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4 month post-op psa 0.15 - looks like I'm done

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Posted 3/5/2014 12:38 AM (GMT 0)
From my reading I understand that such an early post-op 0.15 is almost certainly distant metastasis that was undetected by the pre-op scans. The previous measure a month ago (3 month post-op) was 0.097. So I have a post-op doubling time (almost) of a month.

So I'm looking at an aggressive distant metastasis. It could be anywhere. It could be everywhere. So radiation is a waste of time, effort, and money.

My understanding is that with such an aggressive disease, hormone therapy can only slow the progression of disease while at the same time reducing the quality of life to misery. So I get to choose between a long miserable life or a few more years of energy, clarity, and strength before I go into the fog of pain control.

Neither option provides meaningful relief from anxiety and dread.

I am leaning toward the shorter but more energetic life, to embrace the fact that as far as I can tell I am strong,healthy, clear-minded and love life and the people in it.

Can anyone offer an argument for the other option?

I meet with my doctor next week. I don't know what he will suggest
Posted 3/5/2014 12:46 AM (GMT 0)
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Posted 3/5/2014 1:13 AM (GMT 0)
?
Posted 3/5/2014 1:30 AM (GMT 0)
in your case -- and I may be there some day -- I would shoot for intermittent HT. HT is no fun but neither is bone cancer. you could always try HT and then make the decision. best of luck to you.

ed
Posted 3/5/2014 1:37 AM (GMT 0)
People react differently To treatments. Why not give HT a try and see how it goes? You can always discontinue it if you choose.

Tom
Posted 3/5/2014 1:50 AM (GMT 0)
Don't read too much into any doubling times at this point, even at .15, it's still a minute amount of PSA, indicating there is some cancer left. Don't entirely rule out radiation as a secondary treatment, as if the cancer is still in the prostate bed, it could be a very effective and still possibly curative treatment for your PC.

It's been less than 4 months since your surgery, if I did the date correctly, way too early to throw in the towel, in my opinion. You are still in the healing stage, sometimes there is residual tissue left, that could still die off and lower your PSA over the next couple of readings.

You got a long way to go, and still have plenty of options. If nothing else, seek the advice of a good medical oncologist well versed in PC, discuss a future time line and possible plan of action.

Never give up hope.

David
Posted 3/5/2014 2:09 AM (GMT 0)
Your conclusion that there are distant mets is unwarranted. Distant mets are less likely with your clean margins and clear lymph nodes. The first place prostate cancer travels is typically the prostate bed, and your extraprostatic extension (pT3a) suggests that that is most likely what has happened. It is likely your RO will suggest that the next step would be salvage radiation of the prostate bed, probably with a total of 6 months of ADT, starting 2 months before the radiation.

- Allen
Posted 3/5/2014 2:59 AM (GMT 0)
I am sorry to hear that you feel that you are done. I am no expert at this disease in no way. Look at my signature, my BF had his post op PSA and it was <0.13 which I really didn't think was bad at all compared to what his PSA was before at 45 or 43. It really blew my mind the more I educated myself. After surgery I was expecting his PSA to be zero. A nurse said it can take time for the PSA level to reduce because it takes time to get out of your muscles in your body. His next PSA was <.06.

You seem very proactive. I would think that your dr would be proactive and see what your next test results are coming in at before making decisions on what is next.

I can't say what my BF has for his next PSA because he hasn't went back to get tested.

Good luck and wish you the best!
Posted 3/5/2014 3:16 AM (GMT 0)
Havanon,

You are still alive! And where there is life there is HOPE!

Granted you're a bit pissed off with the neg results so close to a RRP. It is good that you know now and not months later when you have PSA numbers are in the 30s or 100s.

You could still have a wonderful and fulfilling (yet, different) life living with cancer -- most of us do!

..
Posted 3/5/2014 3:21 AM (GMT 0)
Havanon,

I agree with Tall Allen. If your radiation oncologist recommends radiation you will be able to start it soon enough after your prostectomy that the left-behind cancer won't have much time to do anything. Studies have shown that the earlier you do salvage radiation the better it works. Chances are he will also suggest a limited period of hormones to make the radiation more effective. The hormones suck -- no question about that -- but knowing that they are only temporary will help make them more tolerable. I am coming up on the end of two years of hormones and I am sooo looking forward to the end, but to be fair I have been fairly lucky with side effects.

I did radiation after my surgery. It wasn't that big a deal.

You can still come out of this OK.
Posted 3/5/2014 3:30 AM (GMT 0)
Hey there, Cowgirl.

Good to hear from you. I am confused about the "less than" symbols -- "<" -- in front of your BF's PSA readings.

I think you meant to type .13 and .06 instead of <.13 and <.06.

I hope you are well.
Posted 3/5/2014 12:24 PM (GMT 0)
Thank you all for your encouragement. I won't make any decision now but will consider what you have said when it is time to decide.

Thanks again.

Stephen
Posted 3/5/2014 2:24 PM (GMT 0)
Stephen, you are getting some very good advice here.

I can identify with where you are about the PSA so soon after surgery, but the jump to distant mets is a little early.

My story is not quite so different than yours. My PSA following surgery was .40 and the next one was .67 so I started SRT just 3 months following surgery. My PSA continued to rise for the next 4+ years and it wasn't until about 6 months ago that they were able to find something and it was in the lymph system.

I have had more scans over the last 4.5 years than most here and mets never showed up until they found it in the lymph system. I have had a great QoL over this time and only now is it time to do something, read HT.

I started HT about 3 weeks ago and my PSA was 92. So give yourself a little break here on counting down the days or years you have.

In your case the alternative of SRT is probably warranted and something you should give a good amount of thought to.

My best to you,

Sonny
Posted 3/5/2014 3:16 PM (GMT 0)
havanon: Another option would be to have either a Carbon Acetate or Feraheme scan done once your PSA reaches 2 to determine where your cancer is located. Although both probably wouldn't be covered by insurance it's a way to take the question out of "where is it."? You would want your PSA at that level so there would be a better chance of locating the cancer.

One of the down sides to this plan is that if you're planning on having SRT this would allow your PSA to get higher than you probably would want before you begin treatment but if it is in the lymph system or bones you could have targeted radiation instead of a shotgun blast because they would most probably do full pelvic on you for SRT.

Dr. Almedia in Phoenix does the Carbon Acetate and Dr. Bravo in Orlando does the Feraheme. Google either if you're interested.

This is just another option

Good Luck
David
Posted 3/5/2014 3:20 PM (GMT 0)
havanon

I understand your feelings. I was .1 two months post op and .2 five months post op and I'm stage pt3b, Gl9. But my surgeon was happy with the .2 reading and I'm waiting for the next reading May 1st. Distant mets are not an automatic. I had 10 nodes removed all negative, but I had EPE, SVI and +margin at base all of which are poor prognostically, since I probably have PCa in the prostate bed. HT is the next step for me with SVI, then RT. I'm age 70 and am recovering from shoulder replacement surgery, so PCa has sort of been my secondary concern for now. Like you, I will see how I react to HT and take one step at a time. I plan to kick PCa's ass until I'm tired of kicking! Good luck!
Bob
Posted 3/5/2014 4:27 PM (GMT 0)
Stephen. Your post sounds hauntingly familiar to me. Look at my sig. As others have said,its a little early to be trying to figure this all out. Another psa test or two will give you a better idea.
I felt the same way 4 and some years ago. Its the fear of the unknown. I have been thru most of the tx's. Just finished Provenge a few weeks ago. Still on Ht(Lupron). I can say in my situation that my diminished quality of life is still very rewarding and I have adjusted to what it is. I am amazed at how the human body&spirit adapts to challenging situations.
I'll take this life any day. Keep us posted. From Beautiful Jamaica...tom
Posted 3/5/2014 10:08 PM (GMT 0)

Tall Allen said...
Your conclusion that there are distant mets is unwarranted. Distant mets are less likely with your clean margins and clear lymph nodes. The first place prostate cancer travels is typically the prostate bed, and your extraprostatic extension (pT3a) suggests that that is most likely what has happened. It is likely your RO will suggest that the next step would be salvage radiation of the prostate bed, probably with a total of 6 months of ADT, starting 2 months before the radiation.

- Allen

This is exactly what I was thinking, zap the prostate bed with some RT and your could be done with the cancer. Many guys in this forum have had SRT and no recurrence. I have met some of them in person. This is not the time to throw in the towel and give up.
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