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Results of the dreaded Nine Month PSA test

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Posted 8/12/2009 4:20 PM (GMT 0)
I was suppose to call my dr later today for the results, but the person at the lab that read it called me directly right around 0800, kind of surprised me.  It rose over the course of 71/2 weeks from .11 to .16.   That is a rise of .05.

I still have an appt. I kept open till I got the results with a Dr. Duncan, the Radiation Oncologist I was suppose to meet originally some weeks back, but was unavailable at the time.  I guess the wise thing is to keep the appt with him this Friday afternoon.

Its looking more and more like reaccurance to me. :(

Until they can fix my blockage problems, can't move on ahead with radiation anyhow.

So, guys, give me your gut and off the cuff opinions with my post surgery psa readings.  Friday will mark 9 months to the day since my open surgery.

I will update my signature next.

David in SC, disapointed, but not totally caught by surprise

Posted 8/12/2009 4:32 PM (GMT 0)
My layperson's take on it is that it looks like you're headed for just about any doc's definition of recurrence, if you're not there yet.
But you seem to have at least some time to try and get the urinary problems improved before your PSA hits any critical cutpoints.
I keep up with Andrew Stephenson's research into predicting the success of salvage radiation. His research shows that for optimal results, you want to start before PSA hits 0.5. But there are no clear cut lines where salvage is guaranteed NOT to work. Anecdotally, I started at 0.7 and it seems to have "taken" with me.
So if it were me, I'd concentrate on the urinary blockage problem. If you get it fixed and can start before PSA hits 0.5, great, but you're still doing pretty good on the odds if you could start radiation before it gets to 1.0.
Just my 2 cents. Here's the research I mentioned (free full text):
http://jco.ascopubs.org/cgi/content/full/25/15/2035 . This research is the basis of the nomogram on the MSK website: http://www.mskcc.org/applications/nomograms/prostate/SalvageRadiationTherapy.aspx

Best wishes. You deserve a break.
Posted 8/12/2009 4:50 PM (GMT 0)
Certainly is getting complicated, David,
But I agree with Galileo, you have time to try to get a handle on the blockage issue first. I believe that it is recurrence as well, as you have had three consecutive increases in PSA, the PSA is above undetectable levels to most Assays, and you had a positive margin. It is very probably that is it local recurrence, but since you are in a wait mode, perhaps asking if better imaging is a good idea. JohnT swears by it, and this could be a good call to see if you can get it done...

Tony
Posted 8/12/2009 4:55 PM (GMT 0)
Poor David. Like he said, an "As The Prostate Turns" moment--again. Seems like you have figured out a process, take it step by step, first the next week scheduled procedure, then address the rise. I feel for ya buddy, and am praying for you.
Posted 8/12/2009 5:01 PM (GMT 0)
David, Your results closely approximate mine. Except for urinary complications. By the time you PSA reaches 0.2 (a most accepted definition of recurrence) you probably will be at 1 year mark. From what I read, local margin, undetectable post-op PSA and a year+ to recurrence make local recurrence very likely. That means radiation. But the longer you wait, the more chances for it to spread beyond prostate bed. So, my off the cuff non-medical advice is to slow cancer down with short term HT, especially since there is research that suggest better salvage outcomes. That buys you time to take care of your urinary issues AND improves the probability of positive outcome from salvage.
Posted 8/12/2009 5:43 PM (GMT 0)
Thanks and welcome here Galieo, good advice. Thanks to Tony, James, and Greebra. I am not into denial guys, I assure you that, but I have learned over the months not to rush out into the streets and do something just because.

I will meet with the Rad Onc this Friday afternoon. See what I think of him, see what his approach is, and find out what post surgery psa rise he is comfortable treating and has experience with.

But we are all on the same page, I have to get these persistent urinary blockages resolved before tackling radiation, both types of dr
did agree on that. So, I am now on day 23 of this lovely catheter #6. Getting spasms all day long, even in the middle of the night, and I can only take so much ditropan a day. My poor bladder is swollen and sore from trying to expel the latex monster.

And to be blunt, woke up a few morns with a major wood, with the catheter on, not by choice, guess nocturnal, you talk about a touchy situation, because it hurts until it ebbs away. For any of your new surgery guys on the recovery side, don't even think about trying to get wood with your cath on, you can damage your surgeons hard work. Remember this is unsuall being on a cath nine months out from surgery, so I am healed from that point of view.

Still 6 days to the corrective surgery, can't hardly stand the thought of going thru another weekend like this, but got to. Then when I do wake up in recovery, I will find a new cath, the real #7, and would estimate that I would have it for up to 2 weeks. Then mabe I will be fixed of the problem, free of catheters, and ready to move on towards salvage radiation. Sounds like a plan, but not really a fun one.

David in SC
Posted 8/12/2009 6:03 PM (GMT 0)
David,

Not trying to put a damper on things...but just because you will get the cath out after your upcoming surgery two weeks later doesn't mean you're healed enough for radiation treatment...at least in my opinion. Ask the oncologist this Friday his take on your particular situation, because it is certainly not a normal one by any means. Geebra made a great suggestion about the HT as a temporary...something like six months maybe to keep the PCa at bay until you are healed enough for that second shot at a cure. I know it isn't any fun (HT), but going into radiation while healing could cause greater issues.

I know you hoped for better PSA reading, but it did move significantly up enough for any doctors protocol as a recurrence.

Best of luck to you in this new unexpected journey
Posted 8/12/2009 6:33 PM (GMT 0)

Dave, I'm sorry to read that.  A couple of things that I might want to throw out there:

According to Catalona: "Over a 20-year period, Dr. Catalona performed 3,478 RPs on prostate cancer patients. Of these, 631 (18%) had evidence of cancer progression after surgery. Of those who progressed, salvage radiation therapy (median dose 63Gy) was given to 307 patients.

For those who recurred, the median time from RP to PSA-recurrence was 23 months. There were 162 (73%) responders to radiation therapy. A response is defined as PSA less than 0.3 ng/ml after therapy.

A Gleason score of 8-10 was more common in non-responders. The median PSA at the start of radiation was higher in non-responders. The presence of seminal vesicle invasion or lymph node involvement implied a much worse outcome following radiation.

Men with a PSA less than 1.3 ng/ml at the start of radiation therapy had a significantly better outcome.

The study showed that while initial response to salvage radiation therapy to the bed of the prostate after recurrence was good (73%), a durable response out to 10 years was only maintained in 25% of patients. However, men who had an initial response to the radiation had a 35% rate of non-progression at 10 years. "

One other thing to perhaps consider (with reference to your blockage problem) is proton therapy for salvage. It could have less collateral damage than photon alone (I believe with proton treatment in salvage cases it's administered basically as a mixture of proton and photon).

Again, sorry to hear the bump in the PSA.

Posted 8/12/2009 7:03 PM (GMT 0)

Hi David:

Sorry about the PSA rise...I was hoping for better and I know you were also!  Most suggestions at this point are beyond my area of expertise so I'll just stick with support.  I'll pray for successful treatment of your blockage, a swift recovery from that and that you find the right choices as you move to the next step of this journey.

Best regards,

Tudpock

Posted 8/12/2009 7:20 PM (GMT 0)
Greetings, David.  I know this is not the news you were hoping to receive.  Seems like job 1 right now is to get the blockage issues all taken care of.  Doesn't seem like it would hurt anything to ask your doc if HT would buy you some time to get all the other issues taken care of.  I'm certainly just a layman but wouldn't hurt to ask.  We'll continue to pray for you in these days - I know you want that catheter out of there and get back on the road to healing.  David

Posted 8/12/2009 7:43 PM (GMT 0)
Hi David, Away from home and office at the moment. Just had a peek here. Sheesh...not what any of us wanted to hear. The other posters are right in saying you have time to get the urinary block under control and heal a bit from that. And I was pulling really hard for you today too!!!

As always, you'll be in my thoughts.

Talk soon.

Mike

Posted 8/12/2009 7:57 PM (GMT 0)
Hi David,

I'm sure that all of us here are very disappointed that your PSA seams to be slowly drifting in the wrong direction. We had hoped for better numbers for you. I was in a very similar situation just a few month ago and know the horribly feeling that comes with the realization that the PSA is on the rise again. I'm not knowledgeable enough to give you any advise, but when I had a recurrence, it was decided to hit the bad cells as soon as it was clear that they were trying to stage a comeback. Thus far it seams to have worked. I just know that you will do the right thing as soon as you can and put a stop to this rising PSA.

All the best to you in the years jet to come.

Magaboo

Posted 8/12/2009 8:11 PM (GMT 0)
David,
You may want to talk to your Dr about taking Casodex while you are waiting to heal. It should stop any futher progression and the side affects are pretty mild. Loss of Libido, minor hot flashes, but mine went away after about 2 months. Also ask your Doc to give you Femera with the Casodex to prevent any breast growth. The Libido loss goes away as soon as you stop taking the drug. It should also make the radiation more effective.
with any reoccurrance I would also get an opinion from a good oncologist to see what he might. recommend. With such a low PSA I don't think a scan like an MRIS would see anything, but I could be wrong.
JohnT
Posted 8/12/2009 8:18 PM (GMT 0)
David: Im heart sick over the results. I wish I had answers for you. All I can say is you are in my thoughts and I do hope the bladder issue can be fixed fairly qucik for you to move to the next fix.

God Bless. and Know we all care so very much about You.

Jeff T
Posted 8/12/2009 8:33 PM (GMT 0)
les, you make a good point on the healing part, right now, there's no part of me thinking about HT, but reality may have to change my mind, i will bring the rad. oncl. dr. up to speed and see what he thinks about that

squirm, never thought of the proton thing in my case, will put that in my brain file

thanks bro tud, mike, and david/cpa - i can feel the concern

magaboo, you care and concern is good enough for me, thanks

johnt - good suggestion, but this may sound superficial on my part, i am one of the few surgery pc guys that had zero ed after surgery, and thats with only one nerve bundle, i would hate to do anything to end the little bit of sex life i have left. who knows, after radiation, i may never peform on my own again.

Thank you too, bro. jeff for your kindness.

Got lots of things to think about, but hey, another blinding bladder spasm is tearing into me even as I type. Life gets gooder and gooder.

Sure glad to know you are all out there.

David in SC
Posted 8/12/2009 11:12 PM (GMT 0)
Dang David I was sure hoping for a zero as I know you were to. Please take care to get well so as to fight this disease. I know you are a positive spirited person so lets learn to live with this cancer.


peace and much love
dale
Posted 8/13/2009 12:21 AM (GMT 0)
thanks dale,

the one thing i have learned strongly in the past year of my life, is that PC doesn't play fair, and it really is an evil class of cancer, not to say that any cancer is good. but with many cancers, once its gone, its gone, and that s all there is to it. The other thing, is the infinite amount of variables when dealing wiht PC, what is normal? Is there anything normal or consistent about it? I think I met those as retorical only.

i feel like my stats are forcing me into action i really dont want to take. when it came to the dx and the primary treatment of surgery, i was enough of a number's person to think that really had a shot of knocking the PC out of the ball park on the first pass. my life has adjusted to the side effects, and that is now my new normal and reality. i sense that if i am pushed into the salvage radiation route, then the playing field is going to change once more, and then, of course, what if that doesn't work either? yes, i know i am getting ahead of the game here a bit. but being a former chess pro, i am use to thinking about things many moves ahead of where i am at, but with PC, that is grounds to drive one insane with worry, fretting, and endless what ifs.

right now, this stupid catheter hurts like the hades, i am sick of it, it annoys me endlessly. i have to make it to next week, and then really really trust my dr/surgeon with his laser skills . weird to think that after i am knocked out, they will scope me again, dialate me once again to make room, have video capabiltiy, and still have room to move in the laser surgical equip, all in a tube that fits inside my urethra which isnt large in diameter to start with. i am hoping and praying that it doesnt make me start at square one on the incontinence trail, since i have been 100% dry for some months, or worse, leave me that way. and i hope that my future pee flow will at least somewhat resemble what i had before all of this.

sorry for the rambling, but lot going on in my head right now, its surprising that i am not a drinking man or a user of illegal drugs, i deal with all this unpleasanty being completely straight. perhaps i am the fool for that standard.

but i will keep up the good fight, as long as i have the ability and mindset to do so, which i am hoping will be many more years.

david in sc, deep in thought tonight
Posted 8/13/2009 12:33 AM (GMT 0)
Hi David,
I waited all day to get your test results. Sure wish it was better news.

Regards,
Bob
Posted 8/13/2009 1:45 AM (GMT 0)
David; you are in my prayers.
Posted 8/13/2009 2:05 AM (GMT 0)
Hi David,

I'm so sorry for the news, but happy that you shared it with us and your follow-up feelings today.

All I can say is that you are working your plan.  I know that doesn't solve the problems, but it does give you direction.

I believe the thing to do now is focus and get your urinary system as healthy as possible.  I think that positive results from your upcoming surgery will go a long way of getting back on track with your plan. 

I suppose your doctor believes he's the best for this surgery.  If he does not, you may wish to ask him who is.  Your prior feedback from him sounded to me that he knows what he's doing here.

As far as the salvage radiation is concerned, I have read that it is most successful with people like you who had a low PSA right after surgery and minimal positive margins.

You may find this article interesting:

http://jama.ama-assn.org/cgi/content/abstract/299/23/2760

Here's a clip from the above article:

"Conclusions: Salvage radiotherapy administered within 2 years of biochemical recurrence was associated with a significant increase in prostate cancer–specific survival among men with a prostate-specific antigen doubling time of less than 6 months, independent of other prognostic features such as pathological stage or Gleason score. These preliminary findings should be validated in other settings, and ultimately, in a randomized controlled trial."

I hope that helps.

Our thoughts and prayers are with you!

Barry (Idaho)

 

Posted 8/13/2009 2:06 AM (GMT 0)
thanks bob and down not out, every kind word helps

david in sc
Posted 8/13/2009 2:11 AM (GMT 0)
David,

I'm sorry to see your PSA inching up. It seems that PC may be showing its ugly head again. As has been mentioned, you have time before it reaches a critical juncture so, take care of the urinary problems first and then deal with PC. We are all pulling for you.
Posted 8/13/2009 2:27 AM (GMT 0)
David,

Nothing to say that hasn't already been said. Just know that I like everyone else is pulling for you. Just reading through this forum can give us hope seeing guys who have been beating this monster back for years. Your gun is not out of bullets yet.

With my Gleason 9 I am watching your progress closely, because I fully expect to see a very similar path. I see BARR posting PSA rises after 12 years, so with my G9, I will not be surprised.

In spite of your modesty, your sincerity, and transperency really does help us all. Like all of us, there are times I am sure you just want to be alone and cry, but you continually tell us what you are feeling and thinking. Thank you !
Posted 8/13/2009 2:54 AM (GMT 0)
Hi David, sorry the results went the wrong way, was feeling a bit down myself after meeting with the Oncologist this week, but after posting my thoughts in this wonderful support group, I, like you, can call on the strength and care of our fellow members.

All the best, Mal.
Posted 8/13/2009 3:12 AM (GMT 0)
Hello David,

I really do not have any advice to offer. Just wanted to say that I have been following your posts here. I sincerely hope that things turn around for you and soon. Keep your spirits up.

Don

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