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Posted 6/20/2015 1:56 AM (GMT 0)
Hi, just finished 39 sessions @ 1.8 for 70.2 total. And of course I got a PSA test 45 minutes after my last session. PSA results this early are not generally considered to be prognostic, yet. I've been tracking PSA every 4-8 weeks since RP and want to have the data points for my own personal data set. The last time I checked, my insurance company pays a total of $23.75 for each PSA test after negotiated discounts so not a huge drain on the system.

So here's the recent trend data. Note that I selected .1 as the SRT trigger point versus .03 or .2 or .4. I had a positive lymph node, just slightly positive and that made me choose .1 versus .2. .03 was too low, .4 too high, yada yada.

19 months post RP I hit a .1. Confirmed the .1 a week later. Three days before starting SRT the number dropped to .07 but I continued the path to SRT. At the mid-point of SRT at 4 weeks, PSA was .05 and today at the end of SRT at 8 weeks it is .03.

Next test in 4 weeks and then probably every 6 months since I'm most likely not going to have additional therapy until PSA hits 4.0. Of course if a magic wand cure comes online, I'll take that path.

Best,

Luther
Posted 6/20/2015 3:01 AM (GMT 0)
I finished my SRT several months ago, have decided not to get a PSA for awhile. So far I'm doing fine with that decision. I'm wondering why 4.0 is a trigger for you for further action, and what would that action be?
Posted 6/20/2015 3:55 AM (GMT 0)
Phenom, I've now completed primary and secondary therapies and I won't be doing HT so I'll need to reach a point where a scan will show a hot spot that can be radiated. Don't know if that's 4.0 or 20 so 4.0 is my current cutoff

I'm following Shabba Doug's progress and can foresee taking that path over HT. I'll need a prognostic sign before the next step for sure.

Also hopeful that SRT gives me a few years before needing another therapy and a magic cure becomes available.

Best, Luther
Posted 6/20/2015 4:02 AM (GMT 0)
Luther,
Good to hear you finished that.

Difficult to predict the future, but here's hoping this knocked it out.

Andrew
Posted 6/20/2015 8:59 AM (GMT 0)
Luther, my mets showed up on a standard bone scan at 2.81, you could maybe drop your trigger down to 3.0 if you're comfortable with that. Congrats on getting through your SRT!

Cheers, Doug
Posted 6/20/2015 11:27 AM (GMT 0)
Doug, thanks for the note. I've been following your progress and am heartened to see your PSA staying down. Do you have any symptoms from mets? Pain etc?

Andrew, thanks, I asked for the 30 year SRT extended warranty. Still waiting for the quote.

Luther
Posted 6/20/2015 11:42 AM (GMT 0)
No, nothing now Luther since the Orchi. Those symptoms won't start until after I become castrate resistant, somewhere down the road.

Cheers, Doug
Posted 6/20/2015 12:06 PM (GMT 0)
Doug, do you have the same timeframe for potential resistance as HT or do you get a longer estimate? Also, did you have a scan before RP?

Looks like I will reset the PSA rise trigger. Of course like everyone, I'm hoping for a long PSADT and rapid advances in technology over the next few years.

Luther
Posted 6/20/2015 12:14 PM (GMT 0)
Luther that's a loaded question, we're all different. I would like to think it's a bit longer but I don't think there's a definitive answer. My only bone scan was after RP.

Cheers, Doug
Posted 6/20/2015 12:48 PM (GMT 0)
Thanks Doug, I hope to someday get a PSA <.02. Congrats!
Posted 6/20/2015 4:36 PM (GMT 0)
Luther, congrats on finishing. Did you have radiation to prostate bed and nodes. Also, have you experienced any side effects.
Posted 6/20/2015 5:10 PM (GMT 0)
Luther, you had SRT on your pelvic LNs too, right?

The point at which any mets become detectable depends on 3 factors:
• PSA
• PSADT (which, as you know from your own history, can fluctuate with too-frequent observation)
• The type of scan used

There's really no point in setting an arbitrary value for PSA now. You have to factor in PSA kinetics and the type of scan available to you.

The problem with tracking PSA now isn't cost - it's in knowing what it means. At this point you still have PSA from dying PC cells - I'm sort of surprised your RO is tracking it this soon, let alone during SRT. The best you can do is ignore it for a few months and then track it every 3 months.

- Allen
Posted 6/20/2015 6:47 PM (GMT 0)
Congrats Luther, I finished my SRT in DEC and my PSA Continues to drop, will have it checked again next month and follow up with my RO in AUG all the best!
Posted 6/20/2015 8:16 PM (GMT 0)
Hi Rob, I received 25 sessions to the pelvic lymph nodes and prostatic fossa and 14 sessions to the prostate bed over the course of 39 total session and eight weeks. I had one small focus on a lymph node that may have been a clue to where the PSA was coming from.

No real side effects yet but RO says I can still experience proctitis and cystitis for 6 months to a year from treatment and that the lack of SE's at this point doesn't lessen the chances of having them later.

I used two Immodium caplets and I needed to pee with more urgency 4-5 times. No fatigue that I'm aware of and of course that's all through today, one day post treatment.

Thanks,

Luther
Posted 6/20/2015 8:40 PM (GMT 0)
Hey Allen, thanks for the note. Like the three criteria you list. I did pull the 4.0 from my back pocket.

The RO didn't ask for the PSA test at the midpoint or the end of SRT, that's all on me. I did get the RO to hazard a guess at the end of treatment and his guess/wager was .03, right on. Looks like I have to pay for treatment now!

I'm not easily flummoxed by numbers so having a series of PSA results fits my personal need for data and yes PSADT for PSA <.1 is a bit of a cluster. I did a lot of prep work for SRT (and RP before that) so perhaps I'm a little more persistent to look at intermediate trend results. I always ask "what can I do to assure the best results from this treatment?". Heck, I even practiced lying flat and still for 10 minutes!

Best,

Luther

PS - I'll post in another thread, but I did boost my cardio 2-3X and according to my log books I ran 57 miles @ 9 minutes or so over the course of eight weeks of treatment. Not sure 9 minute miles qualify as running but it's what works for me. I think you had recommended increased cardio for radiation patients in another thread and I'm on it.
Posted 6/20/2015 8:45 PM (GMT 0)
Paul, thanks for the note. Looks like you're heading in the right direction and should reach zero before me! How the new hardware feeling? When do you activate?

Best,

Luther
Posted 6/20/2015 9:20 PM (GMT 0)
9 minute miles is better than I could do, so it sounds like running to me. Did you experience any fatigue, or did the running help prevent that for you? Certainly, the increased oxygenation is a big benefit.
Posted 6/20/2015 9:31 PM (GMT 0)
Hi Allen, no fatigue from SRT, but again, yet. I also cleaned up my diet and thanks to the good folks at Costco and LaxAClear become extremely "consistent" in bowel (and bladder) prep.

Not sure about the end results of SRT but felt great during the eight weeks of treatments. If Logo asks, those were 6 minute miles. I'm a slacker.

Luther
Posted 6/21/2015 1:44 AM (GMT 0)
Luther,

Yes doing good, not sure the exact activation date but it will be in about another five weeks. Getting better ever day, kind of feels weird with the pump in my nuts, and the bulb that is full has quit a bump out from being full so that my pan pressure or pain point. Over all doing much better than I anticipated thanks.
Posted 6/21/2015 3:00 AM (GMT 0)
Had Robotic in Jan 2012, PSA been from 1 yr.. .02, 2nd yr .04, 3rd year .17, three weeks ago 1.1, had bone scan this week and MRI, MRI was clear, all Lymph Nodes looked normal, prostate bed looked fine, Bone Scan showed a small spot on hip, Radiologist determined it to be arthritis, DR going to have a Cat Scan to verify it, hurt right hip a few years ago. So not sure why 1.1 PSA, Dr says i should have Radiation theraphy, in case any left over tissues from op, but after three years am surprised. Not sure if Radiation needed or not.....Any comments if anyone has been through this scenerio......Thanks
Posted 6/21/2015 3:04 AM (GMT 0)
Running is if during the forward movement both feet are in the air at the same time…anytime. 6min, 9min, ich mach nix. Ive discovered over the years, as you age it all feels the same any way. When I was in my late fifties I was running at a clip I felt pretty good about and noticed I guy across the street in the same direction running and commented to my self…wow he looks really slow. I said this and then noticed that he passed ahead of me and he still looked really slow. Theres a truth there somewhere. Congrats on completion of your treatment. ps 9min miles are very good for a 61 y/o man. I run rarely now…not quitting,just retired. too easy to screw something up somewhere and hinder my other activities that keep my heart lung machine machinating. Shucks thats a real word…no spellcheck involvement. Im staring to scare myself again… Oh the stories I could tell… "truth is the best lie" in the counterintuitive way that no one will believe it. "They think they know…they think they know" Walt Whitmen
Posted 6/21/2015 3:57 AM (GMT 0)
woodyt,

Your PSA of 1.1 and its rapid rise means that you have had a recurrence of your prostate cancer. Because your PSA is already quite high, it may already be too late to treat you with salvage radiation, but unless you are elderly with other diseases that are likely to kill you first, it's worth a try, isn't it?

- Allen
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