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Posted 1/15/2015 10:55 PM (GMT 0)
Allen and others,

I have a problem in that the doctor who did the RP on me is diametrically opposed to the reccomendations of my oncologist, Dr Gross. Even to the way of measuring doubling time. Dr Gross says you cant measure doubling time accurately using an ultrasensitive test. For example, mine went from .13 on 8/15/2014 to to .23 on 10/22/2014. The operation was 12/10/14. Dr Ahlering, the surgeon, says that is doubling time. Dr Gross says no it would have to be something like 2 to 4 to 16 etc.
Dr Ahlering says external radiation is useless that there is no evidence of benefit and hormone that hormone therapy is a better approach. He quotes messing trial to sustain his view of hormone therapy. My first hand experience via my father with hormone therapy ( in the 90's) is that after a point it no longer helps and the cancer comes back with a vengance. Dr Gross feels waiting till the numbers are at 2. or 4. if they get that high then do something. Ahlering says get on it right away with HT.

Totally confused,

Damon

 

Posted 1/15/2015 11:32 PM (GMT 0)
Welcome to the forum{ we're all confused}, the treatment options are more of a crapshoot than the disease. Gross is right on the doubling times. Whenever there is new technology, a use must be found for it. Ultra testing is like the Navy airfield, that had an extra obstruction light, so they built an obstruction to put it on. This after many conflicting studies, so as to justify it. Its crazy I tell you, its crazy.. signature will help the others who will need it to give, the more accepted replies. BTW , based on your post both medicos are sending mixed messages.ex,while you psa is an ultra test it is close enough to gross's number to fit his criteria. Aherling's right on HT rather than Radiation. If this confuses you, again welcome to the forum.
Posted 1/15/2015 11:48 PM (GMT 0)
As someone who does low end lab work for a living, the most important thing to know that they won't tell you is this: "what is the limit of precision and the relative accuracy of the test". That means that any lab test is a plus or minus value within the limits of precision. Ultimately a "0" value is impossible. The correct way to report what appears to be a zero is actually a less than value, with the value being the precision limit.

Confused yet?
Posted 1/15/2015 11:48 PM (GMT 0)
Damon,

Perhaps you're confused because you've talked to every kind of doctor except the kind you should be talking to -- a radiation oncologist.

Ahlerling may be right that it may already be too late for salvage RT to be effective.This is hard for me to comment on because you didn't include a signature with your path findings. He is looking at your rapid doubling time (and it would be the same even if you hadn't used an ultrasensitive test), and surmising that there are already distant mets growing.

Gross may be right that it may make no difference in your survival if you start non-curative HT now, or if you wait until mets become apparent.

But I recommend you talk to a radiation oncologist (like King) who deals with this type of thing all the time to get a more informed picture.

- Allen
Posted 1/16/2015 12:16 AM (GMT 0)
Allen,

I just finished the signature hopefully it will appear. In case it doesnt I will cut and paste it below.
I fully plan on talking to Dr king about radiation awaiting a call back at this time. Ahlering's position isnt that its too late for RT but that it flat out doesnt kill cancer "only lowers PSA".

RP 12/10//2014 Dr Ahlering
path report (epstein)
positive margins
4+3=7
lymph node neg for tumor
PSA before RP 20
after
1/20/14 .1
2/13/14 .09
2/13/14 .02
3/17/14 .02
4/25/14 .04
5/19/14 .06
6/09/14 .07
9/15/14 .09
10/22/14 .23
11/21/14 .27
12/22/14 .33
Posted 1/16/2015 1:03 AM (GMT 0)
Well, I hear that Dr. Ahlerling is a very good surgeon. That is an excellent example of why we don't look to urologists for their knowledge of radiation oncology.

Now I better understand your situation - thanks. If you read my article about early salvage RT in the New Prostate Cancer Infolink, you'll see Dr. King's analysis (Kang et al.) where he shows that in men with positive margins (or pT3), if they hit a PSA of ≥.03, they always go on to hit a PSA of 0.2. You are, unfortunately, a shining example. He went through hundreds of patient studies to see how it progressed from there, so I'm sure he will have a lot of insight to share with you.

Your PSA was high, but it did get down pretty low after surgery, indicating they probably got most of it. The neg LN is also a good sign that it may not be systemic. And the fact that there were identifiable positive margins is actually a good sign - it indicates a local, and therefore, potentially curable source for the PSA rise. Tell Dr. King hello for me.

- Allen
Posted 1/16/2015 2:35 AM (GMT 0)
Will do. I have an appt scheduled for tues. He works out of the santa monica ucla which is quite close for me.
Dr Gross agrees I should explore radiation perhaps with adjuct 6 mo of hormone therapy. Perhaps Dr king could advise me on that too.

thanks for the help,

Damon
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