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Posted 2/13/2019 1:20 PM (GMT 0)
It is looking like salvage radiation did not work. My Feb 12 PSA is .11, up from .08 in August. I will meet with my oncologist to determine the next steps. I was hoping it would continue to decline.
Posted 2/13/2019 1:59 PM (GMT 0)
Howard,
It may be too early to be certain but there does seem to be an overall trend. I have experienced the disappointment of failed salvage, a bitter pill to swallow.

The consolation is the velocity, which seems fairly low. So, if the trend continues, it may be quite some time before ADT becomes necessary.
Posted 2/13/2019 2:41 PM (GMT 0)
That's not the number you wanted.

Do let us know what the oncologist says.

but it could be a long time yet before you need more treatment.
Andrew
Posted 2/13/2019 7:01 PM (GMT 0)
Your PSA may indeed continue to either decline, or flatten out over time. Good luck with your oncologist, but at your relatively low numbers, don't rush into anything.
Posted 2/13/2019 8:49 PM (GMT 0)
It’s really unfortunate you are in this situation. Hope your PSA stays low for a long time.

Just curious, what was your pre surgery PSA.
Posted 2/13/2019 9:20 PM (GMT 0)
Pre surgery PSA was 4.58. Tumor was 5 percent!
Posted 2/13/2019 9:44 PM (GMT 0)
Howard, your numbers both pre and post surgery were very much the same as mine, so much that its uncanny. The only difference being that your PSA became detectable sooner than mine, if i read your sig correctly.

I truly hope for you that this is a freak outlier and that your PSA stabilizes. If it doesn't just remember, you left nothing on the field, you did everything you could and did it in a timely manner. (and if i end up in the same boat, please remind me that i said that.)

I am curious, in a situation like Howards, can anyone comment on at what PSA level systemic (ADT) treatment would generally begin?
Posted 2/13/2019 10:11 PM (GMT 0)
Howard:

It may not be that dire. You have a 0.03 increase. Not a large #.
In fact, if you used the "regular" PSA test, it would be 0.1, both times.

You need at least one more data point to surmise any trend. Good luck.

Oh, and I did HT when my PSA was about 7.0. I think most would recommend sooner.

Mel
Posted 2/13/2019 10:23 PM (GMT 0)
Thanks Mel,
These new tests create a lot of anxiety but it is what it is. I will test in three months. Good luck to you as well.
Posted 2/13/2019 10:49 PM (GMT 0)
Prato said,

“I am curious, in a situation like Howards, can anyone comment on at what PSA level systemic (ADT) treatment would generally begin?”

I would say no one knows the best answer to that, at least according to my MO. A dozen MO’s may have a dozen fairly different answers. This area of PCa treatment seems to be a frontier.

The two MOs I’ve had are okay with the PSA going above 20. The criteria they would pull the trigger for ADT for sure are high PSA velocity, Mets on a scan, or physical symptoms.

My current MO just retired. In March I will visit my third MO. It will be interesting to hear his view.
Posted 2/13/2019 11:03 PM (GMT 0)
Not the direction you wanted it to move, but it sure didn't move much, which is good. I also couldn't tell from your signature how long about you had your SRT. If it was in the last year or so, there still might be a little wiggle room for it to drift--just surmising there.

Will be interested in what your MO says. Good luck to you!
Posted 2/13/2019 11:10 PM (GMT 0)

Howard3569 said...
Pre surgery PSA was 4.58. Tumor was 5 percent!

That’s not that high of a pre-surgeory and 5% tumor is not large tumor combined with a g 3+4 , would have puts you on the lower end of intermediate risk.

I still hope your PSA stabilizes.
Posted 2/13/2019 11:32 PM (GMT 0)
Thanks,
I guess that I need a few more tests to establish a trend. Tall Allen suggested that I consider radiation of lymph nodes but there is no way to determine if they are hot. My salvage radiation ended Jan 2008. It was higher dosage for a shorter time. They have a fancy name for it.
Posted 2/15/2019 5:07 PM (GMT 0)
Met with oncologist today. She indicated that she was expecting a continuing decline but to not panic. The PSA could go down, up, or stabilize. No way to tell at this point. A Pet Scan would not detect anything at the .11 level, so we will test again in 3 months.
Posted 2/15/2019 5:37 PM (GMT 0)
Up, down, stay the same. That about sums it up.

Let us know what the next test results are.
Posted 2/15/2019 11:51 PM (GMT 0)
Mine did the same and it’s now at .51. I have not started ADT yet. I expect to start in 2 weeks. I saw studies to suggest starting early is better for overall survival and it does not make resistance sets in early.
Posted 2/16/2019 12:24 AM (GMT 0)
AK
My oncologist told me that if it continues to increase then they would do a Pet Scan to locate the PC. Perhaps it’s in the lymph nodes, then they would surgically remove it or radiate it. Meanwhile it’s a wait and see game.
Posted 2/16/2019 12:31 AM (GMT 0)
You need to wait until psa reaches around .5 to have a good chance of a pet scan finding something
auxium scan won’t find anything untill you teach about 2
Psma also needs something around .5 to give you about %66 chance of finding something
18 f dcfpyl can find something at .2 but you need to be on a clinical trial. So, like everyone said, it’s a wait game.
Posted 2/16/2019 12:49 AM (GMT 0)
Thanks AK
For all the info. We are both at least for the time being in the safe zone. May buy us a few mo years but with PC you never know.
Posted 2/22/2019 4:58 PM (GMT 0)
Howard, I just posted in my own similar topic which you had written in also.

My latest PSA dropped back down from 0.3 to 0.2. In my case, since Kaiser doesn't do the more precise test, it could be round off error also with the usual test uncertainty. Your increase is pretty small, so I would think your next reading could also drop down.
Posted 2/22/2019 5:24 PM (GMT 0)

Pratoman said...

I am curious, in a situation like Howards, can anyone comment on at what PSA level systemic (ADT) treatment would generally begin?

When I first switched my care to an MO due to return of rising PSA four years after SRT he told me that due to my history of long intervals of undetectable or very low PSA both after surgery and after SRT he would be inclined to wait longer to start me on ADT than someone who had a more aggressive history. He mentioned probably looking to start somewhere between a PSA of 5 to 10 depending in part on doubling time. As it happened, my doubling time started accelerating about two years later. I agreed to go into a clinical trial, and while I was in the screening phase my DT kept dropping - my PSA rose from about 2 up to 6.6 in the few months I was discussing and screening for the trial. Just as I was about to start the trial I began having intermittent back pain on the left side that turned out to be a blocked kidney due to an enlarged lymph node pressing on the ureter. So, even if I hadn't yet been ready to start SRT that would have been the event that made it necessary. As for the trial I was randomized into the control group that would get Degarelix only (Firmagon), rather than a triple whammy of Degarelix, Zytiga, and Apalutamide. The Degarelix shrank the lymph node restoring normal kidney function and dropped my T and PSA to nearly undetectable within a month.

Jim
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