Post Op PSA

Becasue Gleason 9 is an entirely different kettle of fish. It doesn't make much PSA (thus you low pre-op number) and you really don't want to let it get ahead of you. My surgeon didn't care what my PSA did. As soon as my post-op report came back Gleason 9 with dodgy margins I was sent to a medical oncologist and a radiation oncologist to plan my ongoing treatment.

My adjuvant RT was scheduled before my first post-op PSA, based on an ugly pathology report.

Doug, sounds to me like the doc was thinking all along that with your stats additional treatment was highly likely hence the relatively low threshold to pull the trigger. In any case, I still hope for good news...

Jim

With high-risk patients, follow-up RT is almost a given and just for good luck you might as well throw in 24 months of HT as well. With G-9, you hit it as hard as you can with everything you have..

So why even bother with the surgery? Because it removes 98-99.5% of the cancer which makes all the followup treatments more effective since they have much less to deal with..And if you get lucky, surgery can get 100% of it, even in a G-9...

I have a hard time justifying SRT in my case, even before receiving the pathology report. My reasoning is that with my stats there is a high risk that there is already distant mets.

At the same time as the prostrate investigation another investigation was being conducted on my left lung for two questionable "spots". A PET scan with contrast was done and proved negative. The planned biopsy was cancelled based on size(difficulty in hitting it), location and PET results; follow up CT scans ordered at 90 day intervals to monitor. Further research informed me (and later confirmed by my Uro) that that the contrast used in my PET would not detect PCa. I realise that the two issues may or may not be connected but logic tells me to consider that that they are. The investigations are in two different cities, two different disciplines and am not convinced they're "talking" to one another.

Using the above (logic?) I see no reason for SRT unless it can be proven that any detectable PSA in the future is emanating from the prostrate bed only. HT would seem (to me) the route to follow, if required. In my case I think SRT would be more of an diagnostic exercise rather than curative measure; it would likely have to be followed by HT anyway. I personally do not want to subject my bladder, rectum etc. to potentially useless radiation. I'm using "HT" to cover all forms of treatment other than Radiation.

Pros and cons welcome on my reasoning would certainly be appreciated and respected.

Cheers, Doug

French_ Traveller,

I'm supposed to get my pathology next week and 1st post -op PSA in June, pathology may change that date. My next lung CT should be this month. Nothing has been said to me about the lung spots, two very close together, 28mm in size in total. Though they didn't say, I think the lung people deferred to the prostrate dudes; which makes sense to me. There has been no explanation of the lung spots given to me, definitive at least.

Regardless of my pathology, someone is going to have to make a very, very hard case for SRT before I consider it. This goes against conventional thinking but.......

Keep checking in and I'll this updated as I go. Remember these are only my thoughts based on MY logic. I'm certainly open to having it modified.

Cheers, Doug

Peter, there is a bit more to the lung storey. I was referred to the lung specialist after a CT scan. The Doctor was in in her early '60's and head of the department, so not a flunky. The day we met she was highly confident it wasn't "just a spot". That day(Thurs.) I was booked for a PET scan the following Tuesday, and a biopsy the day after followed by a booking for a stress test the next week for future surgery. Her and her staff clearly indicated an urgency.

I had to be admitted the night before the biopsy for blood work and prep. Around 20:00hr the nurse came in and told me the biopsy was cnx. I was told I had to wait until the morning to hear from the surgeon as to why. He showed up around 10:00hr and said the PET was neg, and tumors too small to ensure results. The Biopsy is X-ray guided. As stated above my lung has not specifically been checked for PCa.

Let's suppose... That my lung can be biopsied in the near future and it turns out to be PCa. Would radiation be the logical next step. Conversely if it's negative than RT COULD be back on the table.

I don't see the logic in SRT followed by HT when mets is highly suspected (Hypothetical at this point I know). I want a good knowledge base before the next step, if any, has to be taken.

Please give me your opinion on the logic. I'm pretty much on my own here and value all the input from the members here.

Cheers, Doug

Post Edited (Shaba.Doug) : 4/3/2014 11:07:51 AM (GMT-6)

Thanks Peter, guarantee you the lung issue is not going to be ignored. I don't know if radiation is used on the lung, next research topic probably. My Uro did say a full body MRI was on the horizon now that I think about it. I know the G 9 is nasty but I think I really need to see what is going on with the lung.
Cheers, Doug

Hannah,
The Uro told me PSA test after 3 mos and a phone call with path results after 3 weeks. I'm assuming that is the protocol here. At catheter removal I asked for a hard copy of the path report be mailed to me so I could have it in hand when discussing. That was one week ago.

about the pathology.

Suppose it come back + margin and/or lymph node seminal etc.
SRT, in my reasoning would be just about a no brainier, for a G 6,7 and possibly a G8. But, a G9 with suspicious lung masses is to me, a horse of a different colour.

Now suppose it comes back clean, all indicators that the PCa was organ confined, great; but, first PSA is >.03. SRT on the chance that some PCa was left in the prostrate bed? What about the lung or any other distant mets not diagnosed?

Ok, with either of the above scenarios I decide to do SRT. Subsequent PSA checks reveal a PSA rise. The lung, distant mets? Keeps coming back to G9 and probability of distant mets doesn't it?

My logic, right or wrong, tells me I have to be pretty confident that there is no obvious distant mets before I opt for a "Hail Mary" dose of radiation on the prostrate bed.

I think the bottom line is that I need a proper lung investigation, an appropriate scan, pathology report and, a PSA trend.

I don't consider myself naive I know there are many variables to consider. I'm trying to break this down into manageable bits. I've always taken the "evaluate and test" approach to problems rather than "test and evaluate".

The night before surgery I asked the Urologist what his "best guess" as I knew that's what it would be, was for the tumour to grow to its 32mm size; he said 2 to 3 years. To my way of thinking that's relatively fast. Just another thought in my metastic boat.

Anyway, hope I haven't rambled too much. These are just my reasonings put to paper, so to speak. I'm trying to be pragmatic rather than panicking. I hope sharing these with you are more of a help than hindrance. I firmly believe you/I will make the right decision for you/I. Your husband and I are in similar circumstances, could prove interesting.

I see you're in BC, that equates to a 9 hr time difference. I'm ahead.

Cheers, Doug

Thanks Peter, I understand what you're saying and like I said above I'm putting thoughts to paper. Remember, I have not spoken to an Oncologist or Radiologist. This ain't Kansas Totto.

My (new) Urologist seemed disgusted, for lack of better word, by the way I been treated by the initial dude. Again, I'm basically on my own and trying to form some sort of strategy. I'll be speaking with the Uro next week and see if we can get together for a good chat.

Cheers, Doug

Hannah,

A man's PSA scrore drops off somewhat gradually after surgery. It has a half-life in the body for one thing. If PSA productions stops completely in an instant the PSA reading will drop by half every two or three days. Another two or three days later the reading will be halved again -- one quarter the original. And so on. So that takes a while. And the starting point of this decline isn't necessarily the same as the man's pre-op PSA. During the operation to remove it the prostate gets poked and prodded quite a bit before it is disconnected and removed. Quite a bit of PSA can be released during surgery which adds to the time it takes for it to dissipate. Also, sometimes, if there are messy surgical margins, very small bits of prostate tissue may be left behind which is disconnected from their vascular supplies and will die away (hopefully). This tissue can contribute a bit of PSA while it is being eliminated. Any reading taken before about 8 weeks post-op is questionable.

As for three months being the standard. That's about as soon after surgery as you will ever actually do anything different based on PSA readings. There are things you do when you get the pathology report but if the pathology report is OK then the next decision opportunity is at three months or so when the man has at least started to heal.

Your husband's PSA test was at six weeks. That's pretty early. (My first one was at 7 weeks, also early). Your husband's PSA was low but detectable on that first test -- 0.044. (So was mine -- 0.01 which is the lowest detectable level the lab could report.) It won't surprise me if his next PSA test is undetectable. (Mine was).

Doug:

You got a lot going on. I would suggest that you also set up an appointment with a top-notch medical oncologist specializing in PC. Even if you have to travel, it might be worth the consultation. You are bringing up many good and interesting points, but I don't know if they are valid, invalid, or somewhere in between.

Mel