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Posted 4/12/2010 3:34 PM (GMT 0)
Doctors office called and said the doctor wasn't concerned about the results of my latest psa test.  Said see you at the next 6 months test.

Could use some forum opinions on this.   My take is that with the current velocity, I will be at the .4 mark in six months and I also understand that the success of radiation would be about the same, so should I be concerned by waiting or not?

Currently I don't have a problem with the advice of the doctor nor waiting...but was just curious as to others take on this.  It seems from reading some members profiles, some have gone on to radiation earlier than others.  What was the criteria...personal preference or doctors protocol and the reasons?

Thanks,

Posted 4/12/2010 3:49 PM (GMT 0)

Les,

I would make another test - what do you have to loose?

Posted 4/12/2010 4:20 PM (GMT 0)
Les,
Some Doctors like Dr Strum believe that a consistant rise in the ultrasensitive psa indicates a reoccurrance a year or two before it would show up on the regular psa. This is the value of the ultrasensitive test. There is also reason to believe that the earlier you get radiation (while the psa is at its lowest levels) gives the best chance of success.
It's like everything else in PC; you have to make important decisions with very little data. If it were me I would get another psa test to confirm the last and if it is still high would go with the radiation ASAP.
JT
Posted 4/12/2010 4:50 PM (GMT 0)
Les,

I'm probably one of the least studied on PCa on the forum so take my experience as such. Once I hit .2 we agreed that I would go for a consultation with the radiation oncologist only after my psa went above .2 but we would shorten the psa test cycle to every two months. Within two months after my last .2 result my psa had risen to .3, saw the radiation guy and did one more test to confirm the .3 before starting radiation.

Some advise starting earlier and some advise starting later, for me I wanted to wait until I felt solid evidence of a recurrence was established so the back to back .3 within two months was my line in the sand. During radiation and at the end of week 5 of 8 weeks, my psa was tested at .4 (rising from .3 just before the start of radiation). So in my case, starting sooner was probably a good idea.

At any rate, like others have mentioned, I would not wait 6 months for my next psa test but shorten the test cycle to at least 2-3 months to confirm the trend.

Our best,
Jake
Posted 4/12/2010 4:58 PM (GMT 0)
I am off to IGRT with a PSA of "undetectable". The surgeon wants me to do it based on the Gleason 4+5, pT3a, and mutiple extensions & positive margins. He expects that it would just be a matter of time.
Posted 4/12/2010 5:28 PM (GMT 0)
Hi Les,

My PSA level started to increase about 15 month after my open RP. It was a slow but steady increase (see my signature). I drew the 'line in the sand' at .1. At .08 we (Uro, Onc & myself) decided to go for the SRT. At the start of SRT my PSA was .1. I've decided to start radiation so early because it is my understanding that it has the best chance of success when started as soon as a recurrence is suspected or confirmed. I'm don't know whether I did the right thing or not by starting SRT so early, but that's my story and I'm sticking to it :-).

I don't know if my experience is of any help to you, but if was you, I wouldn't wait for the PSA to rise to high! Keep a close eye on it.

All the best to you.

Magaboo

Posted 4/12/2010 7:08 PM (GMT 0)
Les,

My uro suggested talking to radiation oncologist when my PSA rose to 0.13 near 3yrs after surgery...   A factor for BCR (reccurrence) is 0.2 PSA or also 3 consecutive rising PSA's.    I would retest and if still elevated, seek a second opinion.  Also ask your doctor what factors he would consider as a reccurrence.   I finished my SRT about a month ago...   My numbers are in signature.  I am also of the personality to hit it quick also.   Others may feel differently.

pasayten

Posted 4/12/2010 8:48 PM (GMT 0)
I agree with Pasayten and other who have suggested another test, soon.
Based on that, you might want to consult a radiation oncologist right away.
Six months is way too long, in my opinion.
I actually LIKE urologists and think by and large they try to do the best thing for their patients. One area where mine let me down was in post-surgery PSA vigilance. He was too nonchalant. I hit 0.2 six months after surgery and he had me wait 4 months for another PSA. In hindsight, I should have just had the test earlier on my own. As it was, my PSA tripled in 4 months. By that time it was Christmas/Hannukah and it was difficult to get the consultations (medical oncologist, radiation oncologist) I needed in a timely manner. My PSA edged up another notch to 0.7 by the time radiation started.
In a lot of prostate cancer situations, time isn't critical. But when considering salvage radiation, it is just that. I'm not sure urologists as a whole have gotten that message.

Best wishes.
Posted 4/12/2010 8:56 PM (GMT 0)
Hey Les:

My two cents. Due to my pre-surgery PSA velocity, there was a lot of concern post surgery when I started rising. I went into salvage radiation very reluctently at .16. All 3 rad. oncologists I spoke to thought it would be dangerous to sit and watch mine rise rapidly post surgery. I had my doubts about that strategy, and doubts about the strong regieme of radiation I was given, but now that the miracle happened for me, getting my most recent post SRT PSA of .04, starting to make a believer out of me. No guarantee mine will stay low, but I will take this for now, gives me lots of breathing space.

For you, with your specs, I would not sit and wait for it to double again, if it were me, I would be starting the process for salvage radiation now. Even my own uro, was concerned right out of the surgery box when my PSA started going up right away, and he's not even a radiation guy.

I got your back, no matter what you decide.

David in SC
Posted 4/13/2010 12:45 AM (GMT 0)
Les,I think 6onths is a long time in between PSA tests. I would suggest a test in 2 months and see what kind of results you get and go from there.
Posted 4/13/2010 1:14 AM (GMT 0)
Les, I had RT after the nine month check showed it had doubled, and now it is back down to .1. Doc said wait six months and we'll do it again. I'm going to have it checked at 3 months just for my own peace of mind. Primary doc should be able to draw the blood in his office and you can usually get the results by the next day. Don't wait for the doctor to decide for you, do it on your own. I think you'll be glad you did.

Bob
Posted 4/13/2010 1:29 AM (GMT 0)
If you distrust the advice of the qualified medical personnel who have been treating you, find others in whom you can find confidence.  It will be a mistake to substiitute the advice of unqualified opinions with the trained personnel.  That's my advice.
Posted 4/13/2010 2:20 AM (GMT 0)
mavica,

les already stated that he didn't have a problem with the advice of his doctor or waiting.

and it was les that is asking for "group" opinions.

so where's the problem? so is your advice about advice also a mistake?

David in sc
Posted 4/13/2010 2:59 AM (GMT 0)
I beg to differ.  His Asking for advice from the group is a strong indication to me that he doesn't trust the advice of the medical professionals advising him.  Yes, people here are well-meaning - but placing your health care in the hands of amateurs is not a wise thing to do, IMO.  To each his own.   
Posted 4/13/2010 12:57 PM (GMT 0)
"Currently I don't have a problem with the advice of the doctor nor waiting...but was just curious as to others take on this."

Mavica, that is the exact quote from Bro. Les. Letter for letter. Why put a negative twist on his post, he spoke well and openly for himself. Sounds like he has plenty of faith in his doctor, and the current plan, but being part of a group like this, just wants to hear the thinking of his fellow brothers. Why read anything else into it?

With few exceptions, the vast majority of all men here are very compliant to their doctors and others on their personal medical teams.
We know we aren't doctors or professionals in the field, people answer in the spirit that HW encompasses.

Les, great question. See you are getting a good range of answers.

David in SC
Posted 4/13/2010 1:23 PM (GMT 0)
Sorry for the delay in answering those that reponded...computer crashed. Anyway thanks to all.

Mavica...I don't have a problem with my urologist, nor do I have a problem waiting. My question was centered around why some folks have gone on to radiation therapy in the salvage setting at low psa numbers and others that have waited until the numbers were higher. So I had a curosity as to why...was it the doctors protocol or was it the patients desire to move to salvage therapy. And the follow-up question was why.

Learning from what others have done is the basis of this forum. A person is going to get very sound advise and recommendations from his doctor, but as you can tell on this forum alone, that many men go in different directions, sometimes even against their doctors preference. And why that happens is why men like me ask the basic question..."What would you do in my shoes?" Does that mean I don't trust my uro? Not at all. Many men question what their doctors are suggesting, and come to find out that the doctor was correct in what was recommended, and sometimes they find out they need to ask a few more questions. By asking questions...I am in control of my disease.

For what it is worth, I did search this subject right before the computer crashed and what I learned from several studies, is that PSA velocity as well as Gleason score, psa prior to surgery and time to recurrence is the driving factors for salvage therapy. Based solely on my numbers, my uro is following the protocols that were suggested by those studies. If psa doubling time is greater than 3 months ,then psa testing is recommended to be as far apart as reasonable (suggested 6 months in one study) over a period of time to establish whether or not treatment is even necessary for the recurrence. Much like the recommendations for Active Survellience for low risk patients when initially diagnosed, the same applies to low risk recurrence...which my numbers right now are considered to be low risk. Men can be over-treated in the salvage setting too. If and when the numbers change, action will be taken as recommened by my doctor.

Again thanks to all that responded, this is what this forum is all about.
Posted 4/13/2010 4:00 PM (GMT 0)
Mavica,
There are only a handful of doctors that I would trust to come up with an accurate recommendation for a complex PC case. The unfortunate situation is that 99% of the doctors treating PC only have a basic understanding of it and much of their information is 5 or 10 years old.
There are guys on this forum and and other forums that know much more than the average urologist or radiologist and their input is valuable.
JT
Posted 4/14/2010 3:25 PM (GMT 0)
As each of our cases our different do hope this may help you to make your decision.  I too was diagnosed with PC in 1999.  PSA had gone from 4.0 in 1998 to 6.4 in 1999. I opted for surgery.   My Gleason after surgery was 7 (3+4).  My readings though after surgery stayed at <0.1 until 4 years later when it began to rise and reached .1.  It rose very slowly for 4 more years finally reaching .7 in 2007.  I opted for radiation at City of Hope using Tomo Therapy.  Since that time every test I have taken and my last one was 1 month ago has shown that my PSA is <0.1.  There are discussions and findings that indicate the sooner one takes radiation after surgery if PSA has risen, the better it is.  In my case I waited 8 years.  Hope all works out well for you.  Pat
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