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Clear Margins with a .03 - What should I do?

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Posted 2/27/2016 2:28 PM (GMT 0)
After reading Island Time's post and replies it got me thinking again, and not in a good way.

What would you do with these post surgery PSA's? <.05, <.05, .03, .03 I had negative margins, relatively low tumor volume (8%) but higher pre-surgery PSA (9.75) and a GS upgrade to (4+3) from (3+4) post surgery.

Uro didn't see an issue, wanted to move me to 6 month PSA's. I declined, pushed for and got 4 more at 3 month intervals. At the very least I want to see if there is any kind of trend sooner than later.

Originally I planned to wait until the next PSA but after reading IT's post maybe I'm past that point already and should be talking to an RO now? No way to tell but was I .03 on the first PSA post surgery? With negative margins and .03 at nine months do I fall into the more aggressive disease category and SRT has very little chance of working? Should I be talking to both an RO and a MO?

I also had a stricture post RALP and now have an active case of Peyronies so I'm more prone to scarring. And while not proven, more likely to develop urinary issues if I elect SRT according to the doc that diagnosed the Peyronies. Only a year later and again facing impossible decisions with very little to go on.

Thanks for your input - Jon
Posted 2/27/2016 2:35 PM (GMT 0)
I think you are doing pretty well. Don't think you need to see an MO.
Hang in there.
Posted 2/27/2016 2:35 PM (GMT 0)
There's no harm in seeking expert opinions at this point and might be a good idea. I'd start with the RO, then find a good MO who does PC. I'd doubt they be ready to act until you move off .03.

But that just my thinking. I know it's an anxiety generator, but waiting a month or two and retesting might be prudent.

Andrew
Posted 2/27/2016 2:45 PM (GMT 0)
Ok, I don't see a problem here. You had two <0.05's, and then (I assume) you went to a different lab and have had two 0.03's. Nothing is changing. Your doubling time is infinite. Yes, I know that some practitioners suggest ART at 0.03, but that is based on starting at <0.01. You didn't start there.

Personally, I'd be OK with going to six month intervals (my 12 month test is Monday, and if I'm still <0.04, I'm going to six months). There are still a lot of docs who won't even consider ART until you get above 0.10 or even 0.20.
Posted 2/27/2016 2:51 PM (GMT 0)
I agree. I think you're fine to wait. Give it more time. But I wouldn't wait 6 months. Test every 3 months. The longer you wait the more you heal. If necessary, know that the SRT experience isn't that bad. I've had no SE's or problems, (so far).
Posted 2/27/2016 3:00 PM (GMT 0)
Thanks guys.

I've got one foot back inside the window and will work on getting the other one off the ledge by the end of the day.


Jon
Posted 2/27/2016 6:18 PM (GMT 0)
You had a good pathology report, and pretty stable uPSA - I don't understand why you think any immediate action is called for.
Posted 2/27/2016 7:02 PM (GMT 0)

TA said...

He also did an analysis that showed that among men with pT2, irrespective of margin status, a cutoff of 0.03 ng/ml on a first uPSA was predictive of later BCR, and any postop uPSA ≥ 0.03 ng/mL captured all failures missed by analyzing only the first postop value (100% sensitivity). He also found that in men with pT2, positive margin status was associated with longer time to biochemical recurrence (86 months) than negative margin status (33 months)

I think it was this part of your post on Island Time's thread gave me pause. Given my PSA results I could have been .03 on the first PSA and don't I now meet the "any postop uPSA ≥ 0.03 ng/mL" with my .03 nine months post surgery ? Isn't this predictive of BCR and with clear margins sooner than later?

Maybe I misunderstood your post to Island Time and the studies cited.
Posted 2/27/2016 7:34 PM (GMT 0)
just keep testing every three months and more will be revealed eventually. it'll be more stressfull but there's a chance you won't need to do anything. good luck.

ed
Posted 2/27/2016 7:35 PM (GMT 0)
But even though it is a predictor, and a good one, it's not the only thing to consider. Koulikov found that men with "low, stable PSA" (like yours so far) seldom went on to have a full blown recurrence - with 7 years of follow up, only 6% had a recurrence.

Low detectable PSA after prostatectomy – watch or treat?

Based on that study, it's pretty safe to watch for now to see if a pattern develops. So far, your uPSAs are very stable. But if it moves up consistently or quickly, it may warrant salvage radiation. You can also discuss a Decipher test with your urologist.

Neither of these database analyses is a randomized clinical trial - that doesn't mean one should ignore them, but it does mean that judgment is an important factor, especially when two analyses are telling you different things.
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