support group--interesting topic

Thanks Mel, hopefully some useful information will come from the his speech. Let us know.
Michael

looking forward to what you learn

Well, we had our support group meeting tonight. I will invite Roadrunner to comment, as he was also there.

It was not a good meeting -- rather shocking, in fact.

First of all, the speaker went over a lot of basic stuff that I'm sure everyone knew (and certainlly most of the regulars on HW would know). He gave assorted scenarios and invited comments about what tx. would be best. I won't bother to elaborate. Basic stuff, but okay.

But then the question came up: person has surgery. PSA starts rising. At what level does one decide to get further tx. such as SRT. Well, he said 2.0. I questioned him on that, stating that 0.2, not 2.0, is often cited as a critical value. He INSISTED it was 2.0. The guy who asked this is in this situation. I think his PSA is about .09 or maybe 0.11. The doctor repeated quite a few times that the number should be 2.0 before starting SRT. As far as I know, 2.0 is the point where it's probably too late for SRT.

This, from a medical oncologist.

Roadrunner, did I lose something in the translation?

Mel

I KNOW my thinking is correct on this. Many of us have dealt personally with this.

I just can't believe a medical oncologist would make the statement he did, but as I said maybe I missed something

Mel

Mel, you heard the same thing I heard. The doctor said he was relying on treatment guidelines from the NCCN and that one should consider SRT after prostatectomy when the PSA rises to 2. I went to the NCCN website, registered and looked at the standard treatment recommendations. I haven't read the 50 or so pages that displayed on my IPad completely but what I did get through says that results from SRT are poorer if the starting PSA level is >2. I haven't found the 0.2 recommended value for biochemical failure and starting point for SRT in the NCCN guidelines as yet but maybe a doctor who participates in this forum can clarify things for us.

Road racer

compiler said... ...But then the question came up: person has surgery. PSA starts rising. At what level does one decide to get further tx. such as SRT. Well, he said 2.0. I questioned him on that, stating that 0.2, not 2.0, is often cited as a critical value... Mel, Perhaps I can clarify.  The way I've described this before (in the context of use of the ultrasensitive PSA test)  is to keep separate the patient monitoring for BCR (biochemical recurrence) threshold from the management decision-making threshold.  The management decision-making has multiple variables to consider.  The issue is starting SRT in a timeframe which is considered "early"...or at least earlier than was the former norm. You started THIS thread back in September of last year, and I will simply copy/paste a portion of one of my responses below, but you might need to go back to the thread itself to get the full context.  Here's what I wrote back in September, with the 2nd bullet containing the main point relevant to your comment above and bold added for emphasis on the key words: Coupla quick replies to the recent posts (obviously I'm not a doctor , just an avid reader): ·          Yes, there are variations in the definition of BCR.   There really is no more authoritative source than the AUA, which defines it as ³ 0.2ng/mL with a follow-up confirmational test result over 0.2.   ·          Separate (the verb, not the adjective) ultrasensitive PSA testing for patient monitoring from management decision making…they are not the same.   The very early possible trending that James might be seeing [reference to a James C post on his possible rising PSA and possible BCR] , for example, is not enough—from the work of the esteemed doctors referenced in the Choo report—to trigger SRT management actions.   There is no established “standard of care” for when to start SRT; but, when these reports speak of the benefits of acting early on SRT, they are talking about at the 0.5 to 1.0 ng/mL levels.   Not starting early generally means after PSA is above 2.0 ng/mL.   Furthermore, the report does also speak about SRT overtreatment which would occur with patients monitored by ultrasensitive PSA tests when the trigger for SRT is pulled too early; some increases at the very low levels of utrasensitive measurement capability are just natural variation (measurement variation plus biological variation) and will not result in BCR. Hope this helps clarify...   edit:   typo Post Edited (Casey59) : 4/22/2011 12:31:07 PM (GMT-6)

I fully agree, Mel. Unless he made an honest speaking mistake, I think that was bad advice to be spewing out.