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Posted 8/29/2007 1:59 AM (GMT 0)
Well my three month PSA came in this time at 0.1.  This after two consecutive 0.0 and an initial 0.1.

My urologist was not very concerned.  I don't know how to react yet to be honest.  I wish I had thought of the question I am now forming to ask him.

He explained that there are several explanations for this outside of cancer.  He said my PSA level could be a constant hovering around the 0.1 line from test to test (this could explain my initial reading of 0.1 followed by two 0.0).  As I think about it I am sure that he is correct, but what I don't know is how likely these alternative explanations are as opposed to cancer.  Particularly given my stage of T3A (with one positive margin found at the apex).

He suggests holding off on any further treatment unless/until it rises to 0.2 anyway.  As I think about it I am wondering that if this is cancer what the risks are of delaying treatment as opposed to starting it earlier.  But then again I wonder what the possible side effects of radiation are and would not be anxious for them if they are not necessary.

And then I read that a PSA that starts to rise within the first two years suggests distant metastases, so is it too late already?  That is probably being too pessimistic.

I guess I am writing this for words of wisdom.  I know that T3A stage is debatable.

Gotta go do my homework on this I suppose.

Posted 8/29/2007 10:38 AM (GMT 0)
Mozart,

Yes, try to be optimistic - while you do your homework and aggressively pursue your options.

Others here have more expertise on capsular pentration and will have more solid information.
My second opinion physician from M.D. Anderson led me to believe that Hormone Therapy precedes radiation.  I found Tony's (TC-LasVegas') threads to be very informative on this topic.

Holding you in the best thoughts of higher mind!

CCedar

ICTHUS!

Posted 8/29/2007 12:40 PM (GMT 0)
Mozart, That's interesting to know. I was only a T2A with a 3+3=6 but I too had a positive margin and the Dr. is telling us to wait until my first post-op PSA. I'm sure that's normal but he has already told me that a visit to the Oncologists is in my future. I too am hoping it's not a, "we need to wait until it gets worse to make it better" scenario.
Posted 8/29/2007 5:04 PM (GMT 0)
Hi Moz,
Haven't seen ya around for a while. Hope you are doing OK. For me waiting was not something I was comfortable with. You'll recall my story as a pT3b patient, I wanted to hit the prostate bed right away and completed my IMRT on August 3. I have not had a positive PSA test since it dropped out after surgery. But I was not going to wait and see a rise. My oncologists suggested two approaches. Dam the torpedoes and fire them or wait until a climb to 0.4. The climb method is useful for determining a doubling rate and may affect the treatments to be suggested. I chose to dam the torpedoes and reach for the cure. In your case, I would check the PSA again before deciding on HT to verify it in fact climbing. I am not certain that your oncologists would suggest a benefit using radiation at this point. They would only suggest it if they could verify that it is localized somewhere and there is no evidence of distant metastisis. The timing for adjuvant radiation may have passed as it is usually done soon after surgery. But don't dispair, you can still have great results with hormone deprivation. And you might still be a candidate for adding Adjuvant radiation a month or so after you start HT. Good luck and stay positive.

Tony
Posted 9/1/2007 9:06 PM (GMT 0)
Hi:

After spending days googling "prostate cancer positive margin" on the internet, I have concluded on the basis of so much contradictory information out there that nobody really knows what they are talking about. :-)

I am becoming of the mindset however that I should get a second opinion by a reputable cancer center if that is possible.  It would involve some travel since we live 10 miles south of the Quebec border.

My wife is pushing John Hopkins.  That would be ok even though it is 500 miles from where we live (a good days drive).  Still if there is any place of equal reputation closer that would be nice.  Is going to a cancer center like John Hopkins something that is done (in other words will somebody see me).

My mindset right now is if eventually I do end up with metastic cancer, the last thing I want to do is to look back and have second thoughts because I wasn't aggressive enough treating this thing.

Posted 9/1/2007 9:44 PM (GMT 0)
Hello Motzart,

Hopkins is one of the most renowned PCa treatment hospitals in the world. Certainly if you could get to see someone like Dr. Patrick Walsh, or Dr. Alan Partin; it would be worth the 500 mile trip. Here's the address if you don't already have it: http://urology.jhu.edu/prostate/cancer.php

Good luck, and please keep us posted.

Glen
Posted 9/1/2007 11:16 PM (GMT 0)
Mozart,

So many opinions...I found the more I read the more confused I got!

I'm with Tony on the wait for 1 more PSA and with your wife on Johns Hopkins...you're worth the drive! It's best to go before you HAVE to, you know?

Good Luck and let us know what you decide,

Susan
Posted 9/2/2007 1:02 AM (GMT 0)
Hi ~ Mozart,   Take time to re-read your original personal thread... that follows you along "Your Journey"... Click here….   Refresh once page opens… >    Mozart250 PC Journey Thread I think it will help you.   Pull from the strength that continues to surround you!      Also ~ I’m adding a link that I hope helps (even just a little)…. It can’t hurt that’s for sure….   Low level PSA after surgery  started by Opie.   Mozart ~ you need to do what’s best for you in your research and decisions... but please don’t let it pull you down.    Grab hold of that rainbow and keep it close….   I’ve just refilled it with extra calm ~ for you!  Keeping you close and so glad you’re keeping us close too. In Friendship ~ Lee & Buddy      
Posted 9/2/2007 7:12 AM (GMT 0)

Hi Mozart

I am pretty much in the same situation as you. Both my urologist (surgeon) and oncologist have said it is ok to wait for my PSA to rise prior to starting radiation. I am having my next PSA done on 9-21-07 so we will see if there is any change. I will keep you posted on what my Doc's reccomend for me. I wish you the best in trying to figure out what to do next.

Rick

Posted 9/2/2007 6:35 PM (GMT 0)
Don't go to John Hopkins unless you have an appointment with a specific doctor before hand. You will be disappointed. My brother called a week in advance and still did not get to see anyone. The receptionist just kept blowing him off. They would tell him that they had 4 different departments that treat prostate cancer and he would have to choose the one he wanted. They didn't seem to have anyone there that would provide a consult concerning his recurrence. He just wanted to talk to someone about options as he had an open RP in 1999 followed immediately with 36 radiation treatments. His PSA was about 6.3 and Gleason 8. Cancer appeared to be confined but had entered fatty tissue of prostate capsule. His psa was undetectable for 8 years and know is 1.3, 1.5, 1.7 in the last 4 months. So much for radiation treatments.
He went to Kennedy Krieger Institute for two weeks next to John Hopkins for a case study and evaluation reference a back injury from a plane crash.

Ron
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