3rd Post RALP PSA results and meeting with RO

Yesterday wasn't such good day. The 3rd PSA result came back at .18 so no change essentially. It isn't rising but it isn't reducing either. The RO looked at the path report and said that it didn't really say there were clear margins. We didn't catch that and the surgeon lead us to believe that there were. My DH's nerves were spared which we were happy with and his recovery with continence and ED has been pretty good. The RO feels that sometimes saving the nerves possibly leaves some cancer.
So the recommendation from the RO is for a bone scan and another new kind of scan called I think Axiom. He is suggesting IMRT and IGRT. He gave us a referral for an oncologist with the suggestion that he goes on a 4-6 month ADT regimen. UGH!!! My DH is dreading it especially because he is feeling so good and is pretty happy that he is doing well with his continence. He dreads going backwards. I told him he has to do what he has to do.
We still have not met with the urologist yet. We have the 3 month post op in a few weeks. They contact us with the PSA results. He had told my hubby that unless he sees a 3 time PSA rise he wouldn't need to jump into treatment. That is before the initial .2 PSA result which with everything I read and the posts on HW is the jump off point for salvage radiation. It seems he isn't going above .2 for now. Is there any way it would be ok to hang in until the PSA rises above .2?

There is nothing magic about 0.2 -- it's just an arbitrary artifact of the past. I suggest you forget about that. The important thing to know is that after his PSA exceeds 0.2, his chance for a cure gets cut in half. With his positive margin and high grade cancer there, I would suggest you act quickly. Keep in mind that urologists don't treat salvage RT patients. Maybe that's why ROs are more apt to recommend quick action - they've seen the outcomes. Also, I think Uros are an optimistic lot who think surgery can cure everything - they may be reluctant to admit failure.

/pcnrv.blogspot.com/2017/03/conflicting-messages-after-surgery-for.html

The Axumin PET is good, and may be covered by your insurance because it is FDA approved (always get pre-authorization). There is a more accurate scan available at UCLA - the Ga-68-PSMA-11, but it costs $2650. In either case, it is not likely to find any distant mets with a PSA that low. Still, it's good insurance - why go through salvage RT if it's useless?

As for continence recovery, there is no harm in staying on ADT for a longer period before radiation begins. The ADT will keep the cancer from spreading for a long time. I know a longer duration of ADT is the last thing he wants, but perhaps it will allow for a more complete recovery.

Up4thefight, I agree with the others. See an RO. Test often. And don't let it get above .2 at least without a serious conversation with the RO.

The time is now to get things in place, establish a relationship with an RO, so when the time comes to act, you can do so quickly

Tall Allen said...
Prat- you seem to subscribe to this "magic number" fallacy as well. PSA goes up (not smoothly, but inexorably) as the cancer progresses. There is no "magic number" above which it is too late and below which one is safe.

I agree. Nothing magic about it. It's cancer we're taking about. Works for some...not for others. that said...


That number wasn't just pulled from thin air by people who know nothing about prostate cancer. Isn't that a consensus number TA? The best of the best get together ... look at their research....look at their studies....compare notes....look at their experiences....compare experiences....talk about their misgivings for that number with others who have misgivings about other numbers. But in the end...a number does need to be had. Doesn't mean that everyone has to agree with that number (probably the one's who come up with it don't even all agree on it).....but a number does need to be had for guidance.....as a standard of care....which gives both patients and doctors a reference point from which to make further treatment decisions. One doc may take later studies and come up with something different. Another....something else based on something else.

But...in the end...some sort of number is a must. One would think. No?

Tall Allen said...
The number 0.2 was a consensus arrived at back in the day when 0.1 was the lowest PSA detectable. They figured anything above that - 0.2 - should be deemed a "biochemical recurrence." That is the entire logic. There is no other meaning behind it. It is an artifact of an old, less accurate test. It should not be used to inform a decision about when to treat. We know for sure (from 3 RCTs) that adjuvant RT has better outcomes than waiting. Beyond that, we can only look at retrospective data that suggests that lower is better. 0.02 or less is too low, but 0.03 isn't necessarily too low. One has to look at other risk factors to make a decision.

I've got other risk factors. PSM may lean toward zap but also with the scar tissue from the stricture says "wait" . so....anyway...don't wanna hijack....