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Can you calculate PSADT with UPSA no.s?

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Posted 1/9/2016 2:18 PM (GMT 0)
Well, darn. Latest PSA jumped up to .108 at the end of Dec. 2015. Here is my trend
7/14-.034
9/14-.023
12/14-.041
3/15-.044
6/15-.049
9/15-.071
12/15-.108
I know most pull the trigger at .03 or .05. Or with 3 consecutive rises. My hesitation with SRT and/or HT is trying to figure out if it is worth it for such a low chance of cure with my stats.
Posted 1/9/2016 3:45 PM (GMT 0)
with a G9 post op, in your place, I'd be having a conversation with my medical team about further treatment.

It's possible that there is some left prostate bed that SRT will zap out of there.

Andrew
Posted 1/9/2016 4:57 PM (GMT 0)
Startech - I had a gleason 7 and have rising psa numbers similar to and have coincidentally reached the same 0.108 psa in December!! It has been nearly 3 years since my surgery. I recently had an MRI at Sloan KEttering just to rule out any abnormal issues and am pulling the trigger and starting ADT hormone therapy in 2 weeks. I have read enough online, plus used the sloan kettering nomograms to see that beginning with ADT and then getting IGRT is the best approach, with cure rates of between 50 -70 percent is possible. My belief is that with undetectable psa after surgery and a low psa velocity, that the cancer likely remains in the prostate bed, and I am taking this one last shot at a cure. I urge you to talk to some more doctors to get some insight. In my case, I had 85% gleason 4 which is why I am treating this as if I had a gleason 8
Posted 1/9/2016 7:28 PM (GMT 0)
Well, you're right that PSADT is not validated for uPSA. Some docs think that a uPSA velocity of anything over 0.05 ng/ml/yr, which you certainly exceed, is an indicator of progression.

Since it's already been obvious to you for a while now that you are progressing, and you don't want to try salvage radiation, why do you ask? Are you trying to decide when to begin life-long ADT? I think most medical oncologists would use that rapid velocity or doubling time as an indicator to begin ADT. New data from STAMPEDE shows that docetaxel may slow it down if started early too.

If you haven't given up hope for salvage radiation, you have to talk to a radiation oncologist immediately. If it hasn't gone too far, it will soon.

- Allen
Posted 1/10/2016 12:01 AM (GMT 0)
Agree with TA, you need to do something. I'm doing docetaxel while I'm hormone sensitive, trials have shown that there can be an advantage in overall survivability. In my case I also wanted to see how I would react to chemo while I was "relatively" healthy, it's not too bad. Best of luck in the future!!

Cheers, Doug
Posted 1/10/2016 7:58 PM (GMT 0)
Thanks everyone. Why do I ask? Because I am trying to crawl out of denial and do the SK Nonogram correctly, which requires PSADT value.

It's the ole quality vs quantity conundrum in my situation. My closest friend feels I would not be able to handle the SE's of further treatment. I am not sure she is the smartest...
Posted 1/10/2016 8:00 PM (GMT 0)
Teddy, I will be watching your progress-best wishes.
Posted 1/10/2016 9:51 PM (GMT 0)
Startech,
There are nomograms for determining the likelihood of BCR, and for the likelihood of cure by radiation. The problem with waiting for a validated PSADT is that you increase the probability that SRT won't work by waiting. That's incontrovertibly been proven.

I think you may be better off talking to a radiation oncologist about expected side effects rather than your closest friends.

- Allen
Posted 1/11/2016 3:09 PM (GMT 0)
Thanks again TA, is there a way I can figure my odds of a cure with HT and SRT before I seek an Oncologist?
Posted 1/11/2016 5:15 PM (GMT 0)
I think all of the nomograms in my file are only predictive of biochemical recurrence given the pathology (like CAPRA-S, Briganti,), or they predict salvage RT success after a full blown biochemical recurrence (rising PSA>.2), and where valid PSADT can be calculated. These nomograms were created before we had the results of three randomized clinical trials proving that earlier treatment has better outcomes, and before we had analyses showing that uPSA can reliably predict biochemical recurrence.

I suppose you can use your best guess for the numbers you don't yet know. However, I strongly suggest you talk to a radiation oncologist. His estimates, given your own unique circumstances, are likely more accurate than any nomogram. Here are a couple of nomograms:

jco.ascopubs.org/content/25/15/2035/F3.large.jpg
onlinelibrary.wiley.com/doi/10.1002/cncr.23293/full (See figure 1)
Posted 1/11/2016 6:22 PM (GMT 0)
With a Post op Gleason of 9, I wouldn't hesitate to begin treatment. Not a doc, but everything I've read/heard says sooner is better.
Posted 1/11/2016 7:14 PM (GMT 0)
Star,
I've been watching your thread here and just want to offer support. I know it's a hard decision. ADT is tough to swallow. But it is very doable. .. especially when you're given an end date up front. As for the SRT, the chance for a cure shouldn't be overlooked, no matter what the odds. Heck, I made it through both... and I'm looking ok so far... and if not, I know i threw everything I could at it. No regrets.
Don't underestimate the feeling of hope a possible cure can add to daily life.
All the best, with the decisions. And positive thoughts. Any support i can offer... is yours!
Posted 1/11/2016 8:01 PM (GMT 0)
Thanks all. TA, Thank you for providing the links but I am confused. This looks like a nonogram for predicting BCR after prostectomy. My mathematical mind tells me that I should be at .02 by the end of this summer if I don't do anything. I am looking for probability of cure after HT and SRT for my situation.

BTW, I am already looking for threads that show what should be done to prepare for HT and SRT, along with what scans should be done first, if any. And how to choose a RO and facility.
Posted 1/11/2016 8:24 PM (GMT 0)
Startech,
No. Look closer. Those two nomograms that I provided links to predict survival (progression-free or biochemical recurrence) after ADT and SRT. The Stephenson nomogram (the first one) predicts 6-year progression-free survival after salvage RT. For the radiation dose, assume 7000 cGy. The Suardi nomogram, the second one, predicts 5-yr BCR after adjuvant RT - too late for you I know, but you are looking for a "feel."

Where in Texas are you? If you're in Houston, MD Anderson or Baylor would be good choices. If you're near Dallas, UT Southwestern has some very good ROs.

- Allen
Posted 1/11/2016 9:09 PM (GMT 0)
With G9 you might want to consider also adding Chemo. SRT with ADT and Chemo. At age 55 throw everything you can at the beast.
Posted 1/12/2016 2:43 AM (GMT 0)
We have talked about this before.

I view it all as a time thing. If I got 3 years out of surgery, can get 3 + years out of radiation, and another 3+ years out of RT, I get at least 10 years with a G9. I have never considered complete cure as a high odds deal. If a treatment has any odds of a cure, or a slowing of the progression, I figure it is better than laying down and waiting to die.

Hang in there buddy.

Goodlife
Posted 1/12/2016 5:25 AM (GMT 0)
Star tech

Sorry you have to deal with this again. Deborah Kuban at M D Anderson has outstanding predictive tools. I believe she is only involved with salvage treatment cases. I also think she helped develop nomograms for msk. She knows what she is doing. Good luck in you journey. I would not be waiting to get on with a decision.
Posted 1/12/2016 3:42 PM (GMT 0)
Thanks again everyone. My would be caretaker is the naysayer and I am thinking about making a serious change. So my predicament is somewhat odd. Is this something I can do on my own?

TA, I am in San Antonio if you would like to make a recommendation.

Goodlife, yes I remember our conversation and it is great to hear from you. Hope all is well up there!

Just to hear from others that may have passed on further treatment, if there are any on this forum, I want to start a new thread to get their thoughts also. I certainly don't want to upset those that came in to this terrible disease late, but there seems to be quite some success stories out there.
Posted 1/12/2016 5:30 PM (GMT 0)
Startech

Yes, there are good outcomes here. You also must take into account those that never report back and they are out there living life in long term remission or "cured". You must take charge of your own case, do what ever will give the most productive, long lasting results. That takes informed decision making knowledge. I am not sure that meeting others expectations (needs) are the same as seeking the most appropriate treatment for you. Unless there are some extenuating circumstances, it is important that you think of what is best for you and your future at this point. This discussion has been right on target. Your situation is not at a dead end, it seems as though you are barely starting the battle. You still have the potential to knock this opponent out!
Many men have been exactly where you are today, have a secondary treatment and move on.
Good Luck

Post Edited (Octorobo) : 1/12/2016 4:37:57 PM (GMT-7)

Posted 1/12/2016 8:03 PM (GMT 0)
Well, you're in luck! At the UT Health Science Center in San Antonio, you have Ian Thompson who is one of the world's foremost experts on the subject of salvage radiation after prostatectomy. He's a urologist, not a radiation oncologist, but he is highly analytic and knowledgeable on this subject, and if he believes treatment would be worthwhile, he will recommend a good RO to you.

Once again, don't delay in making an appointment as options change quickly. Talking to someone doesn't mean treatment - it doesn't have to be a slippery slope. You remain responsible for making the decisions because you have to live with the consequences.

If you talk to him, please report back on what he says.

- Allen
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