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Not so good news 2 1/2 years after seeds

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Posted 4/3/2014 4:19 PM (GMT 0)
What a difference 6 months makes! Well, my urologist seems concerned. He thinks the PSA should be down much lower by now. Near 0.3 or close. Says another biopsy might be in order, or a bone scan or a CAT scan to see what we are dealing with. But they could all come back clear and still with the PSA up, there is something going on somewhere. He gave me the option of checking now or waiting 6 months and getting another reading. I chose to wait the 6 months and see what that reading is. If I have the biopsy and it is still local, in the prostate, then Cryotherapy, freezing the prostate though needles, would be a possibility. If it has spread and my PSA goes up, then hormone therapy may be in order. So not good news, really. I'm hoping that my next reading is lower of course, but I'm not really counting on it when I look at my numbers for my past readings. Not really going steadily up though if you throw out the 2.1, but including it, it has. If it does go up next time, I'm not sure i would do anything though. Should I have chosen a different treatment? Who knows with this disease? You can't go back, so why look back? I'm happy with the treatment I had. I've have had a great three years and I'm not going to die today or tomorrow. No matter what the outcome, I'm happy to be alive and enjoying life. Funny thing is, I'm in the best shape I've been in for a while. Something to ponder for a bit.
Posted 4/3/2014 4:35 PM (GMT 0)
G6
Here is wishing you get back on the downward trend, good luck and keep us informed!
Posted 4/3/2014 5:02 PM (GMT 0)
I am not distributing medical advice or promoting services, but...

Infection, or as it would be referred to in your case post-irradiation prostatitis, is a consideration; including possibly a persistent, viral prostatitis which is difficult to resolve with antibiotics.

You did not remove your prostate, and so infection remains a possibility particularly in the first hand full of years following treatment.  Your elevated pre-treatment PSA may have been simultaneously influenced by proteins created by infection; this is likely true for many men diagnosed with prostate cancer and particularly influential (unknowingly) in men diagnosed with low risk prostate cancer.

Are you experiencing any urinary symptoms?

Posted 4/3/2014 5:05 PM (GMT 0)
Thanks. I guess this is a case where I wish I did have some symptoms of an infection, but nope, everything is working fine.
Posted 4/3/2014 5:08 PM (GMT 0)
I thinking about scheduling an appointment with my radiologist to get his opinion, although maybe the urologist is best qualified. Not sure.
Posted 4/3/2014 6:01 PM (GMT 0)
G6, I certainly get your concerns at this point but still would be hesitant to push any buttons yet. Eventually, your nadir should be something less than .5 according to conventional wisdom. Conventional wisdom would also say that you don't have BCR until you have three consecutive rises in PSA after you reach the nadir (whatever that may be). By the latter definition you do not have BCR. And, your PSA remains stable. Perhaps your nadir is in the 2.5 - 3.0 area which, while generally high, is not unheard of. Some docs believe that anything that low after brachy still indicates "cure" if it stays that way for the long term - especially for a G6 patient.

So, unless your downward trend continues when you get your next PSA tests, you likely have some prostate left that is generating a fair amount of PSA (unless NKinney's thoughts about infection or prostatitis are right - which could well be the case).

Given that you were a G6 and could have opted for AS, the chances are still good - in my non-medical opinion - that you are ok. I would schedule a meeting with your brachytherapist at this time however. He/she may have more extensive experience than your urologist with these matters. Certainly his/her opinion should be sought for additional input. (BTW, sometimes it takes 10 years to reach a nadir. I'm almost 6 years out and have not yet bottomed out).

Please keep us up to date - we are pulling for you!

Jim
Posted 4/3/2014 6:24 PM (GMT 0)
Thanks for the input Jim. I seeing my radiologist at this point is a good idea.
Posted 4/3/2014 7:58 PM (GMT 0)
I think the official standard for BCR is nadir + 2.0 for the PSA.  I believe the 3 consecutive rises is no longer used in radiation patients.

My numbers are almost identical to yours.  It is very discouraging.  In fact, I am over a month late in getting my next PSA.  I could not bare another disappointment.  My brachytherapist who is considered one of the best, believes I am still ok.  He told me that in his experience, 15% of brachy patients nadir in 4 years.

He told me that they hover around 2 for several years than fall below .5 in 3-5 years.  I hope he is correct.  I tend to be cynical however.  I do trust him and he is extremely knowledgeable.  I think you made the correct decision to wait 6 months.

Hopefully, both of us will fall soon and be able to help other men that follow our pattern rather than the typical precipitous fall within 1 year.

Jim is correct.  My doc told me that he has a small percentage of men that nadired around 2 and has been there for over a decade.

Paul

Posted 4/3/2014 9:29 PM (GMT 0)
Has to be disconcerting. Hope the next one is lower.
Posted 4/3/2014 10:13 PM (GMT 0)
G6,
You mention the possibility of another biopsy. Don`t the embedded seeds interfere with the biopsy probes? I hope you are able to get things under control.
1snake
Posted 4/3/2014 10:22 PM (GMT 0)
Good question! I'm not sure, but I would hope my urologist knows!
Posted 4/3/2014 11:03 PM (GMT 0)
Hoping and praying your next reading starts a new downward trend, so that you don't have to make a secondary treatment option.

David
Posted 4/3/2014 11:27 PM (GMT 0)
While you do not have an official biochemical recurrence, there are some non-invasive steps you can take while you continue to track your PSA response.

Prostatitis is often symptomless. Unfortunately, it is also often unresponsive to antibiotics, but you can ask your Uro if he thinks it's worth a try anyway.

You can discuss a PCA3 test, although insurance may not cover it. Since it requires a prostate massage anyway, they can check the urine catch for pathogens, killing two birds with one stone.

Do you have any reason to believe your seed coverage was less than optimal due to poor placement, seed migration, or hypoxic areas? Did you have a 30-day post-placement MRI to check coverage? Perhaps you may want to consult with a different brachytherapist (not one recommended by your first doctor), and get an MRI, perhaps a 3T mpMRI. It may identify areas suspicious for a future biopsy.

If it comes to salvage someday, salvage brachy may be a less toxic option than salvage cryo.
Posted 4/3/2014 11:58 PM (GMT 0)
Purg, thanks for your thoughts.

Tall Allen, good suggestions. My brachytherapy doctor did come from a Mayo doctor recommendation and has a lot of procedures under his belt, as well as teaching, but it may be best to see someone else for a second opinion. Thank you
Posted 4/5/2014 5:03 AM (GMT 0)

Gleason 6 said...
Purg, thanks for your thoughts.

Tall Allen, good suggestions. My brachytherapy doctor did come from a Mayo doctor recommendation and has a lot of procedures under his belt, as well as teaching, but it may be best to see someone else for a second opinion. Thank you

G6, sorry to hear this, but it may still be OK. My understanding, from talking with some seed/EBR combo guys was that while it could go down pretty quick, it also could take quite a while, and it didn't have much negative connotation if it took longer. I'm thinking they told me in some cases it could take 2 or 3 years to reach the nadir, if memory serves.
Posted 4/5/2014 5:34 AM (GMT 0)
G6,
Just want to wish you the best!! Sorry that you are having anxiety and I sure don't have an answer. I'm sort of with Tud; maybe it will take 4 or 5 years to go down or you may die at age 95 with a psa of 2.8--lol (sorry).
Yoop is the "seed man" and had a rockstar in ChiTown do the deed to him; he could put you in contact with this Dr and maybe do a phone consult...All the best!
Bill idea
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