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Slow rise in PSA

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Posted 1/19/2011 12:11 AM (GMT 0)
We got last week's PSA results today. It has done another slow rise to .05.

The doctor has asked Mr.GFM to return in 4 months rather than 6 for another PSA. He mentioned radiation therapy may in the future.

We are scared/sad/anxious, etc.

Any words of advice, please? Thank you!Mr GFM's statistics:
Age 50 at diagnosis
PSA History: 10-05 1.3, 01-07 2.09
8-07 - PSA at Biopsy: 2.26
2 of 12 positive
Gleason Score 3+3 6
11-07 - Robotic surgery hospitalized overnight.
Path Report:
Prostatic adenocardinoma, Gleasons 3+3+6, moderately differentiated
Percent of Prostate involved by tumor 5%
Staging pT2c pNx pMx
Margins free of tumor - no further invasion or extension
Catheter out in about 9 days. No incontinence.
Back to work in 2 weeks
ED - resolved. No meds needed at this time.
Post Op PSA: 03-08 0.01, 10-08 0.02, 7-09 0.04, 1-10 0.04, 7-10 0.04

Post Edited (MrsGFM) : 1/18/2011 5:15:10 PM (GMT-7)

Posted 1/19/2011 12:13 AM (GMT 0)
Since you haven't posted often, it would help if you could re-post Mr. GFM's stats, I honestly don't remember his post surgery pathology.

Perhaps you could add that back in for us to see.

Good luck

David
Posted 1/19/2011 12:15 AM (GMT 0)
Sorry - somehow my profile disappeared. It's back now....
Posted 1/19/2011 12:19 AM (GMT 0)
Like your husband, I was pT2c after surgery, but mine is a Gleason 7 case with high velocity, unfortunately, I had recurrance less than a year after surgery and needed radiation.

From looking at your husband's post surgery PSA, it doesn't seem like he's heading for recurrance anytime soon. Even the reading of .05 is still well within the range of a "zero". Your husband had a very small amount of cancer, and a clean pathology report. Doesn't look like anything dangerous should be happening anytime soon.

Curious why his doctor would be saying that radiation may be in his future, at this point, and with that low a PSA.

Good luck to the both of you.

David
Posted 1/19/2011 1:56 AM (GMT 0)
His stats look pretty good and even if radiation is in his future the Partain tables are in his favor. Basically 4 years of zeros and the PSA doubling time is slower than mud. Go see a good movie are take a mini vacation to help ease the worry. Anxiety is part of PCa, but once again his numbers look pretty good if those numbers are correct.

Michael

Posted 1/19/2011 2:52 AM (GMT 0)
Your husband's PSA is still considered low. Typically, radiation is not recommended unless the PSA reaches .1 after 2 or more increases. The increases seam to be very small and may never get to .1 for a long time if at all. His pathology report looks good, small tumor, and low Gleason. By monitoring the PSA you will know if and when radiation becomes necessary but that time is not now.
Posted 1/19/2011 2:54 AM (GMT 0)
There is a individual in our support group who is a G6. He had a recurrence and waited until his PSA to approached 10 before he started SRT. It took 13 years. He has just finished SRT and a 3 month round of HT. It still appears PCa is still local and he has every reason to believe he will still be cured.
Posted 1/19/2011 4:37 AM (GMT 0)
Thanks guys, I appreciate the info and support. Somehow I thought if the PSA got up to .05 more treatment was probably needed.

I guess living with anxiety is just part of this disease process.
Posted 1/19/2011 5:18 PM (GMT 0)
The National 'standard' still recommended by the major accrediating agencies is two .2's. Like him, I have travelled your road a little ahead of you, so I know how it feels, the uncertainity, etc. After much discussion with my chosen Radiation Oncologist, I am gonna wait until I get that second .2 before doing anything. This ia an individual decision, and one not to be made lightly, as the side effects from radiation can be rough.

Facotrs used in deciding was the length of time since surgery (3 1/2 year), the Gleason scale (GS6), and the doubling times. There's a lot that goes into that decision. If you wish, you can plan ahead by consulting a radiation oncologist either now or after another rise, if that occurs. That way you can discuss the situation ahead of time and not feel rushed. Or you can wait- there's a good possibility that it may rise to a certain point below that first .2 and stabalize. It's too early to tell right now, honestly.
Posted 1/19/2011 6:56 PM (GMT 0)
Have you thought of getting his post-op and biopsy slides read at Bostwick or Johns Hopkins, if you already haven't.  They may see something the other lab missed.  If lets say they see a positive margin or a suspicious one, then you have reason to look at SRT.  If not, then you probably have a long time to play cat and mouse with his PSA.  I know stories of G6 guys that went to .2 and have stayed there now for over 8 years. 

 

Read this.

 

http://prostatecancerinfolink.net/2009/09/22/surgical-outcomes-for-patients-with-organ-confined-gleason-6-prostate-cancer/

This is from Epstein at J.H.

The authors conclude that most prior reports of organ-confined, Gleason score 6 with progression have, in fact, been undergraded, understaged, or situations with ambiguous staging. They go on to say that, “Even for the rare true organ-confined, Gleason score 6 (no pattern 4) tumor with supposed biochemical progression, some may be false-positive progression based on low post-radical prostatectomy prostate-specific antigen levels and minute tumors that seem highly improbable to progress.”

But notice they said "some", not all. 

G6 organ confined and a rising PSA is tricky to figure out when to have SRT if you even need it at all.  Like James C said, I would not pull the trigger on SRT before "2" consecutive rises above .2  And that could be a long time.

Posted 1/19/2011 7:26 PM (GMT 0)
With your husband's pathology report, it sounds like there is no rush to radiation treatment, especially with a still-low PSA of 0.05. 
Posted 1/19/2011 11:51 PM (GMT 0)
I do not know why the doc talks about radiation at this point. shakehead

I am near six years thank God
Posted 3/4/2013 7:11 PM (GMT 0)
Lots of info here. I am on the fence myself on having SRT. My psa levels have been slowly going up for 10.5yrs. Had a radical prostatectomy in PSA was 8. and had RP in 8-02. Gleason7= 3+4, neg margins in 7-03 psa was 0 by 1-03 it was .05. 10-04 was .07 10-06 was .13 Has since been on a .01 rise or down up till 12-12 whwn it finally hit .3. Have been to med oncologist, rad oncologist and my Uroligist and now saying SRT is the only thing to do. Have been very hesitant especially when they say it may only be a 50% chance any cancer is there. Been also told I could wait till .4 but do SRT this year. Have not been given any other options. Would like to wait but feeling that I have no other choices. Any input would be appreciated. sturgis.

Sturgis,

I edited your comment slightly to remove the line of plus signs that seemed to make the page format peculiarly.

PeterDisAbelard, Moderator

Post Edited By Moderator (PeterDisAbelard) : 3/4/2013 12:29:51 PM (GMT-7)

Posted 3/4/2013 8:48 PM (GMT 0)
Java read BB's post above. Where o where does this obsession with srt at low , and in java's case, sloooow, I mean sloooooooooow rise come from. I started a major vent on this issue, but practiced some very difficult self discipline. And since the route word is disciple, feel much better….. I know the above is a minor vent, but baby steps, baby steps
Posted 3/4/2013 9:04 PM (GMT 0)
Javabean,

I copied your comment to a new thread

www.healingwell.com/community/default.aspx?f=35&m=2662164.

New members get better information if they start have their own threads. People won't always read to the bottom of a long-running thread and I didn't want you to get lost.
Posted 3/4/2013 9:08 PM (GMT 0)
Thank you, wasn't sure to post a new one.
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