What is my PSADT?

I'm looking at this and seeing a significant increase in your DT starting in 2022. After your proton radiation, it looks like your nadir got down to about 0.8, and it took 3 years to double based on the 2022-2024 numbers--it hit 1.6 sometime between there. I'm looking at this and agreeing that your DT is around 9 months. I don't think the Jan-Feb jump is statistically valid.

What I DO think is that from the various different perspectives that are used, that additional treatment is in your very near future.

Calculating doubling time with exponential data over varying time intervals does not yield good results.

Your rise was linear thru 2022 then takes off after a 2 year break. If you had intermediate points from 2022 - 2024. you might have been able to see the "curve" developing (decreasing doubling rates) but you just have the begin and end points. The last two points don't mean much due to the short period so a third point should help confirm the current rise but that does not really matter much at this point.

I doubt you will get away with no ADT but it should not be started until the scans/diagnosis stage is over. I would hope that there is a targeted therapy that can be employed where the recurrence is. There should be a RO involved with MO for the radiation part and possibly urology for other treatment schemes that can destroy cancer without radiation (or whoever does those treatments). Of course, there is also the difficult surgical removal after failed radiation that is possible but not the best idea I can think of.

I am sure the MSK calculator is fine. However, when you estimate a value, you change the calculation based on your estimate, not real data, so it is a suspect extrapolation.

I don't think there is any point in calculating doubling time with your progression unless you wait 3-6 months to get a next PSA that will provide for a better calculation. I suspect the doctors are not going to care about doubling rates at this point, just a next PSA to see if it goes up as expected and on to next steps.

I’m going to disagree with some of the earlier comments in this thread.

First, doubling time calculation is not complicated. Second, it is not an estimate or an extrapolation. Also, since you retested and confirmed your most recent result, that change IS significant.

However, one thing to know is that since PSA testing (results) itself has considerable variation, do NOT try to make meaningful difference between 20.5 and 19.3. Be practicable…what you need to know is that it’s more broadly in the 10 to 20 month doubling time range. Depending on other things going on in your life and your age (you’re 80, and have gone 10 years since treatment already and only now PSA near 3?), some additional follow up may be in the cards for you. You could very likely do nothing for 10+ years, maybe 20, and not feel any PC impact whatsoever. Or you could subject yourself to ADT, but consider whether the treatment may be worse than the disease.

Post Edited (Casey59) : 2/27/2024 8:52:18 PM (GMT-8)

Casey does make a valid point--at some point QOL comes in to play, and that is such an individual decision. A significant question at this point might also be...if it's growing again, or spreading out, where is it? Is it someplace that can be identified on a scan and directly dealt with?

I like your urologist.

Casey said, <<< You could very likely do nothing for 10+ years, maybe 20, and not feel any PC impact whatsoever. Or you could subject yourself to ADT, but consider whether the treatment may be worse than the disease. >>>

I would tend to agree with this. I have had three MOs (one moved and one retired) who had the same philosophy: With recurrence there is no reason to rush into lifetime ADT because the only evidence (that I know of) is from one weak study that starting ADT earlier is better. According to my MOs, criteria for starting recurrence ADT can be a short PSA doubling time (perhaps less then 9 months). Another trigger can be visualization of Mets on a scan, though these days the much more sensitive scans make this decision trickier compared to the older less sensitive bone/CT scans. The presence of physical symptoms from mets might be a trigger, but again the newer scans would probably detect the mets prior to causing discomfort. Although my situation is different -- my recurrence occurred after RP + radiation, I don't see why the same strategy wouldn't be applied to recurrence after primary radiation, unless my Lupron brain is missing something.

The point is, many men start recurrence ADT much earlier than is needed. But, there is also the factor that some men are very uncomfortable knowing they have an increasing PSA. Reducing the damage caused by anxiety may be worth it for some patients to start ADT early.

Mumbo, having thoughts about next steps, treatments, timeline, etc. Probably not good for me to be doing that now, not having seen my new MO yet. I see him March 5. I'm pretty sure I will be having mpMRI and biopsy. When is the question. Duke is a busy place and I know from talking with radiology last week that they are scheduling MRI's in mid April. A fusion biopsy is a specialty procedure so who knows when that will be. My hope is I can get these tests done and I'm a candidate for a curative treatment. I'm researching them all know. If brachytherapy therapy or SBRT are options for me then It may be that it will be in my best interest to take short course of ADT before and after treatment. My hope is I have treatment in next 3-4 months.

I'm seeing my knee doctor 3 days after the MO and I want knee surgery ASAP so have to work that in. I have 2 vacations planned for August and October. Hate to to cancel them.

P.S. My dad had PCa with prostatectomy done at 75. His PSA remained undetectable until he died at 94. He used to say that the doctor cut out his sex organs and threw them away.
Mom died at 92.