Third blood draw coming up - always nervous

Hey, all. I am 8 months post-op, and my third post-op blood draw is this week. I always get really antsy when this comes, but I am wondering, based on my info below, if I am ahead of the curve for a Gleason 9:

2 month Post-Op PSA = < 0.019
5 month Post-Op PSA = .035

He still expects there is about a 50-60% chance of my needing radiation / hormone therapy, so I am prepared for that, someday.

My surgeon, after seeing the second draw of .035 was thrilled. Still undetectable, no cancer! Actually told me I am 'already a miracle' for Gleason 9.

Would others here confirm his assessment? Not that I question him, his name is Dr. Ingolf Tuerk out of Boston, has done 2,500 + robotic procedures. Should I feel good about going into my third blood draw?

My particulars are below.

Thanks and God Bless you all.

Ken

Diag 6/14/2015
Pre-Op:
PSA 9/2012 = 1.1
PSA 2/2015 = 10.1

Biopsy = 2 cores positive, 5% and 10% same region
Gleason 9 (4+5)

Surgery 8/5/2015 - DaVinci
Pathology:
1 lymph node out of 24 - very small number of micro cells, seminal vesicles

2 month Post-Op PSA = < 0.019
5 month Post-Op PSA = .035

Ken
I can confirm based on experience that your PSA trend is great. Mine is below . I was never undetectable after surgery. My JH surgeon was even thrilled with my .1 reading two months post op. Sadly, Gleason nines are practically guaranteed to need radiation and ADT after RP.
Bob

Hey, guys, sorry to go dark - on 4/1, my third PSA (8 months) came back at .108 - barely peaked over the .1. My surgeon definitely recommends radiation, but thinks the rise is slow, and has a hunch that it is contained in the prostate bed - residual cells from surgery.

He hooked me up with Medical and Radiation Oncologists at Dana Farber Cancer Institute in Boston for consults. Saw them yesterday - they both agree with Dr. Tuerk - likely that nothing is yet detectable outside the prostate bed, very good prognosis, feeling pretty god about things right now.

All three think I need to have another CT Scan w/ contrast and bone scan as a baseline prior to SRT.

One thing my surgeon said that differs from the two Dana Farber people, and I wonder what any of you think:

He would like to see me go through SRT WITHOUT hormone therapy, because at the end of it, the PSA will be pretty close to conclusive that the SRT in the prostate bed really did knock out the cancer cells, and hormone therapy may not even be needed until something pops up later. HE said that doing hormone AND SRT will automatically knock the PSA to zero, so I may never know whether the SRT took out the cancer.

One doc yesterday pointed me to a study, still in progress, that may point to better outcomes if you do both hormone AND SRT at the same time, but the test group was a lower grade cancer.

Thoughts?

Thanks for all the good wishes, and I am thinking of you all as well.

Post Edited (KenHayes) : 4/13/2016 7:18:38 AM (GMT-6)

Can you please explain the abbreviations in "and SRT will add nothing to TX but S/E" - What are TX and S/E?

Also, are you saying that if Mets found, do NOT SRT? A radiologist said the same thing yesterday, why would that be?

Thanks,

Ken

TX-treatment S/E-side effects. Because if mets are found it is systemic and salvage radiation will only kill cancer cells in prostate bed… HT wil do the same the bed and hopefully the the whole house. Don't get down if this is true… with proper TX you can live a very long life even reaching into newer tx's in the pipe line. TX's , like pca.. is increasing at an exponential rate..hopefully faster…I think it is.. If mets are not found …does not mean that they are not there. In this case you must make a decision whether to risk the srt withS/E in the hopes no mets are present and the srt gets all the cancer in the bed…hence a cure.. The odds with a gl 9 are small that with node/seminal + there are no mets systemically. Bring all this up with medicos… they know what I am saying. Cancer in prostate bed are not called mets{tho they are that plus. they are called localized cancer which can be eradicated with SRT. Hope fully others will respond to confirm, add to.. and/or correct my thesis. Hopefully staying on point without straw men{google} for meaning of straw men.

Ken, maybe you would be interested in the GETUG-AFU 16 phase III randomized trial trial which assessed the efficacy of RT vs RT+ADT on 5-year progression-free survival (PFS) rate in patients with biological relapse after RP. From that study RT+HT could be considered as the standard!

Salvage radiotherapy combined with limited ADT improves the 5-year PFS rate compare to radiotherapy alone 79.6% vs 62.1%
• The improvement is observed in all patient subgroups
• There is no significant difference in overall survival but the follow-up is still short
and therefore data will be updated in 5 years
• Toxicity is low and quality of life is maintained in both treatment groups