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Do 3 rises in a row after IGRT radiation mean you have a recurrence?

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Posted 6/30/2014 1:38 PM (GMT 0)
Just had my third rise in a row after finishing IGRT radiation treatment.

I remember a quote by John T saying that if you have 3 rises in a row
you have a recurrence. Never known him to be wrong.

What should be my next treatment now? Should I start on Avodart
and/or Casodex plus Lupron?

What have any of you done after having 3 rises in a row following
your IMRT/IGRT treatment?

PhilC
Posted 6/30/2014 1:57 PM (GMT 0)
Update in my signature....didn't have the date of my
last PSA test for some reason.

PhilC
Posted 6/30/2014 6:39 PM (GMT 0)
That is a worrying trend. What has your doctor said about it?

Looks like HT is in your future. I've not the the HT myself but I hear a number of guys starting with lupron.

Sorry you have to go down that road.

Andrew
Posted 6/30/2014 8:45 PM (GMT 0)
When did you stop the Proscar?

There is a definition from ASTRO that 3 rises can mean relapse but it's not set in stone. I asked the question about the Proscar as it does have a known affect on PSA.

Given that your original PSA was 164 it is more likely than not a relapse. When you get ready to decide how to proceed you may look into a few clinical trials that are being conducted. Ask your doctor about trials.
Posted 6/30/2014 9:27 PM (GMT 0)
How much of the PSA rise could be from higher T after going off of Lupron? Or how much of PSA nadir would be from Lupron?
Posted 7/1/2014 12:41 AM (GMT 0)
InTheShop, Just got the PSA and am scheduled to see the doctor in July.

Tony, Stopped the Proscar when I started the IGRT but continued the Casodex right up to the end of IGRT. What is the known affect of Proscar on PSA that I should be concerned about? That is a great BioSketch you have! Since you are highly educated in prostate cancer why is it that I reached my nadir right away and other men on HW say their PSA continues to go down for up to 2 years after IMRT/IGRT and therefor don't reach a nadir until much later?

robertC, Wish I knew the answer to both of your good questions.

Geez, I sure hope I don't have to go back on Lupron. Just starting to get more energy and am now noticing attractive females.

PhilC
Posted 7/1/2014 1:46 AM (GMT 0)
They discarded the old "3 in a row" definition of biochemical recurrence because they found it was not prognostic of clinical recurrence. The current definition is "nadir+2," so you have a long way to go before you start reacting. Remember that you had ADT artificially suppressing your PSA for awhile and it takes awhile for radiation to bring your PSA down. Bounces like yours are really very common, and seem to predict an even better outcome than a no-bounce scenario.

- Allen
Posted 7/1/2014 2:32 AM (GMT 0)
Tall Allen says:

"They discarded the old "3 in a row" definition of biochemical recurrence because they found it was not prognostic of clinical recurrence. The current definition is "nadir+2," so you have a long way to go before you start reacting." What a relief it is to hear this! So if/when I get above 2.06 I will have a biochemical recurrence, right?

" Remember that you had ADT artificially suppressing your PSA for awhile and it takes awhile for radiation to bring your PSA down."
It has been almost exactly one year since the end of my radiation.
Shouldn't the radiation be bringing it down by now? If not, how long approximately does it take for the radiation to begin bringing it down?

"Bounces like yours are really very common, and seem to predict an even better outcome than a no-bounce scenario." This is really great to know. Don't know how you know all of these facts about prostate cancer, but I am certainly glad you do! Sincere thanks! You have given me great relief from what I thought was horrible. Now I can sleep tonight.

PhilC
Posted 7/1/2014 2:53 AM (GMT 0)

PhilC said...
So if/when I get above 2.06 I will have a biochemical recurrence, right?

If confirmed, yes. But remember that a biochemical recurrence is not the same as a clinical recurrence, which can only be confirmed by a biopsy or other evidence of progression.

PhilC said...
Shouldn't the radiation be bringing it down by now? If not, how long approximately does it take for the radiation to begin bringing it down?

It often takes several years. Mine is still slowly drifting downward with minor bumps after 3 1/2 years. You still have a prostate producing PSA, so it never goes down to undetectable, even though the cancer cells are dead or no longer viable.

I hope your RO told you all this when he gave you your latest PSA. I hope you can improve your communications with him.

- Allen
Posted 7/7/2014 1:33 PM (GMT 0)
Tall Allen said..."I hope your RO told you all this when he gave you your latest PSA. I hope you can improve your communications with him."


I didn't travel to Mayo to get the PSA test. Mayo mails me a BLOOD TEST KIT which I then take to the local hospital's lab. At the lab they draw blood and send it back to Mayo (with a freezer bag inside) by Federal Express. I then get my results both by letter and by going to the Mayo's website and then to my account.


Most of the RO's work is done by his staff. You hardly ever get to talk to him directly.
You give the staff person your request and they then discuss it with him/her.


The letter Mayo sent me said that they are 'concerned' about my increasing PSA. They then say that as of now I should wait another 6 months and we will do another PSA test and see if they think I should do something if it increases.

PhilC
Posted 7/7/2014 4:14 PM (GMT 0)

PhilC said...
You hardly ever get to talk to him directly. You give the staff person your request and they then discuss it with him/her.

I'm barely exaggerating when I say that telephone conversations with a doctor belong to the last century. At most tertiary care centers, most communications with doctors are via email. I'd be surprised if that were not true of Mayo. Those websites such as you mentioned usually have the capability to post questions as well as get messages. Your question at the start of this thread seems like a good one for such an email exchange. Your doctor is there to address your concerns.

- Allen
Posted 7/8/2014 4:17 PM (GMT 0)
Phil,

You are asking a question that apparently there is no simplistic answer to. Each if our cancers, depending on where it is, how the treatments affected it, medications, etc., react in different ways on their own timetable.

I have researched it on Google and have found varying answers. There is some discussion about the bounce phenomena. Some say it is mainly a Brachy response, others say it occurs with all types of radiation.

My PSA dropped after IGRT, and then stated to rise. Then it started to fall again. I am awaiting my next test to see if the downward trend continues.

I have just decided to adopt a wait and see attitude. We have guys on here who had PSA's rise to 100, and it apparently has not affected their treatment plans, or health status.

Good luck to you.
Posted 7/14/2014 1:24 PM (GMT 0)
Tall Allen said: "I'm barely exaggerating when I say that telephone conversations with a doctor belong to the last century. At most tertiary care centers, most communications with doctors are via email. I'd be surprised if that were not true of Mayo. Those websites such as you mentioned usually have the capability to post questions as well as get messages. Your question at the start of this thread seems like a good one for such an email exchange. Your doctor is there to address your concerns."


Having lived most of my life in the last century I plead ignorance. Thanks for informing me on what I SHOULD be doing. However we old guys still learn a great deal here on HW from educated men like you.



goodlife said: "You are asking a question that apparently there is no simplistic answer to. Each if our cancers, depending on where it is, how the treatments affected it, medications, etc., react in different ways on their own timetable."



So it is pretty much impossible to go by what other men's prostate cancer has reacted to treatments. For me it is confusing. But what other ways are there to figure out your outcome to your chosen treatment?


PhilC
Posted 7/15/2014 3:22 AM (GMT 0)
Phil,
I gave you a simplistic answer to a complex question. Of course we can gather some general info from other men's experience, but it is my opinion that I have to figure out what my PC is doing. I do that by watching it like a hawk, charting all my test results, even repeating PSA tests when I get unexpected results.

At some point, I had to determine that I had a definite trend in PSA readings, and decided to pull the RT trigger even tho my PSA was only .06. Now as I watch it, I am watching to see if I have another upward trend. It went down to .02, then rose back to .08, and then back to .06. My next PSA will help me in determining what the trend is. My PC is a G9, which also makes the behavior unpredictable.

I guess for average G6 or 7, there may be more predictable behavior, but for some, the results are somewhat unique.

Good luck to you.

Goodlife
Posted 7/15/2014 3:28 AM (GMT 0)
The "rule" for BCR pounded into me is three rises of any amount beyond a floor of 0.2.

TA may have more recent knowledge. I am ancient history, being 5 years out (in a week) when I had a max life of three years.
Posted 7/15/2014 3:40 AM (GMT 0)
142,
You're talking about recurrence after RP or after SRT after RP. The OP was asking about recurrence after original RT. Two different definitions are used.
- Allen
Posted 7/15/2014 3:49 AM (GMT 0)
After I read through the whole thread, my Lupron-addled brain responded with what it knows.

Correct, for RT it is based on nadir after RT as an initial treatment.
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