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Posted 6/10/2018 4:09 AM (GMT 0)
Should I worry?

My brother finished radiation in February after a June diagnosis, 3 months of hormones and radiation that began in November.

He was diagnosed as a 4 + 3 with a possibility of 4 + 4. 2 or 4 out of 12 cores positive. PSA of 4.56.
Palpable on one side.

His first PSA results was .01

His PSA result now is .02

Fixed typo in subject line. -- PeterDisAbelard

Post Edited By Moderator (PeterDisAbelard.) : 6/10/2018 8:51:59 AM (GMT-6)

Posted 6/10/2018 5:11 AM (GMT 0)
He still has a prostate gland so he is likely to always have a small PSA reading..It may take 2 or 3 years before "nadir", a low, stable PSA number is reached...There could be some bumps along the way..

What type of radiation did your brother have ?
Posted 6/10/2018 5:26 AM (GMT 0)
No. Just noise.

Because the result is expressed only out to two digits, the actual change in PSA could be less than .005. The change is insignificant at these levels. I understand your concern given the aggressiveness of 4+3/4+4, but no need to crank up the worry machine now.

BTW, it's a bit unusual to be on ADT (hormone therapy) only 3 months. The typical minimum treatment time is 6 months. Really only 3 for him?
Posted 6/10/2018 7:20 AM (GMT 0)
Those PSAs are unusually low unless his testosterone level has not yet recovered. What is his current testosterone level?
Posted 6/10/2018 1:19 PM (GMT 0)
Thanks for your replies.

I do not know his testosterone level but I know he still gets hot flashes.

I am nervous, too about the brief amount of time of hormones. Don't they recommend 18 months now?

He has never be given any scans.
Posted 6/10/2018 2:14 PM (GMT 0)
As I understand it, the 18 month recommendation is for neoadjuvant HT administered for salvage radiation after recurrence (BCR), while HT for primary radiation may only be six months. Generally HT duration varies between six months and three years, but again, primary radiation and post-RP radiation are different circumstances.
Posted 6/10/2018 2:50 PM (GMT 0)
If he's on HT, it just mean HT is doing it's job.

and that's a low number.

as he comes off HT, is PSA will rise. No reason to worry.

but every reason to throw a party.
Posted 6/10/2018 5:05 PM (GMT 0)
I don't understand your concern about the duration of ADT. The DART 01/05 trial proved that for intermediate risk men like your brother, 28 months of hormone therapy was no better than 4 months. I also have no idea what you mean when you wrote "He was diagnosed as a 4 + 3 with a possibility of 4 + 4." He was diagnosed with one or the other.
Posted 6/11/2018 12:23 AM (GMT 0)
I am getting second hand. His urologist said 4 + 3. Then the surgeon showed him his slides
and said honestly it is hard to tell a 4 from a 5. (I assumed without surgery there is no guarantee of the Gleason).

My concern was because of something I read here on one of the posts. I will look for it so I can be more specific.
Posted 6/11/2018 12:25 AM (GMT 0)
https://www.pcf.org/news/18-month-adt-optimal-for-locally-advanced-prostate-cancer/
Posted 6/11/2018 1:11 AM (GMT 0)
So he has had surgery..Please disregard my previous post..
Posted 6/11/2018 1:24 AM (GMT 0)
No. Sorry, I am obviously unclear. He went to a surgeon but did not have surgery. The slides the surgery read to him were from the original biopsy from urologist.

He never had surgery
He never had scan
Posted 6/11/2018 2:25 AM (GMT 0)

breakthecycle said...
My concern was because of something I read here on one of the posts. I will look for it so I can be more specific...
https://www.pcf.org/news/18-month-adt-optimal-for-locally-advanced-prostate-cancer/

But he didn't have "locally advanced prostate cancer," he had intermediate risk prostate cancer. I know it's difficult understanding that for men in different diagnostic categories the optimal duration of ADT differs.

Also, his surgeon is not a pathologist. While it's true that some pathologists are not as good as others, most of them are better than a surgeon at reading slides. At this point, it doesn't matter anyway.
Posted 6/11/2018 2:28 AM (GMT 0)
No reason to worry whatsoever.
Most patients who undergo radiation of one kind or another don't reach PSA levels that low. What matters is the PSA after the ADT has washed out of his system and his testosterone (T) has recovered. In the latter context, it would be instructive for your brother to know his pre-treatment T level.
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