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Welcome new member Rust considering SRT

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Posted 10/10/2013 6:51 PM (GMT 0)
I found a comment by a new member and am giving him his own thread so folks can say hello and give him our usual contradictory, non-medical-professional advice.

He said...
Asking for advice on whether I should start 5 weeks SRT soon? I am 10 months post RP and received PSA results of 0.12 this week up from 0.03 in June. I am planning on taking another PSA test in 3 weeks to have results when I meet with the SRT doctor just to verify reading was not an anomaly. My surgeon and I are both puzzled at a 4x increase in just 4 months considering that the RP went well and things looked OK. Post-biopsy reported 1mm focal margin but surgeon considered to be insignificant. No seminal vesicle invasion or protrusion beyond capsule. Should I wait another 3 months and retest PSA or start SRT ASAP?

Posted 10/10/2013 6:54 PM (GMT 0)
Hello Rust,

Welcome to the forum. Sorry you need to be here but glad you found us.

The conventional wisdom is that you want to see several rising PSA values above a certain value before you pull the trigger. There is some discussion how many constitutes "several" and also some debate about the cutoff "value" but getting a few more PSA readings before you panic would seem appropriate.

On the other hand, since you are intermediate risk (Gleason 7) it seems prudent to meet with a radiation oncologist now so that you will be ready.
Posted 10/10/2013 7:20 PM (GMT 0)
Welcome to our corner of the world, sorry you need to be here.

The other question for SRT is it in the prostate bed? Likely you'd be okay waiting another 3 months before pulling the trigger on SRT but it would be prudent to talk to an RO now for an opinion.

There is the chance that the test went bad and you're really okay. Like mentioned above, better to see a rise over a couple of tests before committing.

Andrew
Posted 10/10/2013 9:12 PM (GMT 0)
Thank you so much Peter for posting my question on a new thread and thanks everyone for responding. And, this forum is a great place to be and am realizing I am not alone.

I do not have a copy but the post-surgery pathology report but it showed the 1mm focal margin was at the apex and tumor volume was 40%. I reqeuested a follow-up PSA to verify the last high result and it is scheduled for next week Monday (17 days after my recent high value).

My original post: 

"Asking for advice on whether I should start 5 weeks SRT soon? I am 10 months post RP and received PSA results of 0.12 this week up from 0.03 in June. I am planning on taking another PSA test in 3 weeks to have results when I meet with the SRT doctor just to verify reading was not an anomaly. My surgeon and I are both puzzled at a 4x increase in just 4 months considering that the RP went well and things looked OK. Post-biopsy reported 1mm focal margin but surgeon considered to be insignificant. No seminal vesicle invasion or protrusion beyond capsule. Should I wait another 3 months and retest PSA or start SRT ASAP?"

Posted 10/10/2013 10:40 PM (GMT 0)
The retest is a good idea. It's possible there was an error with the test. If it were me and it came back high again, I'd be looking for a good RO to talk it over with. A number of docs would start SRT around .2.

Even as good as the surgeons are these days, things can escape the knife.

Let us know what happens on the retest.

Hang in there,
Andrew
Posted 10/13/2013 4:35 AM (GMT 0)
Hi Rust,

The AUA considers a BCR when the PSA reaches 0.2 ng/ml. If your last reading with the ultra-sensitive test was 0.12 ng/ml and the four-fold increase happened within four months. I think that it is wise to do a retest very soon and to discuss your results with an RO.

You mentioned a small 1mm positive margin. What was its location? What was the Gleason score at the margin? The size, the location and the G-score at the margin are important factors influencing recurrence.

I mention this because, like you, I am also a G7 (3+4), and also had positive margin (3mm) at the bladder neck with
G6 (3+3) from my RALP 6 weeks ago, and I already talked to an RO and will talk to another soon.

All the best,

Joe.
Posted 10/13/2013 5:54 AM (GMT 0)
Welcome aboard Rust.
Posted 10/13/2013 7:39 AM (GMT 0)
Hi Rust...welcome to HW. Don't have any advice for you. My husband is facing the same thing right now:( Good luck and keep us posted. Alison
Posted 10/16/2013 7:30 PM (GMT 0)
Post Follow Up: Confirmation PSA was 0.10 today and am scheduled for 7 weeks SRT. While I could wait for for another 3 month test before deciding, I read the April 2013 AUA guideline document. Guideline 8 and on page 21 references a study that says, “These authors reported that PSA level before SRT was significantly associated with relapse-free survival with an average 2.6% loss of relapse-free survival for each 0.1 ng/ml PSA increment at the time of SRT”. To me that’s a big change in odds for waiting around for my PSA to reach 0.2 or higher and considering mine increased from 0.03 to 0.10 over 10 months post RP. Pipe in anyone if you think I am jumping the gun!

http://www.auanet.org/common/pdf/education/clinical-guidance/Radiation-After-Prostatectomy.pdf
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