It's baaacccckkkk. (PSA rising)

gene,

sorry to hear of your rise. normally, they like to see 3 consecutive rises, thus the wait for another reading, but if your current reading is correct at .34, if it were me, i would want to start talking to a good radiation oncologist at this point. to me, it appears that you have recurrance. i would also ask to talk to your doctor again before waiting the full 3 months.

david in sc

Thanks.  I don't have access to stats right now, but the Gleason was first diagnosed as a 7, but post surgery lab lowered to a 6 & confined in prostate.  I do have a copy of path report... somewhere.

I thought we were in the clear after 2+ years of low zeros. Another thing for me to worry about. Thanks a lot, Pal !
(I am not a doc so ignore everything I write.)
Why wait? According to my math you have a PSA doubling time of 3 months. I'd use that lab request at 3 weeks and if the result was 0.38 that would confirm the PSADT of 3 months (1.125 x 0.34). (6 weeks should be 1.25 x 0.34= 0.43.) During those 3 precious weeks I'd be calling around trying to find a doc who looked at my situation with the same sense of urgency as I.
Good luck to you.
Jeff

Many studies show that the earlier and stronger you hit this the better the results will be. Many studies show that long term results degrade significantly if one waits until the PSA is greater than 1.0 to start salvage treatment.

I would expect that the treatment should combine SRT with HT like ADT3 as newer studies have shown an increased effectiveness of adjuvant SRT and HT versus sequential treatment. It has become common place to start with HT before starting SRT.

Finally, in my opinion, it is time for a world class prostate specialist medical oncologist. The urologist's job effectively ended with the surgery. Keep him on the team, but now the focus shifts to the med-onc and rad-onc. I would be chossing a med-onc that specializes in PCa and a rad-onc that does a large amount of PCa. Another consideration is that HDR brachytherapy can be used as a salvage therapy very effectively, thus a rad-onc that is experienced with seeding and HDR could be very valuable.

A key consideration is finding out exactly where the recurring cancer is located. If the PCa that is causing the PSA rise is not in the prostate bed area, then no amount of SRT will do any good. Sounds like the time to get busy trying to locate the offending cells so that the treatment can be effectively directed. It would not be wise to go through a few months of radiation only to hear you docs say that the PSa is still rising so the PCa must be somewhere else. As Snuffy Meyers says, treating PCa is just like playing golf....you have to play it where it lies.

Sorry that your PSA is back. I personally could not wait 3 months for a confirming test. I agree with you. Why wait 3 months. Why not have anothetr test is 30 days.

Thank you, everyone.  I'll be seeking an oncolongist (sp?).  That was how I was feeling & you helped confirm my feelings.  I'll stay in touch.  Again, thanks.  Gene

Tony,

Average time for what?

I had something similar happen after four years of successful HT---rising PSA doubling every other month-- I am now on Provenge, but had a "scare" of a tongue of lesion intruding into my bladder and shutting off the flow.

I would only wait a month to get PSA tested, meanwhile consulting a radiation oncologist (I already have, just in case the Provenge doesn't work).

Good luck.

Chris,
It's important to note that the keyword is average. Additionally, 13.3 years (160 months) is a lot of time in research and development. And with your G6 case, it could be a dozen years before a relapse ~ if ever....

Tony

Tony, does the 160 months assume that some salvage RT or/and HT is done?

Sorry for the slow reply.

The presenter of the 160 data was Mark Scholz. I have his presentation for PCRI 2011 here in front of me and let set this up...

Scholz said there are "Five Shades of Prostate Cancer.

#1 Low Risk
#2 Intermediate Risk
#3 High Risk

These three assume no previous local therapies.

#4 PSA Relapse (after any single local therapy)
#5 Advanced (with or without local therapy)

Scholz presented slides for each "shade" that outlined survival and options.

In the slide that started describing "The 4th Shade" the following is outlined:

Cancer Type Life Expectancy after Relapse
Pancreatic 4 Months
Kidney 6 Months
Stomach 8 Months
Lung 12 Months
Prostate 160 Months

Scholz was clearly attempting to show how prostate cancer after relapse is by far one of the most manageable. Relapse in this slide is referring to the first slide that indicates that relapse is a rise in PSA after initial local therapy.

Now he did speak about the caveats. Clearly a G6 relapse will have longer survival benefits. A G10 much shorter than the medians shown. But before anybody gets discouraged you need to keep in mind some key points:
1> If you are going back 13.3 years for the median that is expressed in these slides, that means that many patients were diagnosed as high a 20 years ago. A lot has changed in treating prostate cancer in the last 20 years.
2> If G10 patient was diagnosed in 1994, and he died in 1999, would he have had better survival benefit if he was diagnosed in 2011? I believe it's reasonable to say absolutely. There was no Zytiga, JEVTANA, Provenge...etc.

It's very reasonable today to believe that 13 year survival is possible regardless of Gleason score just as t's reasonable to believe that this median will continue to rise as treatments improve.

Sp stay positive guys...

Tony

Hey Brothers and Sisters

Don't freak out on the 160 Months statement. I think the really important thing to note is in Tony's last post
1>If you are going back 13.3 years for the median that is expressed in these slides, that means that many patients were diagnosed as high a 20 years ago. A lot has changed in treating prostate cancer in the last 20 years.
2> If G10 patient was diagnosed in 1994, and he died in 1999, would he have had better survival benefit if he was diagnosed in 2011? I believe it's reasonable to say absolutely. There was no Zytiga, JEVTANA, Provenge...etc.

How many new drugs and treatments are in the pipeline? Lots and lots!

As Tony ended with and just to paraphrase a little
So stay positive guys and gals

Live Long and Prosper!

Bud

Post Edited (Raddad) : 9/15/2011 1:48:24 PM (GMT-6)