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Detectable or not?

User
Posted 06 Oct 2017 at 22:52
Good evening everyone.

I had my latest consultation with my oncologist. My PSA has gone from 0.014 in January to 0.02 in September. My oncologist said she is highly suspicious my cancer wasn't fully dealt with as I now have a detectable level.

I've read the debates on here about the merits of testing to two decimal places. I was just surprised to hear her use the word detectable.

Now, with Gleason 9 and a T3b and positive margins, it was always likely that some rogue cells were left behind. But 0.02 is less than 0.1 and I thought that was undetectable? I just wasn't sharp enough to challenge her, which really isn't like me.

Another test in December to help determine next steps.

Ulsterman

User
Posted 07 Oct 2017 at 01:31

I think your oncologist may have been thinking of your diagnosis and histology rather more than your small increase in PSA.

Barry
User
Posted 07 Oct 2017 at 08:31

I wouldn’t dream of reacting to those figures alone , but as Barry says , she knows you have margins so prob wants to get in with salvage.

User
Posted 08 Oct 2017 at 21:43
Hi Ulsterman,

I recall commenting before that at my hospital anything less than 0.05 is undetectable. Others think anything below 0.1 is undetectable and fluctuations occur so it's not fully reliable.

In your profile you say in May that further increase would result in further treatment and in June it went down again. I'm no expert but I'd ask for another psa test to confirm it and perhaps fortnightly depending on the result. I also think I'd be keen to have more treatment even at the very low levels of psa. Presumably they'd go straight to RT without hormones at such a low level? My own feeling on treatment is early is best.

All the best

Peter

User
Posted 08 Oct 2017 at 23:18

It is NICE that defines what is detectable or undetectable, because NICE dictates what funding can be spent on salvage treatment and at which point. NICE says that anything below 0.1 is undetectable and therefore does not need further treatment. It also defines biochemical recurrence (after RP) as PSA higher than 0.2 or 3 successive rises above 0.1. Different thresholds for adjuvant treatment ... first post-op PSA of more than 0.2 and / or positive margins being 2 aspects.

Either way, you know where this is going and it all comes down to personal preference, doesn't it. John knew that his path results were poor, the uro gave him a 55% chance of needing further treatment, his pSA climbed upwards (but at tiny numbers) and he chose to a) pretend it wasn't happening and b) wait until there was irrefutable proof that the cancer was back (he held on until a PSA of 0.18 I think). Partly a good decision in hindsight; it gave him time to get his head round 'it hasn't worked' and recover as much as possible from the RP side effects before embarking on new treatment with new risks. Partly a bad thing because recent research shows that the outcomes from adjuvant RT are better than for salvage RT. Hey ho.

As for challenging her - it isn't easy to remember all the things that you think you would say in an appointment. I would be more interested in asking her whether she is aware that many hospitals have stopped offering the ultra-sensitive test because its reliability has come under fire. But my guess is that she is more interested in the pathology and her intuition is that your PSA is going to do the three rises over 0.1 at some point.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 09 Oct 2017 at 21:14
Thanks folks.

My oncologist is a great doctor and I trust her. I really do get great attention from her and my urologist usually pops his head in to see me at my consultations too.

It looks likely that I'll be starting radiotherapy sooner rather than later. Next PSA test due to be done on Christmas Day! I think we'll need to rearrange.

In any case, I think I've made up my mind to take radiotherapy as soon as she offers it. She is very cautious as she says it is linked to bladder cancer 20 years down the line. So, if she recommends it, I know it's because she really thinks it is the right thing to do.

Ulsterman

User
Posted 10 Oct 2017 at 10:09

Hello
Seems we are in similar positions to some extent. My post op 6 week PSA was 0.084. Not giant, but higher than the hoped for <0.03. My onco recommended immediate HT and RT - 27 sessions, to lymph nodes and prostate bed. My guess is that this was driven by the positive margins and PCa found in one lymph node rather than the PSA, That, and a Gleason 9, young age and fitness that she thought would handle all the treatment in a short space of time. So adjuvant RT as opposed to salvage RT, probably different rules.

I agree with you on the bladder cancer gamble, but that is now all part of the decision process. Strange how life works out.

User
Posted 10 Oct 2017 at 13:34

A bit depressing but I am not sure how significant the risk of bladder cancer is when you set it against a) if I don't have additional treatment I am unlikely to still be here in 20 years and b) spreading PCa could go to the bladder anyway if left unchecked.

Since J had already had to have a bit of a bladder remodel during his RP they targeted the bottom of his bladder during the salvage RT. It seemed a risk that had to be taken. I am more concerned about the research into RT and bowel cancer tbh

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

 
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