HealingWell
Search Close Search
☰

I'm so confused! (about SRT)

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 9/23/2016 3:55 AM (GMT 0)
Hi all

I've been reading Tall Allen's post regarding better outcomes when SRT is delivered early . But I remain confused! Eugene Kwon said in one of his youtube clips (from a PCRI 2014 conference a while back) that only 27% of PCa recurrences occur in the prostate bed. So if that truly is the case, isn't the likelihood of success with SRT only ever going to be 27% or less?

Also, I note Tall Allen also said in high risk cases a PSA of 0.03 would be defined as recurrence. With my GG sitting close to that mark 12 weeks out from surgery, I'm guessing we'll be looking at further treatment options sooner, rather than later by the sounds of things.

But considering his pathology (mostly his high pre-op PSA), I'd guess his disease is systemic rather than 'regional', as to all intents and purposes it was completely 'contained' - in which case we'd be pointlessly blasting away at his pelvis for no good reason. Oh how I would hate to see him subjected needlessly to that.

Can anyone shed any light for me please? Is it straight onto ADT for my beautiful man?
Posted 9/23/2016 5:21 AM (GMT 0)
Can't imagine anyone believing that .03 post surgery as being recurrence. In my own case, my first PSA post surgery was a disappointing .05 (12 weeks post) and my surgeon said that I was probably heading for trouble. He was right, as it quickly doubled and continued to rise, ultimately in me having SRT about one year post surgery. Most people would be thrilled to have .03. The real issue, is it still rising above that .03, and at what rate or doubling speed? That's the question that needs to be considered.

And true, if surgery fails, its often the case that the remaining cancer isn't guaranteed to be in the prostate bed, nor is there any sure proof to show that it is. In my case, the doctor felt I had escape via PNI, probably even before I ever had surgery.

In my circumstances, I was told by my RO, that I had at best, a 20% chance that the SRT would be effective. That means of course, there was a 4 out of 5 chance it wouldn't work. And it didn't, and it was considered a failure 6 months post SRT.

We won't talk about the damage done, as my case is too well known and documented here at HW.

In your case, I would most definitely await further PSA testing to determine if recurrence truly happened. Why take the risk, if there's not definitive proof that you even need a secondary treatment?

Just my personal opinion based on my real life experience.

Good luck ahead, choose wisely.
Posted 9/23/2016 6:39 AM (GMT 0)
Jaybee & GG,
I really don't have enough knowledge to chime in, other than like Purg said, give it time. In the mean time I will be sending positive thoughts your at for declining psa and no need to decide anything nono
Beth
Posted 9/23/2016 8:32 AM (GMT 0)
JB&GG-

I have no idea what Kwon is referring to. Almost all recurrences after prostatectomy are near the site where the prostate was cut out. If Kwon has contradictory data, it should be published in a peer-reviewed journal. A youtube video is not a good source of info, imho. Perhaps what Kwon said is that the recurrence is seldom detectable, which is certainly true. Here's what's been published:

Predominant Treatment Failure in Postprostatectomy Patients Is Local: Analysis of Patterns of Treatment Failure in SWOG 8794

Pelvic MRI findings in relapsed prostate cancer after radical prostatectomy

Local recurrence after retropubic radicalprostatectomy for prostate cancer does not exclusively occur at the anastomotic site (It was at the anastomosis in 76% and where the vas deferens was cut in 22%)

I don't think I ever said that 0.03 would be a recurrence in high risk cases - where did you see that? Because GG's pathology was all good, he should wait for evidence of rising PSA before pursuing SRT, imho.

Low detectable PSA after prostatectomy – watch or treat?
Posted 9/23/2016 11:32 AM (GMT 0)
TA
What I believe you said is that for high risk cases , PSA of .03 should trigger SRT and that .2 is way too late. No?
Bob
Posted 9/23/2016 2:11 PM (GMT 0)
Must be "triggering SRT" and "recurrence" are two different things.
Posted 9/23/2016 2:54 PM (GMT 0)
In my opinion, a PSA result of 0.03 might as well be considered undetectable. The ultra-sensitive assay bounces around that much all by itself..When the result is at the lower limit of the tests ability to provide a reading, rushing into a $130,000 SRT might be a little premature....
Posted 9/23/2016 5:17 PM (GMT 0)
What I wrote about a uPSA of 0.03 was that "This remains a difficult decision, and the patient with a detectable PSA after surgery should begin discussions with a good radiation oncologist as soon as possible. " And that "We have seen (see this link) that a low PSA on an ultrasensitive PSA test, as low as 0.03, can be a predictor of full biochemical recurrence later. "

What I'm advocating is talking to a radiation oncologist and close monitoring with uPSA. Urologists have been dropping a lot of balls of late, and talking to the right kind of doctor is important. There are many factors to consider, and the decision is not automatic.

For someone with a good pathology report and with no evidence of consistently rising PSA, a detectable uPSA alone is not an automatic call to treatment, imho (I differ somewhat on this from opinions expressed by researchers at Johns Hopkins and UMich who advocate lower thresholds). For someone with adverse findings on the pathology report (significant positive margins, high GS at the positive margin, Stage 3 or higher), I think that waiting for a uPSA of 0.03 is safe (rather than adjuvant radiation without waiting), but we have learned that it always predicts full biochemical failure eventually.
Posted 9/23/2016 6:55 PM (GMT 0)
Discernment is a gift from God!. Reading is fundamental. A mind is a terrible thing to waste. Hey stupid, now I bet that got your attention!

For the past several years the research and follow-up documentation is confirming that when an individual's PSA rises up to .03, that individual, will at some point in the future move into BCR. This information has given many individuals 18 to 24 months of early decision making time before they reach the previous stated psa marker of .2 as the BCR threshold. Now the research is showing that there is benefit to proceeding with SRT at this very early stage (.03) in the continuum.
Frankly speaking, none of our "IMHO's" really matter when it comes to individual decision making when medical data and reputable published studies, from nationally recognized institutions, explain what the CURRENT findings are concerning who should consider SRT and when it should start.
When an ultra sensitive psa can be read down to .003 or lower, a reading of .03 is significant. Yes, we all realize that the ultra sensitive psa's do have volatility and "noise". However, consecutive increasing patterns do emerge. As always, this becomes an individual decision.
Do I want to explore and move forward with the best possible secondary treatment available at this time to bring about the greatest chance of "cure"? Of course I do!
Lack of knowledge and personalized fear can and will have potential life threatening consequences. Individual exceptionalism aside, the volume of pessimistic, high word count negative posts can be injurious to one's well being. I would choose wisely between those who have firm standing on verifiable medical data and those who are simply experientially based in their remarks. Please, do not shoot the messenger, even when their reported data contradicts your choice that you made 3, 5 or 10 years ago. The world of PC treatment changes about as fast as the world of mobile phones. Many of us have benefited from the exponential rate of new discovery and treatment options. In a sense of full disclosure, my doctors here in Houston have been and continue to be on the cutting edge of the .03 discussion. They are definite proponents of the .03 trigger for SRT.

Post Edited (Octorobo) : 9/23/2016 2:42:23 PM (GMT-6)

Posted 9/23/2016 7:15 PM (GMT 0)
Since "reading is fundamental" and I read "For the past several years the research and follow-up documentation is confirming that when an individual's PSA rises up to .03, that individual, will at some point in the future move into BCR." That pretty much settles it , I guess. Several years of research , follow up and the HW doctors all agree. An RO thinking otherwise is clearly in error and "dropped the ball" . Get one who agrees or risk death.
Posted 9/23/2016 7:37 PM (GMT 0)
When I was initially diagnosed and treated "way back" in 2013, my surgeon at Johns Hopkins and my local urologist didn't even see the value of an ultra-sensitive PSA test! And these were supposed to be experts? So I waited until two consecutive readings of .2 before SRT even with my terrible pathology! Have we come that far in only three years or did I run into two Neanderthals?
Bob
Posted 9/23/2016 8:19 PM (GMT 0)
two neanderthals, clearly and unaware of this forum.
Posted 9/23/2016 8:32 PM (GMT 0)
Bob,

I can't agree with sheepguy. This is all very recent data, and they are not "Neanderthals" for not knowing what learning would emerge later. If you had asked me in 2013 if there were any value to uPSA, I was not aware of any then. Yes, we knew that adjuvant RT gave better results than waiting, but we also knew that that policy (although officially recommended by the AUA and ASTRO) would lead to overtreatment in many.
Posted 9/23/2016 10:01 PM (GMT 0)
Thank you everyone, as always, for your informed and enlightening responses. It scares the cr@p out of me that we're already staring down the barrel of surgical failure, but it was always going to be touch and go. Taking into account the advice received here, it seems perhaps we should make contact with a good RO now, in case things proceed in that direction. That way, GG won't have to wait too long (hopefully) if that is the suggested path. I have no idea how to even find a good RO who specialises in this stuff, so that will be my next challenge. Don't suppose any of you know a good one here in Melbourne (Aus)?!
Thanks again for all the info and help - it is always hugely appreciated.
Health and wellbeing to you all
Jaybee&GG
✚ New Topic ✚ Reply