Not even close to 0

I'm 5 weeks out from my RRP and had my first follow-up this week. The PSA test came back at 1.59, and a second one that was done to rule out lab error came in at 1.7. It's probably no big surprise that I'm a little freaked out. The doctor's office sent me an email saying they are recommending a Lupron injection and Casodex tablets. From what little I've read so far about hormone therapy, I am not at all thrilled. They also said that after I'm fully continent that they recommend radiation therapy.

After surgery the final pathology showed clear margins and lymph nodes, but with seminal vesicle invasion detected.

I had such high hopes that the surgery would be the end of it.

Pog:  First take a deep breath and relax as much as possible.  The next thing I would do if I were you is go get Dr. Smuffy Meyers book on Hormonal therapy, you'll understand a lot more about the therapy.  There are some people on this forum who pooh pooh HT but the alternatives aren't very palatable in my opinion. 

I've been on HT for one year and although it hasn't been a cake walk it also hasn't been the beast that some make it out to be.  Everybody does react differently to the therapy.

You'll probably do a couple of months of HT and then begin SRT, the HT will do a couple of things, it will probably drop your PSA to undetectabl and it will help weaken the cancer so the SRT will have an easier time of killing the cancer.  When you start SRT you'll probably stay on the HT for a total of 2 years and then stop and see where your PSA goes from there. 

That's basically what my treatment has been and it seems to be the norm.

There are some very promising drugs in the pipeline right now that may help many of us down the road.  A couple are Arbiterone and MDV 3100, they're both in clinical trial right now and the reports are very promising.

Good luck

David

 

Thanks, guys. This has been a heck of a week. I saw the local urologist (the surgery was done out of town) on Monday, saw the nurse practitioner for continence training and the rep for the vaccum pump on Tuesday, then had a trial with trimix on Thursday. I got the PSA results on my way out of the office. I had the repeat PSA done Thursday night and got those results this afternoon. On top of that, this is my first week back at work.

Pog:

Can you add a signature with your information (G score, etc.)?

Mel

Forgive my ignorance, but what would they be looking at with the color doppler? I recall hearing about it before, but I thought it was used for imaging the prostate. Since I don't have one anymore......?

Wait a second. You are only 5 weeks post surgery. You should be waiting 3 months before you determine if your PSA is undetectable. What was your pre surgery PSA? What was your post surgery stats? Did you have a positive margin? Etc. Everyone is jumping to conclusions at this point without enough information.

I also don't understand what "barn" you are talking about ed c. He doesn't have a prostate.

Post Edited (ChrisR) : 8/29/2010 6:09:04 AM (GMT-6)

Well, johns Hopkins says three months to first PSA. I think they have more experience then "anyone" here. Again what "barn" are you talking about. This makes no sense. If his PSA was 7 before surgery 1.7 might be reasonable at 5 weeks. Your PSA doesn't instantly disappear right after surgery.

Sephie where are you getting your data from that says his PSA is too high. Everyone washes PSA out at a different pace. What do you know that I don't that says his PSAis too high?

Post Edited (ChrisR) : 8/29/2010 7:04:15 AM (GMT-6)

I'm not saying he does not have systematic desease. Anyone of us could. What I am saying is 5 weeks is too soon to tell.

Here's hardcore med. info from Dr. Catalona (Chicago) quoted verbatim: "Management of Postoperative Biochemical Recurrence: Patients with detectable PSA (>0.1ng/mL) after radical prostatectomy usually have persistent cancer, although some have only retained benign prostatic tissue causing the PSA elevation. In the latter case, the serum PSA level increases slowly. Of patients destined to have biochemical recurrence after radical prostatectomy, approximately 50% of recurrences appear within 3 years, 80% within 5 years, and 99% within 10 years. Rarely, recurrences appear more the 15 years after radical prostatectomy.
The PSA velocity or doubling time, the interval from surgery to biochemical recurrence, and the Gleason score usually reflect how rapidly the tumor is likely to progress (Freedland et al, 2005) In many patients, progression occurs reatively slowly, and only about one third actually develop mestatstases (Pound et al, 1999b)"
The article continues, but it shows it isn't necessarily bad news with PSA still readable post-surg so soon. It also mentions how important immediate salvage radiation is for survival ("If salvage radiotherapy is planned, it should be initiated before the PSA level rises much over 0.5 ng/mL")

Forgot to list this keypoint summary from the same chapter:"Adjuvant radiotherapy shortly after surgery is most likely to benefit patients with positive surgical margins or extracapsular tumor extension without seminal vesical invasion or lymp node involvement. Patients most likely to have favorable respones to salvage radiotherapy are those with PSA recurrence long after surgery, slwoly rising PSA, low-grade tumor, and no seminal vesible invasion or lymph node metastases."
There's also a section of intermittent hormone therapy as being a reasonable alternative. There's a scarcity of data for hormone therapy's efficacy mentioned in the article.
Frustrating disease with all it's grayness. Wishing you good luck, Pog...

Chris - your anger/frustration/intolerance is showing in your posts above. No need for that. First rule here: you have to learn to agree to disagree. No one is an expert or a trained doctor hear. Your remark to Sephie is uncalled for, you owe her an apology. She is perhaps one of the finest women posters we have here, and you remarks do her a great disservice.

5 weeks is way too soon after surgery, I can't imagine any surgeon/uro wanting at reading at that point. My surgeon insisted on a full 90 day window to make sure all things are calmed back down.

Also, my doctor only uses ultra sensitive post surgery and/or if a patient is post-radiation. It only needs to read to .xx, not .xxx. The trouble with the <.1 readings, it may not show a recurrance trend until it jumps and rounds up over that range.

David in SC

It's hard to second guess Pog's Doc's. We don't know his PSA pre-surgery or his gleason score. His PSA may have been low and his gleason high. Also, it is troublesome that the second test came back higher than the first. SRT is more efffective with a lower PSA. Who knows what it will be at 90 days.

Pog, didn't see your stats before my previous post.I am not expert either, but with your gleason and postive seminal vesals many doctors would suggeste adjuvant RT. I know that Dr Walsh says it's advisable in his book.