PSA results - not happy but not unexpected

Yesterday’s blood draw came back at .068. Just for context, my detectable PSA was in January 2017, which was 2 years post op, and at that point it was .02. That was followed by .033, .033 (again), .046, .060, and now today’s .068 (this last one was 2 1/2 months since last test, before that it was always 3-3 1/2 months.

Now I have appointment with RO on Tuesday, who is going to tell me time to act, then August 3rd with surgeon Uro, who says don’t do anything till .2, based on my pathology, unless velocity starts to ramp up.

RO probably holds more weight with me at this point, but I am going to try and have them talk to each other.

Post Edited (Pratoman) : 6/15/2018 12:24:27 PM (GMT-6)

Tall Allen said...
That was a very small increase - probably within the noise of the test.

Pratoman said...
RO probably holds more weight with me at this point, but I am going to try and have them talk to each other.

What would be the point of that? It's your decision to make after hearing what each has to say. You can't relegate your responsibility for the decision.

Well, I’m thinking, Tewari/Surgeon, has told me that his advice is based on my pathology. I’m just thinking maybe, just maybe, there is something about the pathology that he knows, that wasn’t transferred to Zelefsky in the records I sent him. I know it’s unlikely, but I want to leave no stone unturned before making a decision. If they can agree, (unlikely) then it makes my decision easier. If not I’ll just have to plow through it and mak th decision (which will probably be, to treat after one more PSA (might as well enjoy the summer)

Re your comment about it being noise....are you saying that it might not be an increase at all? I am thinking that I’ll retest just for sh!ts and giggles at the end of July just before my August 3rnd appt with Tewari.

Revthe third decimal point, I would think that “.068” would round the reading up,to .07. But I understand your point. I guess you are saying always throw out the third digit which would mean I’m effectively unchanged from the last test.

Re Tewari. I would agree. It’s doubtful there is something else he knows about . Still worth them having a conversation IMO.

I feel for you, Ken, it’s a difficult decision you face. Been there.
I kinda don’t see it as very helpful to have Zelefsky and Tewari talk, either. To me, it seems more useful to press each of them to explain the reasoning behind their recommendations thoroughly.
My impression, from when I had a similar conversation with Patel, is that the surgeons trust their eyes and hands to tell them whether they got it all or not. If a surgeon thinks you’re one of the lucky ones, it’ll take more than .068 to convince him otherwise. They think ROs overtreat, lump you together with everyone else in the statistical pool and fail to see what they saw. Something like that.

So .06 to .07. How frustrating! First, because it went the wrong direction, but at the same it's still close enough that it could just be noise!

Thanks guys.
@TA, and SP, As far as the two Drs talking, i understand your point. I am just trying to be complete, and close as many gaps as possible. I do sometimes wonder if the difference between RO and Surgeon opinions on when to start SRT is a result of Surgeon ego's, making them reluctant to admit that their treatment didnt work (I'm not blaming anyone, i realize that sh!t happens).
If the surgeon was some dude in some regional hospital, i wouldn't bother, but considering the rep of Tewari, i think it can't hurt so why ot

@ddys , Jim, and Michael T... Yeah, its a small increase. But it does continue the trend. Just to make sure its an actual increase though, i am going to retest end July as i said. If its >7, i'm done waiting.

I am firmly of the believe that i am heading for SRT, I have no delusions. Considering the barbaric standard of care though, of flying blind, and radiating in a place without knowing that its the right place, i want to do everything i can to make sure that this is the right path, and that the chances are good that
this isnt just a big waste of time, or a big nothingburger.

I fully get that there is no black and white answer, and that the only way to know 100% if its in the prostate bed is to radiate the sucker and then wait to see what the result is. I do intend, however, to be very deliberate in my decision making process.

I'm good with all this. I wasn't even upset when i got the call with the result nor was i anxious while waiting for it (this mental state surprised me.) It is what it is, and if all a putz like Garyi can get through it, so can i ( just kidding Garyi). Hopefully it works, and if it doesn't i'll deal with it.

Maybe i am practicing mindfulness without realizing it. HAHA.

The significant takeaway from your recent PSA's is that each is higher than the previous, other than the single duplicated .033. If it was just noise then it would likely be going up and down, not just up. Good news is that it is a gradual rise and some would say that it would take years to reach 0.2 to declare BCR. But then what? Still too low for anything to be visualized by most scans.

I believe your best chance is to pursue SRT and hope that the PSA producing cells are still confined to the prostate bed. At these levels I'm not even sure whether HT would be called for, but I do agree with Richard that your surgeon doesn't WANT to believe that he had left anything treatable behind. Deal with just the RO for now, and ask if you should get an MO involved. It would be unlikely just now, but it would be a good idea to have a backup treatment plan in place should your PSA continue to rise following RT.

The JH RO told me there's a good chance it'd leave me impotent. (I think he even used the word..."probably"). I wasn't expecting the comment. I felt a brief but palpable wave of sadness that caught me...myself...off guard (it watered my eyes just briefly) and I knew they felt it when it happened...it just lasted a second.

but your potency score may be higher than mine. My guess is he took that sheet of paper into account with that statement. I don't know. (he may just "know"....these guys are pretty smart...when it comes to their experience)

You might ask mr. operation what his intuitive sense is of things are. Same with RO man.
Prat....I think both of these men are straight shooters. You have to take 'em at their word.

you might also ask ro what you're losing...percentage wise for cure...by waiting. ask him to put a number on it. There's book answers....and then there's real world answers that's come from a man's own personal experience.

Prato, agree with your analysis. Steady rise in psa suggests something is going on. My experience with MSK surgeon Karim Touijer is similar — wanted to wait six more months after post RP persistence and increase. He did support my moving to MSK RO, who said it was time for ADT/SRT sooner (at psa = .14) rather than later. Surgeon and RO never talked, so I ended up passing information between them. Suspect surgeon did not want to admit there was residual PC after telling me he got it all.
Reinforces the need to be informed and advocate.

Purg, there have been a ton of studies showing earlier is better. So the concern is, the trend shows something is clearly going on, and so something is going to have to be done. Sooner or later. And I’m thinking based on the studies, that sooner may be wiser.

Pratoman said...
Question, ....
What are the five most important questions I should be asking...?

1. What country club do you belong to?
2. Can I have one of the cute young techs assigned to me?
3. How far’s the bathroom from the gantry?
4. Do I get to ring a gong at the end or do you skate by with giving out a cheesy certificate of completion?
5. If the treatment fails, will you refund me my copays?

(Admit it, Ken, you were begging me for a smart-ass response.)

You’re right Richard, I deserved that. 😩🔫

I’m just trying to make sure I don’t miss anything. I think I’m starting to get a little nervous. I think my hair is starting to catch fire

Prato, I think the standard at MSK is 72 Gy in 40 treatments, with six months of Lupron timed to begin two months before the radiation. Some radiation is wide pelvic (not sure how many) and all 40 doses target the prostate bed.
That’s for reference; you could ask Dr. Zelefsky why that is or is not best for you.
As you know, scans won’t tell you anything at your low psa, nor will DRE, but I would want to know why he thinks it’s in the planned radiation field.

ADT not bad for me except for some fatigue to push through every day, but we’re all different I know from HW.

Otherwise SP’s questions and the confidence that you’re in one of the best places with one of the best doctors in the world.