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Posted 9/10/2009 9:17 PM (GMT 0)
It seems from reading on this forum and another one that I belong to their seems to be a difference on the acceptable PSA level after different treatments.

For example it appears the surgerical procedure looks for < .2

Radiation seems to favor < .5

One man I read from had the cyro procedure and he stated < 2.2

Is there a reason why the different procedures have different values?

The only thing that I can think of is with surgery we know the prostate is gone so the number should in theory be lower.

Just curious.

Larry

Posted 9/10/2009 9:20 PM (GMT 0)
Hi Larry.  It does seem that there are different acceptable levels for post different treatments.  For surgery, I have always thought the goal was less than .1 and that as long as it was less than .2 you didn't really do anything.  If it gets above .2 is when you start to look at salvage radiation or another alternative. David

Posted 9/10/2009 9:36 PM (GMT 0)
Larry,

You asked a great question. More than once the conversation about this has encouraged me to go to the net and look. Okay so with your question I approached it once again. This time success.

Check out this link, it is the University of California at San Francisco. From their Urology Department it is a 40 page book "Prostate Cancer and It's Treatment.

Scroll down to page 24, "What if the Initial Treatment is not Sufficient", it explains in detail why the PSA numbers are different for the different forms of treatment.

http://urology.ucsf.edu/patientGuides/pdf/uroOnc/Prostate_Cancer_Treatment.pdf

Let me know what you think and if it answers the questions. It did for me.

Sonny
Posted 9/10/2009 10:17 PM (GMT 0)
If your primary treatment is conventional radiation or seeding, you still have a prostate, and it will still produce a higher, though small level of PSA.

If you have surgery, and no longer have a prostate, then in theory it should be zero, where the standard is <.10.

As far post surgery "lines in the sand", and I am researching different opionions, and about to talk to a 3rd radiation oncolgist on Monday, there is no one standard from what I can see. Some say at .10, you do something, I have heard first hand as high as 1.0, read about 2.0, but most seem to talk about .40 to .50 when things start to get serious enough for salvage.

Like everything in the wonderful world of PC, there is never a straight easy answer to anything, lol.

David in SC
Posted 9/10/2009 10:35 PM (GMT 0)
David SC....I agree to what you said. The savage radiation after surgery is best done before the .5 mark. From my reading radiation treatment outcome is the same for .1 as it is for .5. It begins to differ after the .5 and almost no benefit after the 1.0 mark (probably because it is systemic at that point). Thus for me, if I should need to go that route, I am going to hopefully (with doc's approval of course) wait until the very last minute so to speak before going into radiation treatment. My climb in PSA is very slow, so I think I will be on the safe side by waiting. I know lots of guys have gone through radiation with a breeze...but there are those that didn't. Even though they are a small number that had complications, I haven't figured out how some do and some don't and which group I would be in after SRT.

I just can't get my head comfortably around the radiation thing just yet.
Posted 9/10/2009 10:57 PM (GMT 0)
Les, me either. That's why I am meeting my 3rd radiation oncologist this coming Monday morning. The other two from the same clinic use the same reference that you did in a post surgery salvage radiation situation. They said that from .10 to .50, it is pretty well effective in most cases, but from .51 to .99, you lose 50% of the effectiveness, and from 1.0 and higher, not much point doing it. (Though we both know that there are exeptions to all these number they may pop up to the surface).

When I had my original radiation 9 plus years ago, it was suppose to be a fairly easy path. It turned out to be one of the greatest medical challenges of my life. I reacted poorly to it before the end of the first week of sessions, and it grew worse by the week. Old story on here, but ultimately, it required a full year of physical therapy just to make me reasonably functional to my former level. This many years later, I still have perm. residual effects from it.

So yes, while I very well may have to have it, again, I am a bit unnerved about the whole subject, thus taking my time, asking questions.
I am almost certain from talking to the other doctors and my own, that I will definitely have additional blockage problems if I undergo radiation, and you can only imagine how the thought of that rubs me.

Best to you brother.

David in SC
Posted 9/11/2009 4:15 PM (GMT 0)
Larry,

I'm that man from the other forum (cryo=2.2).

Failure is defined actually at nadir +2, so there could be a range of 2.0-2.5(cryo nadir of 0.5 or above is associated with likely failure).

The nadir +2 is the failure mark determined by Dr's Cohen and Miller who have been doing cryoablations since the early 90's. I personally cannot accept that high of a psa to wait and Dr Miller gave me the choice of acting on my rising psa much sooner (which I will). 

Posted 9/12/2009 12:54 AM (GMT 0)
Larry,

My primary treatment was radiation no surgery. The numbers given to me by my oncologists and supported by my own research indicated that a nadir of .5 or less bodes well for radiation treatment as a stand alone. Also the longer it takes to get to that nadir the better and more durable the result. Twenty four to thirty six months. If it does rise but remains stable below 1.00 then that is also good news for a radiation patient. At a PSA of 2.0 it is generally considered that the treatment has failed. There is also the three consecutive increases to consider as well.

I am also doing hormone therapy, single agent, as it has been shown to improve the odds for advanced cases. I just had my fifth Lupron shot and one year radiation follow up this week. PSA was down slightly from a few months ago. I would like to see it keep going down but time will tell. The hormone does confuse the issue for radiation nadir as some patients get to extremely low PSA levels on hormones alone.

Take care and best of luck to you.
Don
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