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Posted 6/13/2011 12:15 AM (GMT 0)
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ART & PSA

I'm headed into my 1st of 38 ART (IGRT) sessions tomorrow @ 6:45am, then off to work.

I had a "sensitive PSA test" from my uro that came in at 0.03 (33 days post RP), then a few weeks later my med-onc ordered a (non-sensitive) PSA test that came back at 0.1  (not <0.1)  I figured my PSA had shot up three fold in a short time - not good. Well I just got my results from another sensitive PSA test (75 days post RP - again ordered by my Uro) it was 0.03. Both 0.03 test were from the same lab and assay - DPC IMMULITE 2000 Method. Quest diagnostics seems to be taking over the world. Thus far I'm not real impressed.
 
So I guess my nadir PSA going into ART is apparently 0.03 and stable. I think the stats are better for ART if PSA is low and stable - not that it means a whole lot in this crazy game. My rad-onc said my odds of long term PSA control were 50/50 - sounds more like a WAG (wild as5 guess) than a data- based assessment.

My med-onc boldly promised my PSA would be zero (<0.01) following ART. I'm not a big fan of such assertions about the future - it lowers my confidence in the doctor. 

What  do I make of my non-sensitive 0.1  PSA result? PSA flux or just number rounding of a less sensitive test.

My RP was no problem and I'm expecting the same with ART.

K2
pT3a, one positive apex margin focally,-SVI,+EPE,+PNI,+LVI, N0, M0
open RP 3/17/2011
ART Begins 6/13/2011
Sensitive PSA tests 0.03 (33 days post RP), 0.03 (75 days post RP)
Posted 6/13/2011 2:09 AM (GMT 0)
k2

good luck with your radiation run. hope you have smooth sailing with few or no side effects.

did you get that doctor to put that "promise" in writing. that would make me uncertain if one of my doctors made such a claim

let us know how it goes

david
Posted 6/13/2011 1:02 PM (GMT 0)
K2,

Can't speak much to your 0.1, as it seems contradicted by the .03 before and after. That is why we are all so big on suggesting keeping the same lab.

I'm about to deal with that this week - my 6-month PSA tests have all been with Bostwick, but they just went "out of network", so I have to change labs.

Hope your RT goes well. Try to follow their suggestions and drink the water as directed.

Been there myself.

Posted 6/13/2011 1:05 PM (GMT 0)
Good luck with the ART.  The .1 looks out of place compared to the .03's.  I hope all went well during this morning's session.
Posted 6/13/2011 1:25 PM (GMT 0)
Wish you the best on your ART journey. Hope it went well this morning and please keep us posted. I am confused as to the need for Adjuvant RT if the PSA was stable at .03? I thought .03 was supposed to be a "good" number, especially so soon after RP? I must be wrong or missing something here.
Posted 6/14/2011 11:22 PM (GMT 0)

RCroller,

Agreed, 0.03 PSa is a good number (<0.01 is better) but I'm high risk with pT3a and I chose ART over SRT because I expect to tolerate RT fairly well due to my age (51) and condition. There's some evidence of an advantage of ART (with low PSA) over SRT (with higher PSA) - but admittedly it has not been comprehensively studied over the longer term. The subject is controversially - I voted with my feet. I also had an open RP (went well) after being diagnosed as a cT3b - also controversial. Walsh states carefully selected T3s are canidates for RP - but I doubt he'd consider me a canidate. I also have other unfavorable factors +PM, +PNI, +LVI, +EPE

BTW - Two ART treatments (IGRT) thus far, its been a simple matter. When I'm closer to the half way point (~19 treatments) I'll be more likely to experience the side effects - hopefully mild.

K2

Posted 6/15/2011 1:53 AM (GMT 0)
Sometimes I wonder about the PSA tests, I have been on HT for 12 months and had a PSA test each month. 10 times it comes in at < .01 and 2 times .01. I get freaked out by the .01 tests but the next test comes back at < .01 again. Sometimes I think that they just miss the <. But this is a bid deal. You would think they wouldn't make this kind of a mistake.
Posted 6/15/2011 2:12 AM (GMT 0)
BB,

Just think of it this way, you might be fluctuating between .009 and .010.

A .001 difference could be the line between a < or not.

smilewinkgrin  

Posted 6/15/2011 3:20 AM (GMT 0)
K2, I noticed NOTHING until about the half-way mark, then a slowly increasing feeling of urinary urgency and slightly increased frequency..near the end, a little rectal discomfort, itching, nothing major..A month later, back to normal...That was it..72Gy in 40 fractions..

What was your Gleason score after surgery?
Posted 6/15/2011 4:31 AM (GMT 0)
Fairwind

My post op G-score was 3 + 4

Pre op PSA was 16

U2
Posted 6/15/2011 12:17 PM (GMT 0)
K2, very interesting and thanks for the information. I just got my first post- op PSA drawn this morning and have an appt with the Uro tomorrow. I also have similar stats: pT3a, G-7 (4+3), +PNI. +EPE, very close left margin <0.1mm., pre-op PSA was 3.5, am 53, and otherwsie in good health(to my knowledge). Wonder if I should have that ART vs. SRT discussion with the doc or just wait and see what my PSA is before going there? I got the impression from him that he wouldn't do anything further unless I had three consecutive rises in PSA, but I'm still not sure about him. Are you doing any HT with the ART or is that only done with SRT? Thanks and best of luck to you.

Post Edited (rcroller) : 6/15/2011 6:20:52 AM (GMT-6)

Posted 6/15/2011 6:33 PM (GMT 0)
Rcroller,

As best as I can tell there are few, if any, hard and fast rules with PC and PSa - it's a crazy game. SRT i.e., waiting for a rise in PSa is common. There's lots of debate about SRT vs. ART.  With SRT you have a chance of avoiding RT which is a treatment not without risks. Do you homework before talking to your doc and HW is great resource. The studies on SRT vs. ART are limited but it seems like there is an increasing trend towards ART for high risk folks - but that's ONLY my preception. I am currently trying to come up to speed on adjuvant HT - can't say much about it yet because I just started looking into it.

K2

NCCN Guidelines for Patients with Prostate Cancer
http://www.nccn.com/images/patient-guidelines/pdf/prostate.pdf
page 46

Posted 6/15/2011 7:50 PM (GMT 0)
K2, did your R-doc make any mention of including a short period of hormone therapy to compliment the radiation?
Posted 6/15/2011 8:25 PM (GMT 0)
Fairwind,

Negative - but I'm going to ask when I see him Monday.

I'm interested on any info you might have on the topic.

K2
Posted 6/15/2011 10:11 PM (GMT 0)
I had my 27th SRT today and haven't noticed any side effects yet. That suits me fine. I went with SRT despite being T3b because there was a chance, albeit 35%, that I wouldn't need any radiation at all. My clinic doesn't publish the ultra sensitive results so I started getting mentally ready when my PSA hit 0.1. When it rounded to 0.2 I pulled the trigger. Near as I can tell there is change in the efficacy of SRT at 0.2 and again at 0.5.
Posted 6/16/2011 1:01 AM (GMT 0)
STW,

No study has shown ART increases bio-chemical relapse compaired with waiting or SRT and given I'm confident (fingers crossed) I'll do ok with 38 sessions in the microwave - I went ART. As a T3, I have not seen a published number I like anywhere. But gezz, ....really, the data is murky, studies small and in the end everyone is an individual - as a HW old timer told me "you're not 10,000 people, you're an individual, what matters is your individual case." (paraphrased)

Small sample of the debate-

Argument for ART - Published June 2011

Study at Thomas Jefferson University and Hospital cited in ScienceDaily

http://www.sciencedaily.com/releases/2011/06/110609181547.htm

Argument Against ART - Published 2007

Department of Urology, CHU BICHAT, Paris, France

http://www.eu-acme.org/europeanurology/upload_articles/boccon%20gibod%20supp.pdf

K2

Posted 6/16/2011 1:34 AM (GMT 0)
As a T3a person, my Rad Doc and Uro where pleased with a 0.08psa at 12 weeks.At 8 weeks I was 0.26. My next PSA is August 9th. According to them, we won't do anything unless there is an increase. I was feeling pretty good about a 0.08.
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