SRT Process begins next week

SRT process begins next week on Aug 23. I go for imaging for planning and casting, and presumably my ADT/HT shot.

So, as I head into this, are there any brothers out there that got a nice long run from SRT/HT? My mind is thinking the worst....I need some encouraging news. I start this with a uPSA of .06 at about 38-39 months out from RP.

Just got back from a nice family vacation out west (Grand Canyon, southern California)......now back to reality!

J
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Age at Dx: 54 (DOB: 01/28/62)

08/31/15: PSA 2.5;
01/01/16: Urinary Frequency;
02/05/16: DRE Pos Nodule;
02/22/16: Biopsy;
02/26/16: Dx: 7-12 positive; (5) 3+3=6; (1) 3+4=7; (1) 4+3=7; T2B;
03/11/16: Bone Scan Neg;
03/23/16: CT Scan Neg;
03/31/16: Surgery Consult UPENN;
04/08/16: RT Consult/2nd Op Fox Chase CC upgrade to 4+4;
04/14/16: 3TMRI "organ confined", EPE-, SV-, LN-;
06/01/16: DaVinci @ UPENN (Dr. D. Lee);
06/08/16: Catheter Out;
06/08/16: Post-Op Path: EPE+;Marg +;SV-;LN-;G7(4+3) (G4 80% - G3 20%);tumor vol 25%;T3a;
07/01/16: Start 5mg Daily Cialis, 20mg once a week on Friday's;
07/06/16: Decipher: 0.56 (Average Risk);5 Year Metastasis 7.6%;10 Year PCa Specific Mortality 6.9%;
08/01/16: Penile rehab started (Pump);
01/30/17: Decipher GRID PORTOS: Avg ADT Response (21%);Avg Docetaxel Sensitivity (56%);
Lower RT Response (45%);Avg Dasatinib sensitivity (38%);High Genomic Gleason Grade (81%);
High Metastasis Risk (70%);High Tumor Cell Proliferation (82%);Avg AR Activity (56%)];
09/26/18: 99% continence (some stress every now and then); ED no issue (5 mg Cialis/Day);

Post-op uPSA History:

08/31/16: uPSA <.006; (3 months);
12/01/16: uPSA <.014; (6 months);
03/01/17: uPSA <.006; (9 months);
06/01/17: uPSA <.006; (12 months);
09/01/17: uPSA <.006; (15 months);
12/01/17: uPSA .007; (18 months);
03/01/18: uPSA .010; (21 months);
06/22/18: uPSA .015; (25 months);
09/21/18: uPSA .018; (28 months);
12/21/18: uPSA .035; (31 months);
03/22/19: uPSA .044; (34 months);
06/21/19: uPSA .055; (37 months);
07/22/19: uPSA .061 (38 months);
08/22/19: uPSA ???? (39 months and 1 day prior to start)

Sky,

That comes from the Decipher GRID PORTOS report. The Decipher test provides an overall score, mine was .56 (high average risk), but doing some research, they also provide other genomic "scores" in a very detailed GRID PORTOS report. I asked for it from my Dr. and he was able to get it for me without cost. One of those scores was a "High Metastasis Risk". My signature gets unformatted from the Word Doc I keep it in which makes it difficult to read here. But here are my individual Pcts from that report:

Avg ADT Response (21%);
Avg Docetaxel Sensitivity (56%);
Lower RT Response (45%);
Avg Dasatinib sensitivity (38%);
High Genomic Gleason Grade (81%);
High Metastasis Risk (70%);
High Tumor Cell Proliferation (82%);
Avg AR Activity (56%)]

My main concern going into SRT is actually the Lower RT response (45%). I asked my RO about it and he does not put any stock in this info at all. I guess that could change over time as more and more data is loaded in the Decipher database.

J

Jaymot, i also asked my RO about the Grid Report showing low chance of success with RT. He totally discounted it saying it has not been proven to be of any clinical value. So far, as of 6 months after SRT i am undetecable, but my Testosterone was (and probably is) still low, so not putting much stock in that

You should take heart in the fact that you had a positive margin, that bodes well for your chances, as well as the fact that you are hitting it very early. Plus the fact that it took 3 years + to get to .06.
You wont know for a year or two if it worked anyway, because you need to have your T return to normal, which could take 6-12 months. So just try to not sweat it, and stay positive. Assume you are being cured, until proven otherwise. (i know easy to say, but thinking otherwise aint gonna help)

JayMot said...
Sky,

That comes from the Decipher GRID PORTOS report......
My main concern going into SRT is actually the Lower RT response (45%). I asked my RO about it and he does not put any stock in this info at all. I guess that could change over time as more and more data is loaded in the Decipher database.
J

True, but there is a tremendous amount a validated data there already.

I suggest your RO's opinion may be short sighted. The Decipher GRID reports have an enormous amount of data to sift through. The free GRID reports can be sent directly to you from Decipher, and you can call them to clarity any portion of the report. May of us find it most valuable, especially in an area where hard data is so hard to come by.

Just in the last 18 months, ADT medical thinking about the value of when to get it, and how much it improves the odds of a successful outcome have made significant strides. It's yet another very foggy area with no absolute answers. In my experience, many (most?) busy RO clinicians are not as current as we would hope, and that includes 'celebrity' physicians.

Do your own in-depth research on these critical personal decision points. Don't rely on one RO's opinion, or second hand, possibly old, information online.

https://euoncology.europeanurology.com/article/S2588-9311(18)30215-3/fulltext

Good luck, Jay!

Will be thinking of you Jaymot. I start my SRT next week as well. Wishing you all the best.

I had surgery in 2005 and recurrence 3 years later.
I finished SRT in January of 2009 and have been undetectable ever since.
I know RT has come a long way since then, so I would think you will be fine.
Good luck with your SRT journey!

Bohemond (Jim), I am well aware of your journey. I refer to it when I need a mental boost. Seems like you're 17 years post Dx. I was thinking of waiting until a higher PSA to start SRT, like you (.4) and some other guys on HW. But, I guess now-a-days, the practice is to hit it at the lower PSA's, like mine at .06. Did you do ADT/HT with your SRT? J

There is lots of room for hope. My post-surgical pathology was not encouraging -- I had EPE, SVI, and PSM. My first PSA test after surgery was <.008, but it started upward soon after. I started IMRT about 11 months after surgery. It was annoying to go in every day for 7 weeks or so, and the full bladder thing was a pain, but radiation itself was no problem at all. I got a little tired halfway through, but that went away. No other side effects. Two years later my PSA is undetectable. My overall mood has improved a lot, too. For a while I expected bad news with every PSA test, but now I don't get as anxious in advance of the test and I expect the result to be good.

Jay, I've had a 3 and 1/2 year run after SRT. Seems to be working so far. ADT wasn't offered nor recommended when I asked about it, so I gladly passed. The protocol might have changed in the past 3 years. You still have a great shot at a cure. Get after it!