PSA Rising 5 years after Salvage Radiation

I was diagnosed with Gleason 8 (4+4) 1n 2004. It took 3 (12 needle) biopsies to finally find it with 2 cores. I had a laparoscopic RP at Memorial Sloane-Kettering Cancer Center (MSKCC) in Manhattan in 2004. Clean margins etc.

My PSA was less than .1 for 46 months and began to climb. I struck early with IGRT by the time my PSA hit .17. This was early 2009. My PSA dropped immediately (eventually to .02 and stayed there for a while.

Now, 5 years later my last 2 PSA readings have gone .06 and .10. The last two were 6 months apart.

I am 64 and otherwise in very good health and taking no meds.

I now have to educate myself on the next phase of where I go from here. I suppose I will have a consultation with Dr. Michael Morris, Oncologist at MSKCC I know enough to know that at this stage the way becomes even more controversial of when and how to proceed with hormone treatment. I think Dr. Morris is also somewhat involved with some work with targeted nuclear medicine ??? I know PROVENGE is only given when they can prove metastatic disease and I am not at that stage yet with my .10 PSA.

I welcome any informed input and opinions.

Thanks

With your cancer progressing very slowly, it's usually possible to keep it well under control..PSA doubling time is an important indicator of survival and yours is measured in years...

The next treatment step they will recommend will probably be hormone treatment which while very effective but comes with a heavy side-effect load...If you have not checked in with a Medical Oncologist, now would be a good time to do so..

Tiercel,

I am also a patient at Memorial Sloan-Kettering. I am about five years "behind" you in my treatment cycle, having surgery upstate in 2009, then moving my case to Sloan in late 2011 when surgery had clearly failed. I undertook SRT (to both the prostate bed & pelvic lymph) along with HT at Sloan in the winter of 2011-12. My history is below; key numbers almost identical to yours.

The first physician I met with at Sloan was Dr. Michael Morris. We met three times, he was excellent, more than excellent. Generous with his time, frank, a caring and profoundly experienced physician. As you probably would expect my case is now being handled at radiation oncology; my latest PSA in June returned "undetectable."

Last month a major finding was revealed at the annual meeting of ASCO (American Society of Clinical Oncology) about treatment when surgery and SRT have failed, such as you express concern about your latest numbers. Dr. Morris was quoted extensively in the article I read. The finding was that adding the chemotherapy drug docetaxel to standard hormone therapy significantly extended the survival time of patients. Dr. Morris and others called this a major breakthrough and finding. I would expect that Sloan may be adding this approach to their treatment protocol, so encouraging was the study. You can find info on the web about this study by searching "docetaxel and prostate cancer."

I have been very grateful about my treatment at Sloan, particularly as things were not looking so great back in the summer of 2011. I do not consider myself "cured," but could not have asked for better care and outcomes. I am sorry for your latest numbers, but you could not be in a better place. I wish you well!

Newspaper Lover
Age 70
11/09 DaVinci surgery upstate NY; nerve bundle taken; clean margins, clean seminal vessels, no incontinence, alas no erections.
06/11 PSA re-emerged.
Gleason 8
Time to recurrence 18 months
Three month doubling time (summer 2011).
PSA rose from .07 on 06/11 to .17 on 11/11.
09/11 hernia surgery to repair hernia resulting from the DaVinci.
10/11 Moved management of my case to Memorial Sloan-Kettering in New York City.
12/11 Started hormones (Lupron/Casodex).
02/12 Began radiation (SRT), including pelvic lymph. 40 sessions.
03/12 Last Lupron shot.
04/12 Finished SRT.
07/12 PSA and testosterone "undetectable."
01/13 PSA “undetectable”; testosterone (T) level at 452 ng/dl.
07/13 PSA “undetectable”; testosterone (T) level at 444 ng/dl.
01/14 PSA “undetectable”; testosterone (T) level at 435 ng/dl.
06/14 PSA “undetectable”; testosterone (T) level at 444 ng/dl.
Have received no treatment since spring of 2012.
Started “Paleo diet” in 2013. Only eat what I plausibly could have fished, hunted, or gathered 40,000 years ago (but not with current skill set). No processed food of any kind. No sugars. No starch. Feel physically strong and best in years on this diet.

Thanks for the great replies,

Have there been actual cases of "cure" or even significant PSA reduction with radiation after metastasis ?

I have heard that a C-11 PET/CT scan is the most sensitive test for PCa. I would like more information such as

1. Were in the North-East can I find one ?
2. How high does PSA usually have to be to detect PCa ?
3. Is it covered by insurance or medicare? If not, what is the cost?

My PSA was up to 18 once prior to surgery so I certainly do not have any rare non-PSA producing disease.

It also seems to me that if it took 46 months to get a detectable PSA after surgery, and if salvage radiation to the prostate bed knocked that PSA from .17 to .02 for 5 years that it is likely not metastatic at this point and is likely microscopically lingers in the prostate bed.

Post Edited (Tiercel) : 7/15/2014 9:06:08 AM (GMT-6)

In fact, here's a clinical trial at NIH you may be eligible for. It seems like you may qualify for "Group 2." They are trying out a new PET tracer, and the cost is probably zero or covered. It may be worth a day trip to Bethesda, MD for you. You can call their contact number to see if you qualify.

18F-DCFBC PET/CT in Prostate Cancer

Tall:

 

I always enjoy and learn from your erudite posts.

Regarding the clinical trial, I assume a participant cannot choose the placement group. It's random, right?

 

Also, the concept of a cure is intriguing. Take my situation. Failed surgery, SRT. So far, scans have been negative and HT has knocked the beast down. I am now off HT, but the PSA is unfortunately showing signs of life as my T starts to return. Ok, when my T gets above 2, I will probably go to Mayo for the C-11 Choline scan. Now, my question. Is it conceivable that they find the cancer in one or two or even three places, zap it, and hence effect a cure? My guess is that such a possibility is extremely remote, as there must be micro-mets all over the place. But, given the scenario in this thread, maybe the answer is yes.

 

Any thoughts?

 

Mel

Tall Allen said...


Gleason 4s and 5s (unlike Gleason grade 3) have the ability to leave the prostate environment and survive elsewhere. Cells could have escaped at anytime - before, during or after surgery and survived in an impervious, non-dividing phase of their cell cycle. They don't release PSA until they divide and grow. Nasty ****ers!



- Allen

I know, good description! That is why I do not like them one bit, and wish them harm! I'm sitting here with my
< .01 a few months post op, but not at all feeling over confident about that fact. I actually am more surprised than over confident. The evil buggers will have plenty of time to cause mischief if other unrelated things don't get me 1st. Nothing I know of yet. But back in 2007, I had a buddy, about 5 years younger than me who had the RP a few years earlier. Then had the Penile implant. I don't know what his G scores or path report was like. But he had no other apparent health problems that I knew of. He died of a stroke at age 51. Sorry, off topic I guess.

Tiercel,

I participated in a 18F-DCFBC clinical trial at NIH last month. The objective was to identify the root cause for a rise in my PSA after having a prostatectomy 8 years ago. In October 2014, prior to the clinical trial, MRI scans were obtained at 3 Tesla using an endorectal coil and phased array surface coil. Radiologist found a subtle low-intermediate signal intensity soft tissue lesion about 0.6 cm, within my prostate fossa. The PET 18F-DCFBC scan performed last month confirmed the results of the 3T MRI. I am pursing SRT at MSKCC, NY. An appointment is scheduled with radiology in late January 2015.

I would appreciate if you would share, briefly, your experience, over the past 5 years, with side effect due to salvage radiation?


Lath


Pre-op:
Diagnosed 9/2006
Radical Prostatectomy 3/2007 at MSKCC
PSA 3.6 ng/ml

Post-op
Gleason 7 (3+4), pT2b., negative surgical margin, LNI and SVI

Current Status
Biochemical Relapse: 76 months after Radical Prostatectomy
Current PSA: 0.32 ng/ml, PSADT: 20 months