took different approaches. First, my brother went to RCOG in Decatur, GA, for their ProstRcision treatment of seeds and carefully-focused radiation treatments. The full course took abt six weeks and they stayed in GA for the entire time (at a place that was free for patients). This was abt eight or nine years ago and he remains in good shape with undetectable PSA. He was and remains pleased with the results. Very little discomfort during the procedure and very few "quality-of-life" issues after (one of his main concerns).

The second was a friend of mine that had the DaVinci method just abt five years ago. Recovery for him seemed to be very quick and when I last spoke to him, he was also at zero PSA and was convinced that he had taken the right approach. His one point is that you MUST find a surgeon that does a LOT of robotic prostatectomies so they are truly comfortable with the device console.

Now for me. I had a biopsy last Dec (stats below) which resulted in RRP (open) surgery on 1/21 and I just got the tube out yesterday. I had convinced myself that the robotic method was for me but I found a really good urologist that does both but in my case recommended the open style so he could better see what was going on. All went well (again, see below) and I expect to go back to work next week. I've no complaints.

So, three different stories, three different approaches, three happy customers. How does that help you? Good question. My only bit of advice is to find a urologist that you really trust and go with what they advise. Each of the approaches offers the potential for good results so get comfortable with your doctor and let them do their work. If robotic is your way, find a urologist that does them frequently and that has a good track record. Actually true for any of the approaches so it's back to finding a doc you like. That's most important, IMHO.

Not much help and I agree, too many choices.

Good luck, welcome to the group, and keep us posted.

See ya,
Garth

Good luck to

Dear Nasso. Welcome, I can tell you our story, and it may confuse the issue more, but I believe anyone going into this needs to be aware of all side effects..Well, Pete, my husband had Brachy , and external Radiation and lupron treatment seven years ago. After four years, We were very happy and thought he was cured. with slight incontinence and feeling great again. Well, the cancer reared its ugly head again, and the PSA rose from .5 to 8 in six months. He had salvage surgery which has been devastating to Pete....The damage caused by the radiation caused many severe side effects. You can read his signature.
The point is: if you have the surgery,....and it does come back, then you can always do the salvage radiation...but once you do radiation, that is your best shot.....After that, if it comes back you probably should go on Hormone Therapy..instead of salvage surgery....Even with the best doctors it is a difficult operation after radiation, and also there is 100% incontinence and no hope for the ED treatments to work. We went in hoping for a 40% cure of the cancer., but even the salvage surgery with all of its problems did not get the cancer. It was in the lymph nodes....and is now beginning to rise again... From our point of view it makes a lot of sense to get it out first....We all want to think that it won't ever come back, but it is a gamble whichever route you take....I think it is good to leave some better options open than salvage surgery.... That being said, there are others here that have done well with radiation and brachy.. as Garth pointed out.....Im sorry if this confuses your issue, I just wanted to point out this important fact, that we glossed over in the beginning.... Good luck. Diane

For the RP procdure - I seem to see most people with lower risk going that route, no? From my understanding, the procedure at RCOG kills the entire prostate as much as taking it out. But additionally the radiation would help if there was and extracaptular leaking.

Thanks everyone helping. Dave good luck with your first post op PSA

One more point... I agree with Divo/Diane about the issues raised with recurrence following brachy and that is why I wanted it "out, gone, nothing left". Fortunately, my urologist agreed with this desire and all went well. However, should there ever be a recurrence, knock on wood, I will still have other options available to pursue. Doesn't mean that brachy isn't a good approach. Just means that I like keeping my options open.

Hang in there,
Garth

Nasso,
A transition zone tumor is in the middle of the prostate and usually generates high psa, brcause this is where most of the PSA in the prostrate is made. I think this is what your doctor was referring to, but I'm only guessing.
It is very difficult to biopsy the transition zone and most doctors don't do it or do it improperly. 25% of all PC is found in the transition zone.
The good news is that because of the large amount of tissue surrounding the transition zone the tumor is most likely contained even with a high PSA. The bad news is that it is a very difficult surgical operation with a high failure rate because it is difficult to get all of the tissue. Therefore it is important to know if you have a transition zone tumor or a peripheral zone tumor.
JohnT

The husband of my cyber-friend was recently diagnosed with prostate cancer. He had the cancer treated and apparently destroyed with non-invasive High Intensity Focused Ultrasound (HIFU) heat treatment with a Sonablate 500 machine. He had the treatment done in Puerto Vallarta.

Here's her post from another forum:
"Absolutely no side effects, in fact he says his urine stream is stronger ~ it was probably a bit restricted because of the inflamed prostate, also he says he doesn't dribble anymore. He noticed this the day after the procedure.

And, yes, everything else is back to as before...."

The treatment is not yet approved in the US but phase 3 clinical trials have begun. http://clinicaltrials.gov/ct2/show/NCT00485381?spons=%22Synteract%2C+INC%22&spons_ex=Y&rank=3

http://www.articlesbase.com/cancer-articles/revolutionary-prostate-cancer-treatment-comes-to-puerto-vallarta-425985.html

Nasso,

I gotta agree with the post above...young age was a big reason I did the RP...high PSA (see stats below) and number of cores positive from biopsy convined me to take my doc's advice and do non-nerve sparing. Glad I did,--- big tumor volumne, cancer out to the edges...and STILL a positive margin---would have been much worse if I had nerve-sparing RP.

Remember, the main goal is to get a LASTING CURE here---eveything else can be gotten used to.--- (not total ED with some help, by the way!)

Good luck!

Thanks everyone, much food for tought. I am now waiting for the prostascint scan, and also have an apointment with Dr Patel who seems very recommended.

The radiation procedure that I am so far opting for is actually a combination of seeds + radiation. It is performed at RCOG in Atlanta and has the hghest reported cure rates

David, I am in Florida but ready to go wherever I can find the best treatment. RCOG in Atlanta just came with the best cure rates that I could find and least side effects, especially in cases where the radiation might be necessary even after RP treatment. They compare the seed implants to RP. as it basically kiils the entire prostate. And the later radiation is to make sure extra capsular cancer leaking is taken care of.

Thanks again everyone, I see a lot of support for the RP route and I am still investigating the options. I think once I get some more results I will be able to form a final decision.

My second PSA was taken about 6 weeks after the biopsy - do you think this could be also a reason for the accelerated rise?

nasso said...

My second PSA was taken about 6 weeks after the biopsy - do you think this could be also a reason for the accelerated rise?

I really think the PSA is not of much significance at this point.  The gland has been messed with and it is well understood that PSA is an erratic marker.

And concerning the tumor, I don't think you can assume anything.  It can be, but also is not often a simple mass.

If it can be determined to be local, I think surgery is your best option.

Regards.  Scott

thanks again for the support. You are right, the biggest concern is to be around for my kids and wife. But the side effects are a big concern.

Is there a way to determine if the tumor is local before the procedure ?

I looked at the Partin tables and it gives me a 38% non-local if I keep my GS 6, or 50% non-local if my GS is an actual 7 that would be upgraded after the surgery.

Nasso,
You have been given a lot of advice on this forum based on what others did and their results. These have little bearing on your individual situation as your PC is individual and has to be looked at as your individual PC.
There are things you can do to determine if it is local or not and this will definately affect your treatment options. Your high PSA, number of cores, and % of cores put you in an intermediate or high risk catagory as you already saw from the partin tables. This makes the treatment option highly important. In the low risk catagory the option you pick really doesn't mattter much.
1. MRIS with endorectal coil does a good job at spotting extra capsular penetration. This would be an important thing to know in choosing a treatment. This is offered at Hopkins and UCSF and maybe a couple of more places.
2. A good PC oncologist can use data from the biopsy, gland size and psa history and calculate how much psa is being generated by the tumor and the gland. If there is more PSA then it is likely coming from some where else. Other doctors can do this as the software tools are available, but few do. The good oncos always use these tools. He can calculate the probability of it being local or systemic, like the partin tables but with more information fed into the software.
3. If the probilility of it being systemic is high (your call, but my cut off would be 25%) a Combidex MRI to pin point lymph node involvement is very useful in tailering treatments.
The process is simple: Why more people don't do it is mystifying.
1. Determine the biology of your individual cancer with as many tests and software tools as possible.
2. Match the correct treatment to your particular biology (not someone else's) to give you the best possible probability of cure.
3. Pick the very best doctor in that treatment area.
JohnT