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PSA no longer undetectable - Now What?

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Posted 2/6/2020 8:58 PM (GMT 0)
Diagnosed at G6 in 2012
Last biopsy in May of 2017 showed G9
Had HDRBT, IMRT, ADT, and Zytiga+Prednisone for 18 months, ended in January of 2019.
Have been undetectable for 12 months since end of treatments.

PSA this morning is now 0.13, first non-detectable since end of treatments.
Will be seeing my oncologist this coming Tuesday, February 11th.

What is next for me?

MP

Post Edited (akai) : 2/6/2020 3:17:55 PM (GMT-7)

Posted 2/6/2020 9:13 PM (GMT 0)
I predict we will find out next Tuesday. I am guessing that some of the discussion may include potential scans to see where any cancer may still be lurking.

Probably will want to see some more PSA tests. After radiation as a primary treatment it is expected to have some PSA from any remaining prostatic tissue. If you stay stable and below 2 + Nadir PSA, then you are considered cancer free. So look for some more PSA testing and perhaps scans to see if a trend develops that would indicate growing cancer.
Posted 2/7/2020 1:08 AM (GMT 0)
You were probably undetectable due to the ADT. I would think it is too early to tell if this represents a re- occurrence.

Thanks
Paul
Posted 2/7/2020 1:26 AM (GMT 0)
I agree with JNF & Paul, get a few more 3 month values and see where it is going. My guess is your oncologist will suggest that. No sense hiding a rise with more ADT at this point since you would like to know if it is really rising or just bouncing around. The PSA seems too low to go looking for anything at this point either. Not much you can do since you really don’t know anything for sure and one point is not sufficient to draw any conclusions from.
Posted 2/7/2020 3:58 AM (GMT 0)
Agree with the others... you are a long way from below 2 + Nadir PSA... Hang in there and you will probably end up getting quarterly PSA's to benchmark what's going on. Don't let this detract from your quality of life! Try to live freely w/o significant anxiety and stress... PCa is a beast but we have great tools for treatment and technology is getting better every day... It can be managed! smile

pasayten
Posted 2/7/2020 1:39 PM (GMT 0)
As others have said, a detectable PSA is normal at this point with the type of treatment you've had and the ADT wearing off. Interesting that they included Zytiga in this type of treatment. First time I've seen that on the forum.

The next few years you may have to learn to be patient with your PSA before you become confident that all is well.
Posted 2/7/2020 2:38 PM (GMT 0)
Thank you all for your support and encouragement.
On Zytiga, my former oncologist participated in the early Zytiga trail (Dr. Tanya Dorff) and we discussed throwing everything at my Gleason 9. Others prefer to save the bullets and use it when their initial treatments failed.

Will report back after seeing my oncologist on Tuesday.


MP
Posted 2/7/2020 10:35 PM (GMT 0)
Good luck, akai.

Are you seeing a medical oncologist or a radiation oncologist?
Posted 2/8/2020 4:55 PM (GMT 0)
Hi Gary, I will be seeing Med Onc this Tuesday.
Posted 2/8/2020 6:12 PM (GMT 0)

akai said...
Hi Gary, I will be seeing Med Onc this Tuesday.

Good choice.....be very specific with your questions, and probe for his/her advise rationale.

Keep us posted.
Posted 2/11/2020 11:51 PM (GMT 0)
Just a little update, met with my med oncologist today.
He ordered another PSA test, 4 weeks from last test. He said that the fact that my PSA went from undetectable to 0.13 in 3 months is not a good sign based on his experience. He expects my PSA to continue to rise.
Based on the upcoming result of my PSA, he will probably order a Axumin PET scan, he said that at 0.2 PSA, the scan has a 30% chance of detecting cancer.

He also thinks that an intermittent ADT is the way to go as I responded well to ADT which ended a year ago after 18 months of Eligard.

MP
Posted 5/17/2020 12:27 PM (GMT 0)

Hello Akai,

Just a line, wondering how you are doing?

Last we heard from you, you had pursued some proactive treatments, including ADT and ZYTIGA.

Just checking in with how things are going for you, and hoping all is going well.

With my best,
Cyclone --- # Iowa State University
Posted 5/17/2020 1:19 PM (GMT 0)
Akai,
I guess your most recent post slipped by me. I too am wondering how you are doing. Please give us an update when you can.
Posted 5/17/2020 2:37 PM (GMT 0)
Aka I was last signed on April 9th. Hopefully he’ll sign on again soon, and update us.
Posted 5/17/2020 8:30 PM (GMT 0)
Yes Im a cynic ...I bet akai has good insurance...and the forums take is worth more than medonc's...lets do a test to see if a test is needed to see if a test is needed...then retire and have a testimonial dinner without surgical masks or social distancing...>>>>>>>>>>>>>>>umm social distancing...Ive been doing social distancing since before Dr.Zorba...meandered into Shangra_La ...tis a far better thing I do now than I have ever done before....dadadotsdadadots...connect real to surreal...
Posted 5/18/2020 1:15 AM (GMT 0)
Akai,
Good thing you have Dr Tanya Dorf at City of Hope, She is renowned. I would just do whatever she recommends, I would wonder why they don't just start you back on Zytiga? Were there issues at the end of 18 months?

Logo ,
My friend, just like you mentioned, I do plan to retire soon "and have a testimonial dinner without surgical masks or social distancing". I got that part of your post. And 'test before a test to see if a test is needed" thats so true.!!l

Was you dah dah dots related to Morse code???. lost you there. My Grammy used to teach Morse code to all the cadets during WWI and later in life, she became an air traffic controller for many years. Oops almost wrote tears... She would have felt you and your stories, and I would say logic!!
Winging it
Posted 5/19/2020 3:10 AM (GMT 0)
Logos-Are you happy I named you? I sincerely hope I dont enflame you. (hint: that's perhaps why people dont name names here sometimes, trying to play by the rules) I'm just trying to man up like you suggested to me one time in a gentler post. I admire, like, read in awe at most all of you posts, but sometimes I don't comprehend certain of your soliloquies, and sometimes I feel (and believe me, hope people dont care how I feel here) that you just go one bit or should I say one toke over the line sometimes. Please dont call me out here cuz the post aint about me, aint about no one here, but was the one about COVID and Vitamin -D and PC.
AND since I did want that one to get locked, as it would have, I posted this serendipitous reply here, so if read you could also read the compliment I paid to ya, da other day.
Wings aka Dan, aka all that and a bag of chips, etc
Posted 5/19/2020 11:19 AM (GMT 0)
hey ya Logo you must be getting back in da water riding those waves! You were starting to sound to normal there for a while good to see ya back to your old self! 🏄‍♂️🏄‍♂️🏄‍♂️

Larry
Posted 5/19/2020 5:35 PM (GMT 0)
skypilot...yep been out since last Friday,the day before the beaches totally...opted out Saturday as I figgered it would be a mass invasion...Ill be going regularly now as the tasmin swells arrive...I sense one is leaving about now with my name(puns always intention of nonintention(but of coarse) surfing is like riding a bicycle without the finger wave...no pun intended intentionly...go figger
wings...when and from what facility did gramma retire from...the rest of our exchange is behind me...I have a random style of thread reading...usually it ...having said that I double down on all posts I write...there is wisdom in them all...you just can't find em by osmosis...even if osmosis is how I create them...its a lot like ATC tho when one is up to ones butt in alligators...one reacts to the engagements and well...makes it work it...very much so if you have the mind of Dadaism...now there...wasn't that ez?
Posted 5/19/2020 11:53 PM (GMT 0)

JNF said...
I predict we will find out next Tuesday. I am guessing that some of the discussion may include potential scans to see where any cancer may still be lurking.

Probably will want to see some more PSA tests. After radiation as a primary treatment it is expected to have some PSA from any remaining prostatic tissue. If you stay stable and below 2 + Nadir PSA, then you are considered cancer free. So look for some more PSA testing and perhaps scans to see if a trend develops that would indicate growing cancer.

I had brachytherapy in 2011 and reached a PSA nadir of 0.1. Unfortunately, my PSA started rising in 2016. When it reached 1.5 (below 2 + Nadir PSA formula), biopsy and MRI established an extra capsular recurrence in a mass of about 1 inch in diameter. Therefore, the 2 + Nadir PSA formula is simply a guideline.
Posted 5/20/2020 4:21 PM (GMT 0)
I reckon no response on Grammy means you figger she was way before my time...you would be surprised what I know and remember about old time ATC...it did not actually exist until WW2and it was all done by the military...Ernest K Gann never even mentioned it in his book Fate is the Hunter...very little commercial air traffic and then it was all see and be seen and the they will never hit syndrome that prevailed...After WW 2 as commercial flights increased...federal controllers were hires and controlled airtraffic...military included...used flight trips on stacks of flight boards...utilizing time and pilot estimates and various other tools...the mind et al...This all worked until the grand canyon midair of 1956 tween a United DC7 and TWA L1049 killing all aboard both (over 100)This is where I came into the picture 1961...intitially in the USN...then the FAA...The the Flight boards was still the main methods of ATC...but soon raw radar came into play which evolved into other methods...Folks today think it is all done visa vie computers...au contraire...tho computer interface is more active...what it does is allow the controller to handle much more traffic than the good ole days..I have had as many as 30 aircraft on frequency...commercial military general aviation...climbing descending...whining crying(hey what about me...I was first) crossing...emergenc-eeing icing..you name...which is why I am so adept at having the final word...as to whether I can or even want to break that habit in retirement...that would be another story... I would consider myself a second generation controller...trained by many many first generation ones who knew...who knew...all with the same skills...making what ever situation one finds one in WORK...puh lease...do not pull the HiJack schtick on me(rhetorical question0...I know and was part of the generation which created the fracking word...so put that in your funk and wagnallis...logo...freaking Out...
Posted 5/20/2020 9:25 PM (GMT 0)
Akai,
Hope all is well with you, I think you are being treated at City of Hope so you are in great hands. Still wondering if a restart of Zytiga is what Dr. Dorf may have recommended as an option.

Mr. logo,
Not ignoring you, just busy helping daughter move. Grammy was my Idol. Born in 1907, I remember, not sure what year but she worked for the FAA near San Francisco and later near Palmdale for LAX approach, and finally many years at Phoenix Airport before she retired around 1967. I wish I have taken and followed advice she gave me throughout t he years. You and her would have been very compatico and shared stories of the craziness of ..de planes, de planes. 30 aircraft at once? WOW "I picked a bad day to stop smoking!!"- (The movie Airplane with Lloyd Bridges) She told me many times she had to scold de pilots. From your above very nicely phrased post, I could tell you had many, probably more of the similar insane yarns. Is yarns even that still a word? She died in 1993 of Lung Cancer, I was her caretaker in the end.
Speaking of advice, I would do well in heeding your advice, you have some gems. Thanks for the advice and even the schooling. Thanks for the background on Dadaism, now I think I can comprehend more of where you are coming from, That's neat, and great, and revealing, and something else at the same time. Sorry for the run-on drivel here, but I'll weave thru your words more later, alligator. You really do double down and I think that is great! Happy surfing man.
Book em Dan-o , aka Wings

Post Edited (Wings of Eagles) : 5/20/2020 8:46:13 PM (GMT-6)

Posted 5/21/2020 4:01 PM (GMT 0)
Yo Grammy was without a doubt one of the pioneers in ATC......yarns...I have always threatened (perfect word for any of my writing lol) to write a book on the subject...Zen of Air Traffic Control? or maybe...my favorite...Dreams Schemes and Flying Machines...tho I may save that for my memoirs...both are dreams and will remain so...thanks for your Grace...Wings...one more yarn...then into the barn...a hint of mint...The theme song from Arthur...'caught between the moon and new york city.'..was penned by Peter Allen( I think that was his name) while in a holding pattern during a " wildcat strike' by controllers in the NYC area...I got a million of em...yarns...made of threads encased in truth floating in drops of whimsical dew...blessed...regards logo PS the 30 a/c is no embellishment...
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