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bad psa result

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Posted 6/7/2017 5:05 PM (GMT 0)
I just got a bad PSA test result -- 0.05. That's up from 0.01 in late December and <.008 in late October. I think I will be heading for salvage radiation soon. I see my urologist on Monday, but obviously I'm not going to stop thinking about this for the next five days, so I'll ask you folks a few questions.
1. Do they usually use ADT in conjunction with SRT?
2. How many treatments are there with standard SRT?
3. Is SBRT an option for salvage radiation post-surgery?

Thanks!
Posted 6/7/2017 5:47 PM (GMT 0)
1. Addition of ADT to SRT improves outcomes but those studies was done with men with high PSA, maybe 10 times higher than yours.
2. 70 Gy in fractions of 2 Gy is common.
3. I don't think so, it would be experimental in clinical trials
Posted 6/7/2017 5:47 PM (GMT 0)
1. sometimes. Depends on your risk level. Higher the risk, it's often suggested.
2. depends, normally between 33 and 40.
3. no sure. Need TA on that.

I'd ask for a retest to confirm the PSA number and get over to an RO to discuss options.

and thinking about for the next five days isn't going to help.
Andrew
Posted 6/7/2017 5:53 PM (GMT 0)
Sorry to hear of your results, hope your PSA levels off or goes back down.

Gemlin and Andrew answered your questions. All I can add is I had 25 sessions @ 2.5, UW Madison Carbone Cancer Center, which has been shown to provide equal or better results with equal or fewer SE's. Might be something worth looking into. I was glad I didn't have another 14 sessions to go when I got to the end.

Hang in there - Jon
Posted 6/7/2017 5:57 PM (GMT 0)
fc
Any chance that 0.01 in December was from a different lab, was it the not the "ultrasensitive " test as your October test appears to be? In any case 0.05 seems very little to me , but I am in no means an expert.
Wings
Posted 6/7/2017 6:04 PM (GMT 0)
sorry for this news, Fiddlecanoe -

You might get more specific advice if you post a signature like those above (and below).

When my PSA started to rise 16 months ago I optimized diet and exercise. Perhaps it is helping delay SRT - then again, perhaps not.... You can see numbers below. My email is in my profile if you'd like details.

Wilderness.
Posted 6/7/2017 6:36 PM (GMT 0)
1. Do they usually use ADT in conjunction with SRT?

There is a survival improvement by using ADT, but it will depend on many factors, especially the radiation dose received, your pathology, and your PSA.

2. How many treatments are there with standard SRT?

about 35. Usually 1.8 or 2.0 per fraction for a total dose of about 70 Gy. Some believe it should be higher. UCLA and MSK are using 72 Gy.

3. Is SBRT an option for salvage radiation post-surgery?

USC has been running a clinical trial of that, and Dr King plans to do one later this year. At this point it's very experimental. There have been a few trials of hypofractionated SRT, reducing the number of treatments to about 20.
Posted 6/7/2017 6:57 PM (GMT 0)
Thanks for the prompt replies. They help with thinking about how I'm going to get done all the stuff I need/want to do over the next few months. I won't spend too much time worrying between now and Monday, in part because I'm sailing in a regatta in Annapolis this weekend. Sailboat racing does not allow time for worrying about other things.
Posted 6/7/2017 7:02 PM (GMT 0)
Enjoy the regatta - sounds like a lot of fun!

Kind of thing I wish I could do, but sadly I get sea sick just looking at boats, sigh ...

Andrew
Posted 6/7/2017 7:14 PM (GMT 0)
Fiddle, I seen the tall and smart one has weighed in so you have the answers. I simply wanted to tell you that I'm sorry for these results but wish you the best as you try to sort thru this.

Jim
Posted 6/7/2017 9:07 PM (GMT 0)
I used to have a signature. Let's see if I can make it reappear. Ta-dah! It's back!

There is always a possibility that the reading is a measurement error of some kind, but at this point I doubt it. In my second psa I lost the "less than" sign, which was a bummer. On the third it continued the upward climb, so the likelihood that it's a change in the lab or a lab error drops a lot.
Posted 6/7/2017 10:43 PM (GMT 0)
Fiddle, your questions have been answered, so I don't have much to add. Just want to wish you well and say I really hope this turns out to be a false alarm.

I'm in a similar situation although not quite the same. (3+4) negative wow, sv, and margins, BUT, my intra operative margin was positive and surgeon did additional resection to get me negative FINAL margins.
And I went up till the two year mark with <.02 PSA. At two years, I went to .02, then at two years 5 months I just went to .033 (diff lab, like you)
My Dr's NP said it could be the fact that it's a different lab, and also that he's seen situations like this where it goes back down, or more often, just levels off and goes nowhere. Let's hope that's the case for both of us.
I see your surgeon was Samadi, I used Tewari, his arch enemy LOL.
Posted 6/8/2017 1:22 AM (GMT 0)
...idolatry...lets get real lambykins... shocked smhair
Posted 6/8/2017 6:05 PM (GMT 0)
I will be very interested to see what doctors have to say about this. I have consulted a number of docs. An RO said months ago that based on my pathology I should have adjuvant radiation as soon as possible. One neurologist I consulted also said I should opt for ART. But my surgeon (Dr. Samadi) and another urologist both counseled against ART. I'm now past the point of ART and into the zone of "early salvage." Given the bad pathology (SM+, EPE+, SVI+) I suspect that pulling the trigger on radiation now might be the best choice rather than waiting a few months, during which time the PSA might double.
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