PSA recurrence and additional treatment recommended

 

Jeesh,    I thought I was over PCa....   Had DaVinci in 2007,  not a bad path with Gleason 3+3 = 6...  First few PSA tests low...  .01, .02...  Then at 31 months I had one come back at 0.13 and a retest at 0.11....

Just had a followup appt with my DaVinci doc and hew thinks there may be a few cells left in the localized area and same day had me talk to one on their oncoloogists.   Even though the levels are still somewhat low,  the oncologist says recent studies show that treatment now would be in my best interest...

I was certainly not ready for this bump in the road.   He did say that is was also OK if I decided to postpone things for awhile, but basically the sooner the better.   He would reccommend a 7 week treatment regime (5 days/week) of lesser doses for minimal side effects...

It is early and besides being totally freaked out and depresssed right now,  I will start doing some more research on this...   I wish I would have waited til spring to get my psa test until things were more settled in our lives and moving!   

Any comments or links on a recurrence such as this would be greatly appreciated as my wife and I digest and determine our next steps...

Thanks

pasayten

pasayten, What a shock...Sounds like your Dr has the spin on this that will have the least side effects. I have a friend that did the rt and he found it to be a breeze for him that is.

As Tony commented. Mop that sucker us and lets get going again...

Stay positive. Attitude is so very important.

Jeff T

Hi pasayten, Been there done that. It is quite a shock as I was at the 3 yr mark. As you can see in my bio my numbers started to climb at the rate of .01 every 3 months. I started my SRT a year ago and finished in Jan. of this year. I worked nearly every day as I had my appointments early. A little tiredness but other than that not a problem. I am now due my 6 month psa draw and I must admit there is a little anxiety which I guess goes with this. Good luck and go ahead and check on this. Now is the best time for a cure!

David

While I agree with others that SRT is fairly easy procedure (just had mine completed a couple of weeks ago), let me be a devil's advocate and ask why you need to jump into SRT when your PSA is still so low. Give it a bit of time and see what the next test will show. The textbook definition of recurrence is two consecutive rises above 0.2. You are not there yet and may not ever get there (God willing).

Lots of us are worried about if the other shoe will drop and we're sorry that it had to drop for you. Radiation has a high potential for success so try to stay positive.

Should you go for radiation now or wait? Waiting probably doesn't hurt your chances much, but why take a chance? With two labs and you doctor saying go why give the little devil more time to dig in?

I can't find the link now, but a recent ten year follow-up study suggested that immediate treatment could lead to longer survival.

I think my views are pretty much middle of the road with the other guys. No need to rush at that level, but you should probably get prepared now to take action. If you are going to have salvage radiation, optimally you want to start before you hit 0.5, and if you happen to miss that mark, before 1.0. That's based on my understanding of Andrew Stephenson's research, which is the basis of the prediction tool on the Memorial Sloan Kettering website.
Immediate radiation, meaning adjuvant, does seem to have an edge over salvage, where you wait until you're declared in recurrence. The literature has gone back and forth over this, but I think the most recent studies are in favor of adjuvant.
You can weigh for yourself whether or not the slight edge in going straight for radiation outweighs the risk of radiating unnecessarily, IMHO. Just don't get too relaxed about this.
My PSA dropped below 0.1 after my Da Vinci, but then on the second followup, it rose to 0.2, and from there started doubling quickly. At 0.2 my uro was not alarmed, and didn't have me come back for 4 months, when it was now at 0.6 and now I was sweating. Christmas, New Year's, etc. were all coming up and I needed appointments.
I managed to get SRT started when it was at 0.7. Afterwards it fell to less than 0.1 and has remained there (now approaching 3 years post-radiation). I had a problem with proctitis as a side effect, but it was treatable and resolved itself. My blog goes into all of this, probably in too much detail for most people.
Best wishes.

Passayten,

As was mentioned earlier, many of us have gone through the same thing.  As you can see by my profile, just a raise to .08 for me was enough to go for the additional treatment.  However, I did have positive margins.  I was really fortunate not to have bad side effects during treatment.  I keep very active as a high school sports official, so the hormone treatments didn't seem to cause a lot of fatigue.  Minimum hot (warm) flashes were an annoyance, and I still have a few as the hormones work their way out of my system.  The one thing my surgeon stated, was that the radiation would probably destroy the nerves he saved.  Can't say he was wrong, but that's an issue with surgery as well.  My driving thoughts throughout all of this were to kill any of those pesky PC cells before they had a chance to go anywhere else.  Final thought, my PSA is still 0 6 months after my last hormone treatment.

Good luck in your decision.

Best to you nobody wants to see psa rises and especially post surgery. There are different ways of mopping up PCa, residuals. Get further opinions is in your best interests, see an onco doc too wouldn't hurt. Why make a full plunge without more data, contrast and comparison....salvage radiation even though can be good with results...also can be total gamble or in vain in some PCa scenarios, you might have to make that gamble, and that is hopefully the patients full choice and not because you are told 'you have to' by whomever.
Because PCa is the jungle it actually is....question everything...every test...every proceedure...every choice, or go to Margaritaville and drink xyz and forget 'bout it! How's that for choices???