First Post SRT PSA & Radiation Oncologist Visit

My last PSA prior to SRT was .16 as a reference.  I went by my uro and picked up the delayed test results, and my first post SRT came in at .12.  Didn't know quite how to interpet the number, figured it would be more of a new baseline.  By percentages, it went down 25%, but we are talking microscopics amounts of PSA to start with.

Then took that to my Radiation Oncologist.  She said she was worried that it might have continued to rise, indicating a non-local event.  But she was hoping for a clean knock out blow, she fully expected it to come well under .10 limit for the zero club.  She said unfortunately, there is not much chance of it going down any lower.  She wants to do another PSA by my Uro in April, 3 months out, she said if it stays where it's at, I could be ok for several years, but if it goes up even a 1/100th, or .01, then I would be on way to recurrance again.  I already knew if that happens, I was out of curative means to deal with it.  So we didn't discuss that.

She reacted the same way my uro/surgeon reacted when my first Post Surgery PSA came in at .05, and not lower, he pretty well knew it would rise.

She is a big believer in the dangers of Gleason 7 from a predictability vantage.   Depends how much "4" cells are floating around.  Some apprerently are far more agressive than others.  Both doctors feel the same way about that, and both prescribed  to the real danger in the PSA velocity theory, and in doubling time.

Nothing more I can do on the physical side of my PC at this time.  Three months, I will get another PSA, and hope for the best.  I am hoping for a cure still, or at least a long repreive.  If not, and the ugly beast re-appears in my life, its my intention to let nature run its course.  Probably get some flack for saying that, but have been giving a lot of thought about my life and quality of life issues, and what I have been through so far.

No disrespect to any brother on HT, short term or long term, I know it can help lengthen one's life when in need, or help shrink tumors to more managable sizes, but at this point, I don't want to go down the HT or chemo path.  You guys have seen how ultra sensitive my body is to this journey at each step of the way.

I don't want to be a perpetual patient the remainder of my life.  My next goal, and it will start next Monday, a week, I will be with my uro/surgeon about getting this annoying and painful SP catheter out of me.  Current thinking is still to have a quick day surgery procedure, he can remove this, dialate and re-open my bladder neck ,and insert a Foley catheter for healing purposes, all while I am safely blacked out into the next world.  Don't want another traumatic and painful even in his office.

Not giving up, just accepting what my reality is right now.  As we all say often, it is what it is.

David in SC

Hi David.........sorry you didn't get the knock out result you were looking for. We were praying for better. Since I'm not well versed in the nuances of SRT, is there a chance that there is a delayed effect to the radiation, and hence a possible decrease in the PSA#?.......that it could go down in the ensuing 3 months? I certainly hope so. Not going to try to change your mind or comment on your choice to perhaps forego further treatment. I get the quality/quantity issue. I've done the hypotheticals for myself; imagining scenarios and such. You and I are the same age (although with very different stats)---presenting a really tough decision for one to make. Get the catheter out, check the PSA in 3 months, then revisit, eh?

take care,

Arnie in DE

Thanks, Dallas

Arnie, if I still had a prostate, it would be normal to maintain some level of PSA after radiation, and with many that use RT as a first line of defense, you can even get a "PSA Bounce" where it can go up after x amount of time. That is because you still have a prostate producing legitmate PSA.

My doctor(s) had indicated in this salvage situation, that there should be no reason to indicated any PSA at this point, assuming that the cancer was still located in my prostate bed, and assuming it hadn't already escaped prior to radiation.

Not blaming the doctor, she gave me a big dose of radiation for a secondary treatmet, at 72 gys. She did that, because of my previous PSA and velocity issues, hoping to knock it out of the park.

She felt strongly that it would not be realistic for it to drop anymore at this point, that it would better to think of it holding its own in the future. Time will tell.

I have known from day one, that the long term prognosis for guys with sharp velocity and doubling times aren't very good. There are plenty of studies of that.

Right now, more interested in wanting to get out of the patient mode, and let me have a chance to live my life without tubes and pain. This catheter has been in me now for 96 days, and that doesnt count the other 101 days of catheter time I have had since my main surgery.

There is no bitterness in my thoughts about this, I have just reached my limits of patience on the matter. Feel like I was the good patient, and did all I was told to do, but I have had enough.

David in SC

David I can only imagine the toll on your immune system during the past year. You've been pretty beat-up physically so I suspect as you recover so will your natural defense against any stray cells left. The jury is still out but I take the 25% drop as a positive sign (and that is what my radiation oncologist told me in the three scenarios... lower initial psa = good; the same initially = as expected; higher = not so good).

Our best,
Jake

Hi David,
I hope she is wrong and hope as time goes on your PSA continues to fall. I just keep wondering in back of my mind that perhaps she's comparing it with someone who was also doing HT at the same time as SRT.

Regarding the quality of life issue if God forbid the pc does come back, please at least consider intermittent HT.

Hoping the best for you.

Hi David:

I can't say I blame you for feeling the way you do after all you have been thru for the past year+.  I guess there is not much you can do for the next 3 months except get out of patient mode and hope for the best.  Hopefully, by then you will have recovered your strength and energy and will be prepared to face whatever you find.

I certainly wish you all the best and will pray for a speedy recovery period and good news in 3 months.  In the meantime I think your empathy for others has filled a real need on this forum and I know we are all pulling for you.

Tud

Hi David,

It would have been nice if your PSA reduction was a bit better than 25%. However, my situation is not un-similar to yours. My PSA, about 3 weeks after SRT, went down only 50% (.05 from .1), but went down to <.04 on  the next test 6 month later. So you see, your PSA may well be lower in 3 or 6 month from now. I'm going to the lab later today to make a donation for my next 6 month test. I'll see what the result is in about a week from now. Keep your chin up David. In 3 month from now your PSA may well be on it's way to zero. At least that is my wish for you from me, and I'm sure, from all the guys on this forum.

All the best to you David.

Magaboo

Mag, thanks and true enough. I will be anxious for my next one in April, I think it will tell me a lot more of what is going on this one. I was hoping for me, and obviously my rad. oncl. did too, but time will tell. Hoping a lot of things will be better by April.

Our situations have been very similar for sure, I stay concerned for you as well, my brother.

David in SC

Ray, thanks for your kindness too.

Mike, you have been and are a good friend, always appreciative of that fact. I can only report my doctor's thoughts and feelings, which I did above, and she absolutely doesnt believe in blowing smoke up peoples axx, and I a like that about her, my Uro is the same way. But she doesn't know what it will be in 3 months, and neither do I. Just being realistic about the situation. I plan to keep on keeping on, and helping as many as our brothers as I can, both new friends and old friends. PC is a tough road, even when it goes picture perfect. It's never easy, and all of us wish it probably never happened. Got to stick together. The sadest part about being here, and sure its a common feeling/reaction, is that there is an endless line of new brothers finding their way here, and unfortunately for many, needing to enter our group. But rather this be here, then for someone to go through all this alone.

I hope you keep going as well as you have been, you been a toughie really, and you keep on keeping on yourself.

David in SC

THanks Bro. Sonny, you seem to always have the right thing to say. Yeah, I think we are pretty well of the same mind set at this point. How you want to deal with it in the future, and to be able to devote your times and energy to Lynn is 100% understood by me. I plan to go 2 more PSA tests out from here, at 3 months more, then 3 months after, it should show me the general picture by then. I don't want it hanging over my head forever either. There use to be a lot of things I enjoyed doing, like to get back to them while I can enjoy them.

I don't literally mean this, but in some ways, I wondered what it would have been like if I have never had a PSA test or ever agreed to the series of biopsies I underwent. I would still be blissfully ignorant of what was going on inside my body, and still having sex the good old fashioned way, and thinking I would live forever.

Thanks for your friendship. you have been great ever since you arrived at HW.

David in SC

David,
I can understand perfectly your thinking on this after all the treatments and pain you have been thru. My thinking is probably in line with yours. Will start my IMRT on the 18th and we will see where it goes from there. I will stay positive and as our brother Sonny likes to say, live large. Wont waste many moments from here on out and will make it all count by taking the time to create as many memories as I can with family and friends. Rather go out like a meteorite than in a NH.
Take care my friend and hope that your next psa offers new hope as well.
Michael

Skeener, thank you. A PC path can have so many twists and turns, we never know what we are going to get out it. When you look at averages with things, it usually takes extremes on both sides to come out to "average". Just like with our treatments and procedures.
I will patiently wait the next 3 months and hope that my number either starts moving down (I dont care how slow it does either), or at least doesn't start inching up. I have used up my surgery card and my radiation card.

Michael, appreciate your thoughts on the matter. Cancer makes every person afflicted do a lot of soul and inner searching, about life and other matters. Can be a good wake up call too. Some men have revitalized a stale marriage after going through cancer, other's make major life changes, others get their families together in ways never seen before. I definintely know what is important in my life, and what isn't. I think its healthy to do some self reflection in our own lives.

David in SC

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Post edited to remove quoted material from another post that I had already removed for rules violation, resulting in this post becoming empty...sorry about that if I confuse you all...

Post Edited By Moderator (James C.) : 1/4/2010 5:19:16 PM (GMT-7)