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Doubling Time questions

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Posted 5/24/2018 12:41 AM (GMT 0)
I’m post RP and post SRT with a recent rise in PSA from .054 to .15 in 5 months. Repeated PSA yesterday and in two weeks now 0.2. Met with MO yesterday and he first thinks I’m overreacting; however, today I got a call from his office that they want me to test monthly rather than the three month interval we discussed yesterday. Seems a bit alarming that I’m looking at a really high doubling time. I don’t know what to make of this other than I’m thinking this is rapidly progressing and of course the obvious ADT that lies ahead. I said I had a doubling time question but honestly I don’t know what my questions is. Just feeling very anxious and would like to get some advice. I know in comparison to others I probably seem like I’m whining but this scares the crap out of me. Wahhhh....
Bob R.
Posted 5/24/2018 12:48 AM (GMT 0)
People who know more than I will be here soon, but my RO says doubling time is not mean8ngful at low levels of psa like yours.
Posted 5/24/2018 1:31 AM (GMT 0)
I am very interested in this thread as I am in the same situation. My MO told me I have to
See him every 12 weeks going forward and come back in 3 month and get an mri
Posted 5/24/2018 2:01 AM (GMT 0)
That's a troubling trend - the rising pattern alone is a bit of a worry. Doubling time is a bit tricky at those levels. ADT is the next step, but the question is when? testing monthly might be a little over reaction, but might be the prudent course.

The thing you can't know now is where is the PSA coming from. You'd have to let it rise a bit more before it would show on a scan.

and you've got a right to whine about this.

Andrew
Posted 5/24/2018 2:24 AM (GMT 0)
Here’s some guidance for you on calculating PSADT. Hopefully this isn’t too much math for you; i.e., too intimidating.

    All PSA values used in the calculation should be ≥0.20 ng/ml and follow a rising trend. PSA values need not be consecutively rising and all values obtained over a maximum period of 12 months should be included in the calculation. The maximum period of the past 12 months is recommended to reflect the patient’s current disease activity, since in some men PSADT may change over time. Minimum requirements for the calculation are 3 PSA values obtained over 3 months with a minimum of 4 weeks between measurements.


Reference: /www.ncbi.nlm.nih.gov/pmc/articles/PMC2667701/
Posted 5/24/2018 6:41 AM (GMT 0)
You are almost biochemically recurrent- but you need to confirm that in a month. If so, and if your PSADT turns out to be rapid, starting on iADT may be prudent.
Posted 5/24/2018 10:32 AM (GMT 0)
Thank you for your responses. Information is always helpful to me and I very much appreciate the support here. I’ll try to focus and stop whining now. I’ll report back next month with the results and see where we go from here.
Many thanks,
Bob
Posted 5/24/2018 4:03 PM (GMT 0)
RCroller
Just a comment since I have been in your situation for a while. doubling time is not so meaningful at low psa values, just because of the way the math works. Keeping it simple, in my case my psa (after surgery, and IMRT) increases at 0.1 every 3 months. If it starts at 0.1 and then it goes to 0.2 in 3 months, doubling time is around 3 months. In 3 more months it goes to 0.3, and again in 3 months it goes to 0.4. so it took 6 months to get from 0.2 to 0.4 - DT is now 6 months. If it keeps on this linear trend, doubling time will increase over time and I use the last 3 data points (9 months) to calculate.

I have read there is no standard agreement as how to calculate DT. Some use the simple approach above, some convert psa to a log psa (or natural log of psa for those who remember this math), some use start and end points only, some use all data points). Sloan kettering has a nomograph you can use online.
Posted 5/24/2018 11:22 PM (GMT 0)
Teddy,
Just curious, if I read your signature correctly, your psa is .5. Are you adt sensitive now?
Did it stopped working? Shouldn’t the psa goes undetected while on ADT?
This is the situation which makes me worry so much about starting adt that
It will stop working. I hope I am wrong in understanding your
Situation
Posted 5/25/2018 12:24 AM (GMT 0)
In my opinion, doubling time is very important..Last November, my PSA was 0.5, something like that. Two weeks ago it was 208... My doubling time was calculated to be about every 30 days..Left unchecked, a short doubling time will allow the PSA to skyrocket very quickly...You only get so many doubling's before the cancer overwhelms your body.....
Posted 5/25/2018 3:07 PM (GMT 0)
Thanks again for the additional info. Time will tell but if DT proves to be rapid over the next three monthly readings I think I’ll be inclined to start ADT sooner than later. Would like to get an Axumin before starting. We shall see and thanks again for the information.
Posted 5/31/2018 6:59 PM (GMT 0)
AK123 My lupron treatment was only for 6 months, including 1 month on Firmagon. So currently not on any treatment.
Posted 5/31/2018 8:02 PM (GMT 0)
Last year my PSA went from undetectable to 0.18 to 0.30 to 0.71 in four months.

My MO was clearly concerned.
Posted 5/31/2018 8:25 PM (GMT 0)
Teddy, if I may ask, why were you on ADT for only 6 months. some patients stay on adt
For years and years until it stops working and move to something else. why did your
Mo stopped it?
Posted 5/31/2018 8:46 PM (GMT 0)
AK123
Yes, in my case, with gleason 4+3, and with very good pathology, RO advised that ADT enhances the effect of the radiation, to kill the cancer cells. Some RO might have me stay on for a year perhaps but he felt it was not needed. So I suppose I could have been on it longer and perhaps had a better outcome - I will never know. I will need to go on ADT at some point but am trying to hold it off for as long as possible. MY MO advises to start treatment by PSA 4 unless doubling time shortens to around 3- 6 months, then he might start sooner. It would be intermittent therapy, not continuous ADT.
Posted 5/31/2018 9:19 PM (GMT 0)
Thanks very much Teddy for explaining. I wish us all the best of luck fighting it.
Posted 5/31/2018 10:24 PM (GMT 0)
AK123
just one more thing. Since you appear to be in a similar situation as me, you might consider taking part in a clinical trial for a top notch scan to see where any cancer cells might be lurking. The one I did at NIH in Bethesda Maryland has an easy to qualify for protocol and is free. Although not entirely proven, the idea of surgical removal or radiation of a cancerous node or bone is appealing to me, as possibly delays the need for ADT.
Posted 5/31/2018 10:31 PM (GMT 0)
Teddy,thanks
Is that scan available in NY city somewhere please?
I am very frustrated and don’t know what to do. My MO, a famous Dr at MSK told me that
We need to be careful and not overtreat. He asked me to do an MRI and
Come see him in July/August.
Posted 5/31/2018 10:39 PM (GMT 0)
not exactly. Sloan Kettering is testing a similar scan as part of a clinical trial but it is not the best one. It is Gallium based - and it does a very good job. However, I suggest you go on the clinicaltrials.gov website and do some searching. I live in NJ and driving 3 hr to maryland is not a big deal. on the website, look for the trials on DCFPyl-PET/CT imaging .

your psa is too low to use the axumin scan which is medicare approved and is offered in some places in NYC - I think mt sinai might be one. but you need psa around 1.5 to 2. the scan I did needs psa greater than 0.2, although higher psa increases likelihood of finding something.

SK will likely be testing a the same protocol as NIH in bethesda MD, in the future. Not sure when.
Posted 5/31/2018 11:18 PM (GMT 0)
Thanks again, Teddy. May be i can wait untill I see my MO
End of July and ask him about it. By then, I am sure my psa will be much higher
Unfortunately.
Posted 5/31/2018 11:46 PM (GMT 0)
AK
Suggest you do some research on scans so that you will have some more knowledge ahead of your doctor visit. my MO is also at SK.

good luck
Posted 5/31/2018 11:53 PM (GMT 0)
Teddy,
Sorry for the many questions. Since you get treated at MSK also, did you suggest todo
The scan or your MD suggested it?
Posted 6/1/2018 12:01 AM (GMT 0)
AK
I told my MO that I planned to do the scan and wanted his take on it . He was ok with it. I would have gone ahead regardless of what he said. I wanted a baseline to see what, if anything, could be found. In the future, I can have another scan, perhaps at a different location.
Posted 6/1/2018 12:34 AM (GMT 0)
One last question please: aren’t you nervous or scared about our future since we both
Almost have the same situation? I am to be honest and not sure how to
Think of it
Posted 6/1/2018 12:59 AM (GMT 0)
A psa rise after surgery and salvage RT is almost always indicative of metastasis. Cancer is growing somewhere in the lymph system.
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