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0.03 ng/ml best indicator of biochemical recurrence (Johns Hopkins)

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Posted 9/25/2015 3:54 AM (GMT 0)
All,

Accidents do happen. A few months prior to my prostatectomy, I had a non cancerous lump removed from my left quad muscle. However post op I noticed that my left testicle (scrotum) was burned. On inquiry the doc admitted that they had a small accident in the operation room and the laser singed my scrotum. Except for the discomfort it healed within a few days!

crap does happen in the operating theatre.

To all those with unsinged balls, have a great day!
.
Posted 9/25/2015 5:06 PM (GMT 0)
As mentioned earlier, I mostly stayed away from this forum for several years. Now that I am back in active treatment I am reading again. One of the most interesting points are the studies posted by TallAllen at the beginning of this thread. Obviously my doctor and I did not react to my very early psa movement.

If I had some of this information I might have requested treatment earlier. However the past is past. I do wonder what long term implications this might have due to seeking treatment later rather than when I first moved to a psa of .03?

Upon later research, I see that my G8 cancer was very low volume and well contained. The study seems to look at men who soon after surgery began to show signs of change.
Posted 3/4/2017 10:49 AM (GMT 0)
Allan,

just got a 0.03 result from my psa test, up from < 0.01. as you can see in my profile i'm a 54 yr old high risk guy, after chemo, under adt and enzalutamide. latest scan (scintigraphy and ct) showed no new activity, all old lesions either no longer visible or sclerotic.

i'll wait for another month, do another psa but i want to be ready in case it does not drop back down < 0.01 - in which case i assume i have developed resistance to enzalutamide - would you agree?

your making the point that 0.03 seems to be a good cut-off value to act. so what would you do in my situation?

- local radiation in case a choline pet scan shows some local activity?
- radium 223 (that's what my oncologist would prefer if a choline pet shows activity in a bone, as this would be a systemic approach)
- psma lu 177 (i live in switzerland, could go to munich for that)
- try abiraterone acetate (although there seems to be a lot of cross resistance with enz)
- more experimental: olaparib (histology of my prostate has shown a BRCA2 mutation)
- other options (e.g. platinum based chemo)?

thanks for your thoughts,

m.
Posted 3/4/2017 4:02 PM (GMT 0)
I am having a hard time understanding the difference between the first and 4th bullet point. It seem like there is some overlap. I likely an missing something
Posted 3/4/2017 5:34 PM (GMT 0)
Madagascar_63-

I should have made more clear that this thread is about recurrence after first-line prostatectomy only. It does not at all apply to men in your situation. No, I do not agree at all that you have shown any indication of resistance to Xtandi-- in fact, you are having a great response to it! I hope that continues.
Posted 3/4/2017 5:44 PM (GMT 0)
Jack & Diane-

6 weeks is very early to test, but I know some do it. You can certainly wait for 12 weeks for the uPSA. I sense a lot of anxiety from you because you are worried about all the things that might happen. It is much better to focus on what is than what might or might not be - there is no "preparing."

Right now, Jack, as far as you know, is cured. There was was a tiny bit of Gleason 3 at the margin which will probably never do anything. There is no indication for adjuvant radiation and no need to visit an RO. Take it as it comes.
Posted 3/4/2017 5:55 PM (GMT 0)
raypaul-

The first two bullet points discuss how useful it would be to use a uPSA of 0.01 ng/ml as a cut-off. They show that 0.01 is too low - most men who only reach did not later have a biochemical recurrence. The next two bullet points discuss how useful it would be to use a uPSA of 0.03 ng/ml as a cut-off. Values over 0.03 were much more likely to predict biochemical recurrence, and values under 0.03 seldom went on to biochemical recurrence. Together they show that 0.03 is the better cutoff - it predicts biochemical recurrence and avoids adjuvant radiation.
Posted 3/4/2017 5:57 PM (GMT 0)

Jack & Diane said...
he told me not to try to get the ultra sensitive it would just cause me to worry.


In my opinion a good advice by your doctor. The clinical benefit of knowing the ultra low values ​​is not significant and do not outweigh the concerns it causes also in a patient with a good pathology report.
Posted 3/5/2017 12:27 AM (GMT 0)
The 64 thousand doller question... is what effect all this has on mortality from PCA? ....I maintain the biggest example of OT in the PCA world...is secondary treatment.... I have never seen a study here that the "guru's" didn't like...again...a study is a question asked...not a question answered... read and reap...
Posted 3/5/2017 12:52 AM (GMT 0)

Bololidat said...
The 64 thousand doller question... is what effect all this has on mortality from PCA? ....I maintain the biggest example of OT in the PCA world...is secondary treatment.... I have never seen a study here that the "guru's" didn't like...again...a study is a question asked...not a question answered... read and reap...

Wrong question. The point is that some patients will not have to suffer through radiation sessions (with their side effects) when the PSA action trigger is increased to 0.03.
Posted 3/5/2017 3:09 AM (GMT 0)
Im baffled by your post SR Sailor 'the psa trigger increased to .03???...trigger is decreased to .03 which is why I consider it to be OT...and/or really treatment too soon...that would mean s/e's from radiaton sooner than reall y needed...possibly...what you write says it is when treatment is activated with .03 thats an increas in trigger from something I suppose should be less in your view...and that will eliminate radiation s/e ...Im feeling dumber now that when I posted originally... but can handle...
Posted 3/5/2017 8:57 AM (GMT 0)
There is not one common trigger point that fits all.

European Association of Urology (EAU) Prostate Cancer (PCa) Guidelines said...
...Post-radical prostatectomy biochemical failure...However, it must be stressed that most patients within the low-risk subgroup have an excellent outcome even without any salvage treatment. Patients within the high-risk subgroup need early and aggressive salvage treatment

Posted 3/5/2017 4:06 PM (GMT 0)
"There is not one common trigger point for all" agreed...as well as the EAU statement...generally speaking...I suppose the other question would be then...how do you define the last sentence in their statement specifically...you cannot...which is where studies come in...questions in the guise of statements counter pointed by other questions{blah blah blah}...to get the final answer...{there is one you know}...then finis...problem solved...next problem...next study{question} Its called a scientific method or dialectic...there are no boundries between methodology of thought...in reality thought creates methodology from nothing at all...kinda like Air Supply's..."Making love out of nothing at all"...Studies are always needed as is pure dialectic of argument{court of "law"} Its what we have...I "merely" caution a rush to judgement on any issue as it is the solitary individual{no surrogates}{they only recieve transfered responsibility and lessen guilt} who must stand in the gap of their own doubt and create... Yea I like that...yep.......all humility is self serving tho not always purposely so...'serve in heaven or reign in hell' paraphrase of Milton...no not Berle........

Post Edited (Bololidat) : 3/5/2017 9:11:41 AM (GMT-7)

Posted 3/5/2017 5:22 PM (GMT 0)
After my post RP pathology was so ugly, I used the old JH maxim of two consecutive PSA readings of .2 to trigger SRT. I don't suppose it mattered that I didn't have adjuvant RT because the horse(s) had left the barn before I even learned I had PCa. Maybe years before. I'm just one of the unfortunate 10%. 🤣

NB: latest PSA on Feb 22 was 1.1...climbing fast! Waiting for axumin scan.

Bob
Posted 3/5/2017 6:12 PM (GMT 0)
I understand the study but I think I'm confused by the discussion.

Wouldn't engaging HT/SRT at .03 mean overtreatment by 23% ? My RO encouraged me to wait when I was .07 for one more confirmation. He has a handful of patients with similar pathology as mine that leveled off at .07 and have been there for years. While it wasn't likely I would level off he didn't think I would be losing any curative potential between .07 and what turned out to be .09

Wouldn't this level (23%) of overtreatment be unacceptable ?
Posted 3/5/2017 7:56 PM (GMT 0)
Shouldn't we have an active surveillance attitude for low risk patients with BCR to avoid overtreatment with SRT? I read these conclusions:

European Urology said...
When patients do not have adverse risk factors on their prostate specimen, the risk of dying from PCa when they experience a BCR is reassuringly very low, 1.3% within a median time of 11.5 yr.


European Urology said...
If patients do not have adverse risk factors on prostate specimen requiring adjuvant treatment but present a BCR and are not too anxious about PSA rise, they possibly do not have to endure the side effects of EBRT or ADT.

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