Time to move on?

I had radical prostatectomy (da Vinci) in Feb 2010. All went well. My PSA was <0.1 when I tested it in 2011, 2012, 2013 and 2014. I didn't test it last year and I've just booked in for a test this month.

Now I'm wondering - if this is also <0.1 - whether to call it my last.

I can't find any reference to probabilities of recurrence after several years clear. I'm guessing any doctor will tell me to carry on with the testing every year, for as long as I'm here to be tested. But I'm the kind of guy that would rather say 'let's call it quits and move on'. I hope this doesn't sound smug or cavalier in any way. I just want to kiss goodbye to an episode in my life that I'd rather put behind me.

Are there any references out there as to probability of recurrence over time?

I have read of recurrences after 20 years but that is extremely rare.
Any primary provider could order the blood work so would continue via that route.

I had an 89 year old friend who had a recurrence on the 6th year, but he was an RT if it makes any difference. He died a few months after recurrence, but not from PC. Several folks wondered if the treatment for recurrence contributed, since he went from doing fine to in the hospital shortly after treatment was started. and treatment was stopped and he rallied for a few months before dying. Then again, he was also 89 year old and just fell dead when he got up to go to the bathroom.

But I am sure recurrence can happen after 5 years, but probably pretty unlikely especially with low risk. You were a 7? Here is a little study, FWIW, on Gleason 6 or less with about a 2% BCR rate(but BCR is not = to clinical advance or mets, obviously):

www.medscape.com/viewarticle/748658_4

Somebody said...
There is a paucity of information in the literature regarding outcomes following intervention for disease recurrence in men at low risk for BCR. Hernandez et al.[15] studied a cohort of 2526 patients with pT2, Gleason 6 disease and negative surgical margins after RP. Tumor volume information was not included in the selection of the low risk cohort and men with a preoperative PSA >10 were included. On the basis of initial review of the surgical specimens, 36 (1.4%) of the low risk cohort developed a BCR. The surgical specimens were re-reviewed by a single pathologist, and 25 of the 36 recurrent cases were upgraded and excluded from the low risk cohort. We did not have a single pathologist retrospectively re-analyze our low risk group.

We feel our low risk cohort is more generalizable to the urological community. Of the remaining 11 (0.5%) low risk men who recurred at 5 years follow-up, 4 underwent SRT, and all developed undetectable PSA levels. The criteria for recommending SRT was not described nor was the fate of the seven men who did not undergo SRT.

At a mean follow-up of 5 years and with up to 10 years follow-up, men in our cohort with low risk prostate cancer had an observed BCR rate of 2%. Our rate of 2% is consistent with the Kattan nomogram and the Hernandez et al. study based on the initial pathological review.

Post Edited (BillyBob@388) : 2/3/2016 8:46:13 AM (GMT-7)

I think the odds of this becoming an issue for you in the future are quite low. Then again, the work involved in getting a PSA test is also quite low. Only you can make that trade-off. Do you get regular physicals that involve bloodwork? If so, that might be a less intrusive way to get your PSA...

GooseDrankWine said...
I'm going to stick with the annual test.

I really do think that is wise.


Just for a reference point from someone else in nearly identical shoes as you, I was also diagnosed with favorable intermediate risk PC (3+4; moderate PSA, below 10ng/mL, and only a few cores positive). I also had surgery, but a year or more before you. Negative margins and no EPE on my post-surgery pathology report, and undetectable (less than 0.1ng/mL) PSA since then. I probably never needed an aggressive treatment to begin with, but that's another story for another day.

So it is noteworthy that our cases are generally similar.

I now have an annual PSA test as a part of my annual physical examination (which men our age should all have!!). The physical is done by my internist/GP, and then I email my urologist/surgeon's office with the result (they requested to continue to be informed to track my case). This takes essentially no extra effort on my part (with the exception of the one email to the surgeon once per year).

I believe I will never have to deal with PC again—and to directly address one of your questions, the probability is very low—but I will continue with the PSA test until, and if, I reach 70 at which point I will discontinue if nothing has shown up. It just seems like the common sense thing to do.

Consider talking to your surgeon about doing something similar to what I do...to help keep it simple.

best wishes...

Post Edited (JackH) : 2/3/2016 8:37:44 AM (GMT-7)

shouldn't running your stats through a nomogram tell you the possibility of recurrence.

If I remember right I used one from Sloan Kettering and it the chance of recurrance.

https://www.mskcc.org/nomograms/prostate/post-op

It's only $40 for a PSA test at Labcorp, ordered online through privatemdlabs.com, including the 15% discount code, which is given on their email newsletters.

For $40, why not? You don't even have to go see the doctor. Better safe than sorry!

Goose, there is an old and famous quote (and debate about who said it) that goes:

"You may not be interested in war, but war is interested in you."

I think that the same warning applies to cancer. If you see a PCP every six months, then just ask for the psa test when they take your blood. If yearly, same thing. You have little ($40) to spend, and much peace of mind to gain. Like RobertC noted above, there are a few cases of PCa reoccurring 15 years later. Why take that chance?

quotes.lifehack.org/quote/yogi-berra/it-aint-over-till-its-over/

Current PSA DEC 2015 0.08