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Posted 1/19/2018 1:05 AM (GMT 0)
I met with an Ro today based on my urologist suggestion to prepare for radiation based on psa going from 0.02 to 0.021 to 0.027.
He also feels like knocking it out now while it’s small is the way to go, like my urologist/surgeon said. At my age he feels the risks are minimal and why wait until it gets worse. He didn’t say it’s urgrnt but feels like I should put it on my upcoming to do list. He said it will also help psycologicly knowing it’s gone. But he said it’s probably an 80% cure rate based on the low Gleason and all. I was hoping to hear more like 99%.
So it’s thinking time. Any input would help.
Tom
Posted 1/19/2018 1:38 AM (GMT 0)
Tom, you need to wait. Your pathology just doesn't justify any further treatment at this time. It's possible that you will need SRT later on, but definitely not now. Unfortunately, all you can do is give it more time to establish a trend. It might never happen. I jumped into SRT early, but my pathology was much worse than yours. I don't regret my decision, I've had no SE's. But if I had your numbers I would've waited for a more established trend. You don't have one yet.
I interviewed two RO's. You might want to get a second opinion.
Posted 1/19/2018 1:51 AM (GMT 0)
Thanks JFL. My gut 100% agrees with you. But the worrier in me keeps thinking “what if I just monitor it and it spreads”. But 0.027 seems so low to do radiation on. I was thinking maybe if it rises beyond .05 or even .1 then pull the trigger. Others have told me their ro wont treat at this level.
He also told me that even at such a low level it could possibly NOT be in the prostrate bed where they would aim the radiation and it’s too low of a psa to detect on a pet scan. I asked if the psa would be higher if it spread and he said normally but not for sure. Is he just covering himself?
Tom
Posted 1/19/2018 2:14 AM (GMT 0)
Tom, if you do have some residual cells, they are most certainly in the prostate bed, and they are probably G6! So if you do have stragglers, it's a good chance they are indolent and will die off in time. If not, I wouldn't (try not) to worry until your psa gets to .05 or higher.
Easier said than done. I can relate! But you're doing fine right now. Nothing to worry about.
John
Posted 1/19/2018 3:07 AM (GMT 0)
Thank you John. I appreciate your insight very much!
Tom
Posted 1/19/2018 7:24 PM (GMT 0)
You are really jumping the gun here. The risk is overtreatment - salvage radiation can come with some serious urinary and sexual SEs. There is no data - none - that supports salvage radiation at that low a PSA level, and much data supports not treating at levels this low. Especially with only a GS6 and favorable pathology! I think you are on a path to self-inflicted harm.
Posted 1/19/2018 7:54 PM (GMT 0)
IMHO, you are getting much better advise here, than you are receiving from your Uro or RO. You are still <0.03, and there is no reasonable rationale for jumping into serious and unneeded intervention.
Posted 1/19/2018 11:15 PM (GMT 0)
You have plenty of time, especially as slow as it is increasing. Remember, the longer you can safely wait the science and technique is continually improving.

I was at 0.1 ng/ml for two years before I hit the 0.2 ng/ml threshold. My oncology urologist told me not to do anything until it hits that threshold. Once it did, he made the call to the RO to schedule my first consultation, CT and my little 3 tattoos.
Posted 1/20/2018 4:31 AM (GMT 0)
All numbers are still <.03. Mine is <.1 I asked about ultra psa to see where I am below <.1. URO said treatment of any thing below .1 was over treatment in my case.
Posted 1/21/2018 3:08 AM (GMT 0)
Thank you again guys. It really helps put me at ease because I really do want to hold off until I know for sure it’s necessary. Your insights and experience helps me fell better about my decision.
Tom
Posted 1/21/2018 1:57 PM (GMT 0)
I think you should find another urologist.
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