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Conundrum on PSA

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Posted 11/5/2015 7:52 PM (GMT 0)
Ok, it has been two years since my robotic surgery. The first PSA was <0.1 and then it has been 0.1 for the following two years, until three weeks ago it was 0.2. So I started my salvage radiotherapy. Right before I started the radiotherapy I got an ultra-sensitive PSA and go the results today, it is 0.12, which is below the threshold of 0.2 for radiotherapy. Both were Quest Labs tests. My oncology urologist said I should continue the radiotherapy.

I am leaning towards continuing based on positive surgical margins.

Any thoughts out there?
Posted 11/5/2015 8:27 PM (GMT 0)
Many think the new starting point should be .03. .12 would certainly be past that threshold.
Posted 11/5/2015 8:57 PM (GMT 0)
PSA looks to be increasing slowly which is a great sign . Some say the sooner the better for adjuvant SRT, but there is no consensus.
Bob
Posted 11/5/2015 9:11 PM (GMT 0)
Newer research says, .03 for SRT, so I'm with your docs - get it done.

Andrew
Posted 11/5/2015 11:02 PM (GMT 0)
It sounds like you have become a slave to a number.. But with positive margins and the fact that you have begun treatment, things could get confusing if you stopped now...
Posted 11/5/2015 11:18 PM (GMT 0)
i THINK that by considering the positive margins in your decision making process, you are proving yourself to be very wise.
Posted 11/5/2015 11:43 PM (GMT 0)
Yes, i am leaning to continue the radiotherapy. I will meet this Monday with the radiation oncology doctor to answer my concerns.

My concerns even though they are low includes future problems such as potential incontinence, ED, rectal problems, future secondary cancers caused by radiotherapy, and possible problems of abdominal surgery or hip replacement years from now if need.
Posted 11/6/2015 1:35 AM (GMT 0)
I know it is a difficult decision to make. I pulled the trigger at .03 and I did not have postive margins. Hopefully if you go forward, it will be a faint memory in a few months with ver y few side effects. Take care and keep us posted.
Posted 11/6/2015 2:57 AM (GMT 0)
With all the specifics in your case,even a positive margin of a cancer that is known to rarely survive out side the womb, a definite no on the rt. You sense this in your heart. you know my journey...have some faith. Do you honestly think it will make a difference in your mortality if you waited even to double digits. Come on listen to the force Luke
Posted 11/6/2015 3:10 AM (GMT 0)
LA, I had a similar issue. We used .1 as the trigger and when I hit that I planned SRT. I got another PSA test on the Friday before our scheduled live start on Monday and that number was .07, which was below our self imposed target. Texted the urologist and the RO and decided to stay the course for a couple of reasons. The first being the recent data on .03 as the new target and after that I just felt that the timing was right and I was mapped and ready to go and PSA was trending up and to the right even though these are small numbers. Oh, I had a microscopic, <1 mm, positive lymph node that significantly increases the risk of bad things.

Best of luck with your decision and look forward to seeing future updates.

Luther
Posted 11/6/2015 11:48 AM (GMT 0)
Since I had positive margins and SV involvement I went in for adjuvant radiation 3 months after surgery. The side effects aren't that bad, especially compared to a recurrence.
Posted 11/6/2015 11:16 PM (GMT 0)
My oncology urologist (OU)called me this morning on the results of the MRI that I had to repeat this past Monday. Previous MRI had one sequence that was cut off before it got the prostate. What's a little extra gadolinium in my system without being charged for it! My OU reiterated that I SHOULD continue with the radiotherapy.

My pathology states positive margins on left and right apex is Gleason pattern 3 &4, and extensive surgical margin on left lateral lobe and is estimated at no more than 5 square millimeters total.

I have a meeting Monday with the RO and I want to address the concerns in the prior post. But based on my OU and pathology report I am still leaning towards radiotherapy.
Posted 11/7/2015 6:04 PM (GMT 0)
Hey Nick
To me it sounds like you are taking the prudent course of action. Zap it for a best chance of a cure.

Best of luck

Pat
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