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Posted 12/10/2011 9:56 AM (GMT 0)
I'm virtually one year out of surgery and my PSA is 0.

I've been advised that I can switch to testing every 6 months now.

I trust my surgeon blindly, but a little part of me wonders if I should stick to the 3 month cycle even if to only get the results myself for my own purposes.

When did you guys in the same group switch from 3 to 6 months? Is it always a year or have many of you stayed on the 3 month cycle for 2 years?
Posted 12/10/2011 10:46 AM (GMT 0)
For me....which is pretty common after a few threads like this:

First year - every three months

Second year - every six months

After that - once a year

I too have been getting zeros....But I started a Testosterone treatment and will get tested more often then once a year.

Posted 12/10/2011 3:19 PM (GMT 0)
David,
My case is a little different than yours but my Dr said I could go to 6 month testing at 2 years (due to Gleason and positive margin) I wasn't comfortable with that and suggested every 4 months for the next year then possibly every 6, she was cool with it an it's so ordered.

Bottom line for me is comfort level, I'd rather keep a close check on it.
Posted 12/10/2011 3:50 PM (GMT 0)
I think every Dr has their own thoughts on that. Mine was

2years every 3 months
from then on every 6 months and I asked the Dr last wk when will I switch to once a year

He said "at 15 years out" :(

I guess I need to help him pay for that new house or new wife!

Cajun Jeff
Posted 12/10/2011 4:11 PM (GMT 0)
Mine was switched to 6 months after the adjuvant RT, but then it started climbing again, so I'm back on 3 months, and will be there from now on, I suspect.
Posted 12/10/2011 4:14 PM (GMT 0)
I am three monts for at least two years after my HT stops. My uro and onco are concerned about my risk level and want to keep a close eye on things for the next few years.
Posted 12/10/2011 10:08 PM (GMT 0)
david, what is an example of your "own purposes"?

if you are pulling zero's a year out, and no evidence of a climbing psa or bcr, then why subject yourself to the needless worry of every 3 month psa tests?

david in sc
Posted 12/10/2011 10:22 PM (GMT 0)
I am still at three months and will probably stay that way for at least another year. I do however look forward to the every six months. I agree with purgatory I have no desire to subject myself to testing if it is not needed.
peace to you
Dale
Posted 12/10/2011 10:22 PM (GMT 0)
I am still at three months and will probably stay that way for at least another year. I do however look forward to the every six months. I agree with purgatory I have no desire to subject myself to testing if it is not needed.
peace to you
Dale
Posted 12/10/2011 10:44 PM (GMT 0)
Dale,

As my current oncologist tells me, and he says, what's the point of knowing that often? It's not going to change your situation and it's not going to change your treatment options at this point, and it's not going to change the course of your cancer. So why add all that worry to yourself?

I think it's good advice. Just my opinion, but I honestly think some men (even here at HW), get too self-absorbed and obsessed in general with constant PSA testing. We are talking mostly about 3 month testing, but there are men that choose to be tested every single month. Even if the cost is low, or even free, what is the real point?

My doctor's big kick, is preserving quality of life, instead of worrying about quantity of life. I think there is something to be learned from that philosophy. And if it just another "control" thing in the mindset of some men, I think they are only fooling themselves, as that kind of control serves no real purpose, other than to keep the person in a constant state of anxiety over the numbers.

The longer I have dealt with PC in general, the more amused I am when I see people fretting because one time their PSA is at .003 and now it's at .004. Do they really realize just how microscopic an increase that really is? Do they realize that with that kind of ultra-sensative testing, small bounces would show up every day if you tested daily, and all of them would be well within the normal realms of tolerance for the testing method

Life is too short to start with, and it's even shorter when dealing with cancers, so why torture yourself getting OCD about micro changes in one's PSA score. Just my take.

David in SC
Posted 12/10/2011 11:08 PM (GMT 0)
well the thing is, Purgatory, that we are all very different in how we approach life, trauma, concern, grief. You can tell the hunchback to walk straight till you blue in the face but he won't.

I have no side physical side effects right now resulting from my surgery, But I do believe I have psychological effects such as mild depression, anxiety etc.

So staying on the 3 month cycle, even though my Doctor suggests 6 months now, is actually not a way to make me worry more, perhaps, I would worry less. I say perhaps because like "gone soft" said, six months without testing and "knowing" might be more of a distraction for me. I'm not sure, btw. My approach will be to ride it out and see how I feel come March.

And yes, I am aware that if my PSA jumped in 3 or 6 months I would still just continue to monitor it a few more times before getting into radiation. It isn't about controlling the cancer, it's about controlling myself. Perhaps very different from your approach to things but hardly unique.

Either way, I confess a sense of relief knowing that my doctor believes I can go 6 months. I certainly do have all the trust in the world in him and his idea, although not the word of God, does give me comfort.
Posted 12/10/2011 11:46 PM (GMT 0)
Purgatory said:

"As my current oncologist tells me, and he says, what's the point of knowing that often? It's not going to change your situation and it's not going to change your treatment options at this point"

Funny, that was what mine doctor said as well, even though my outcome was much better, pointing out that most likely the zeros would not change and it was time I started living a normal life. He said that even if I had BCR later, it should not have gone up so fast that a 6 month cycle would not be adequate.

Cheer up davidg. smilewinkgrin
Posted 12/11/2011 12:07 AM (GMT 0)
David (Purgatory)

You make an excellent point regarding test sensitivity and variability.   To make decisions on therapy based upon values that are within the test's margin of error could have huge negative ramifications.  Anyway, I am not aware of any published information demonstrating any advantage of starting salvage radiotherapy for PSAs under values significantly less than 1.0.  I have seen several examples of patients started on radiation after one extremely low PSAs that was greater than zero. 

If I am incorrect, please let me know.

Paul

Posted 12/11/2011 12:58 AM (GMT 0)
Newporter - your point is well taken, sounds like a sensible doctor to me. For all of us with cancer, it's just to easy to get trapped into emotional spells, either directly or indirectly, which then turn into high anxiety, and if we are not careful, can turn into needless depression. We are constantly told that PC is slow moving, and generally that is true, so when it comes to post-treatment PSA readings, why should we act like it's life or death with small incremental movements.

Paul, true, there are radiation oncologist that feel that SRT should definitely begin before reaching .5, and there are others comfortable letting it rise to 1.0, where they feel it's most effective. My same oncologist said that he is grieved by the number of men that rush in SRT based on very small rises, especially when the readings are still in the .1x range.

david in sc
Posted 12/11/2011 3:21 AM (GMT 0)
davidg -- on my last visit my doctor said:  "i think we got this thing beat!"  and then he said he was moving me to six-month testing.  it kinda freaked me out to see him so positive because he doesn't say things casually nor will he say something just to make me feel better.  and on that day i was expecting my PSA to either be the same or elevated (it had moved back down).

i told him i didn't think i was ready for six-month testing and he said he'll see me whenever i want.  he's seen me freak out so i really appreciate him giving me the final say.  i'm not sure what i'll do.  after vacation i'll make an appointment with him.

like you, i feel great physically but mentally and emotionally i have changed.  that's neither bad nor good it's just the way it is, and it's not the first time for me either.

ed

 

Posted 12/12/2011 7:33 PM (GMT 0)
You all make good points, but it is also such an individualized decision. I have a friend who has had a good string of 0.01 and <0.01. He can easily test on an annual basis, but he gets worried every 3 months or so and eventually just breaks down and gets the test.

If I had such good PSA numbers, I would greatly prefer 6 months or 12 month intervals.

Regarding tx., again we can all get in to our age-old debate: when to start SRT and even when to start HT when things go south. I thought the studies indicated that for SRT, the sooner the better once it is clear that a BCR has occurred (3 rises above 0.20 or something like that).

I am personally dealing with the when to start HT decision and also whether or not to do ADT-1 or ADT-2 or ADT-3. I have to say that from my reading and consulting I have just about decided on the "sooner." I will be getting bone scan results on Thursday and I'll have one more telephone consultation now set for the 27th. I'll also do one more PSA. Barring totally clear scans and a major PSA reversal (unlikely), it looks like my 2012 posts will be dealing with the impact of HT.

Really, we can argue all day about this. The fact is that many of the top doctors seem to advocate the "sooner" argument, but yet others (including Dr. Hussain, one of the top researchers) do not. THERE SEEMS TO BE NO UNIFORMITY OF THOUGHT HERE.

Certainly, from the QOL point of view, one can make the argument to NOT do HT early. But I doubt that there is any QOL in dying of advanced metestatic PC. But, then, we know HT will not cure this disease. So, what will it do? Will it delay the onset of advanced disease/symptoms? I think so. But, at what cost? A big cost. The only way early HT is a winning strategy here would be if one can go on it, it knocks the PC out, and then one can go off HT for many years.

In all honesty, I am still wrestling with this dilemma.

Mel
Posted 12/12/2011 10:07 PM (GMT 0)

F8 said...
davidg -- on my last visit my doctor said: "i think we got this thing beat!" and then he said he was moving me to six-month testing. it kinda freaked me out to see him so positive because he doesn't say things casually nor will he say something just to make me feel better. and on that day i was expecting my PSA to either be the same or elevated (it had moved back down).
i told him i didn't think i was ready for six-month testing and he said he'll see me whenever i want. he's seen me freak out so i really appreciate him giving me the final say. i'm not sure what i'll do. after vacation i'll make an appointment with him.

like you, i feel great physically but mentally and emotionally i have changed. that's neither bad nor good it's just the way it is, and it's not the first time for me either.

ed

I don't see how anyone can deny not changing mentally. We wouldn't be here after all if we hadn't. People come here for many different reasons, but all of them a result of some need. That is a sign of change in itself. And yes, neither bad nor good, just the way it is now.

I'll consider it beat when I'm 65.
Posted 12/13/2011 1:24 AM (GMT 0)
I'd say a bit of perspective combined with the final path report are what is called for. If mine was a Gleason 6 stage T1x then I'd be okay with 1st year every 3 months, 2nd year every 6 months, but it wasn't.

At a stage T3a and 20% involvement I'm more comfortable with my docs recommendation for every 3 months, for ever. Some guys have the slow growing PCa others have the aggressive kind(mine) so staying on top of it is better IMO. Sure any PSA test invokes some sort of anxiety but the guilt of waiting 6 months and then seeing a spike would open up too many what if's.
Posted 12/13/2011 2:30 PM (GMT 0)
David,

My Uro has me on 3 month testing for the first 2 years and 6 months after that, I guess forever. He told me with my G7 and high tumor size this is the best course of action and that I will not be on yearly testing in the future. He just bought a new BMW so I guess all of these PSA tests help pay for the new car. smilewinkgrin

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