PSA rising to 0.11, 5 months after RP Surgery

I take your point which may or not be relevant in my own case, but although I am not ignorant, I am blissfully aware that although I have been told that I have been cured by my oncologist, I am not so naïve as to believe him.

So if (and when, most likely) I suffer bio-chemical recurrence, I will consider my options, such as chemical castration and Dan Dare and his ray-gun.

I have looked at the Nomograms with morbidity rates for my condition with and without adjuvant / salvage treatments and they vary very little.

If I have to be subject to ‘kill or cure’ chemicals and radioactivity I would prefer it to be later rather than sooner. I might have died of something else first!

Funny, people ask me “How painful is your cancer, how are you?” I tell them I have had no pain and have never felt so well.

Cheers, John

Edited by member 14 Sep 2018 at 19:49  | Reason: Not specified

I don't think there is such thing as a cure for cancer - NICE and most oncologists only talk about it as remission. My dad got his letter from the NHS 10 years post-RP congratulating him on achieving 'full remission' ... but it still came back 3 years later. 

Our local hospital, a centre of excellence for cancers generally and urological cancers particularly, was involved in a trial which offered ALL men ART following on from RP regardless of their pathology - Mr P tells me that data showed the outcomes to be much better than for RP on its own. Of course, there will be more risk of side effects. 

I have seen the Cleveland Nomograms and had a dabble with them. The one my oncologist uses - the guy who told me I am cured 😂😂😂😂😂 is the one below.

Frankly, as there is nothing wrong with me I can’t be bothered to fill any of them in any more, but when I mentioned before that I have not been psychologically affected at all by my cancer diagnosis, I may have been mistaken.

I think I have become the Messianic Jehovah’s Witness of prostate cancer awareness, much to the disdain of people around me and also on here! Expect to see me on a soap box in a town near you.

https://www.mskcc.org/nomograms/prostate

Edited by member 15 Sep 2018 at 10:49  | Reason: Not specified

Midcentury

Within a year post RP, my psa went from 0.014 to 0.023.  I had a PSMA scan for which I had to pay, but it found the remaining cancer.  I was pT3b, Gleason 9, positive margins, pni etc

I've now had SRT and am on bicalutimide.

Lyn - is there a link to any of the UK nomogrammes?  The US ones rate my chances as 65%, with which my oncologist agreed.

ulsterman

Fresh

I wrote my post in haste. It was not my intent to take a pop at your research. I'm sorry if I offended you.

All I was trying to say was what you said was that we have to be diligent with what we read because there is a lot of conflicting information out there and not all papers are equal.

Pete

I don’t know. Mr P showed it to us on his screen - first the % on the MSK and then the result when adapted for local data. With a PSA of 3.1, small soft prostate, clear scan, assumed T1 and age 50 the nomogram predicted a 55% chance of biochemical recurrence. 

After SRT, Mr B put the stats in and got an 80% chance of J still being here in 10 years. 

And they don’t take any account of the skill of a surgeon during a prostatectomy. I hope I backed the right horse - so far - so good!

Yes of course, that's why the medics that use them then adapt the results for local trends. 

As regards more advanced scans, I did post a link sometime ago wherein the course of a lecture a Professor said that in Australia they only used the Choline one for about 6 months before adopting the better 68 Gallium PSMA one. As has been mentioned elsewhere, even this scan does not work for 5 -10 % of men with PCa as member Chris will attest. However, research into scans continues and one developed by Marty Pomper and his team at John Hopkins termed 18FDCFPyL showed more mets than the 68 Gallium in on in a small trial. Larger trials are now underway mostly in the USA and Canada.

I have posted this before but for those who have not seen it, I like the reasoning of Eugene Kwon to treat early while the cancer is small and before it mutates. It is principally about oligometastic disease. It should be pointed out that this lecture was made before the 68 Gallium PSMA began to be widely adopted. Bear with the credits at the beginning. This Dr has been widely praised on an American forum and look at the comments beneath the video. https://www.youtube.com/watch?v=NkqizmvqJPo

What do you think?

Edited by member 15 Sep 2018 at 22:41  | Reason: Not specified

Thats because the RADICALS trial is not complete. The trial is a confirmation study on US data that is very compelling. The risk factors that predict biochemical reocurrance seem to be;

a) Detectable PSA and a value of 0.03 is used, however I think that number is just the first reliably observed number above the commonly used “undetectable” (<0.02) in the same way that 0.1 and <0.1 were used historically. A post operative detectable PSA is hugely significant. 

d) Pathology staging of T3 (any T3)

c) Positive surgical margins

d) PNI invasion

e) Extra capsular extension

Put simply. Any positive margin means your not likely to get that post operative remission period. The sad bit is that it seems that it’s only the aggressive cancer that tends to breach the nerve bundle. So the less aggressive gets bagged and binned leaving a 40% or 80% chance (depending on uni lateral or bi lateral sparing) of a stiffy but a 100% chance of PCa.

Fresh

Edited by member 16 Sep 2018 at 07:25  | Reason: Not specified

Fresh what you are saying simply isn't that black and white.

There are guys with positive margins who don't progress, guys with high grade T3 who don't progress and guys with low and stable PSA who don't progress.

That's the problem with ART medics know they overtreat.

What radicals will ultimately report (I beleive) will be in line with the original US research it's the only sensible outcome.

So should Fresh have ART? possibly but there is probably only a small risk waiting to get a PSA trend to be sure.

Should Bollinge have a supersensitive test? Yes IMHO life would then be less of a gamble because if it comes back as "less than" he can have greater faith in a full remission. BTW if the "professor" really mentioned the cure word he needs re-educating!!!

Should I have ART? Well I was offered the radicals trial but I didn't want a flip of a coin to decide if I had RT so I declined. So far I think the decision was correct, I have recovered my erections, I am continent and my PSA is still very low 3 years on. So I think I have, will I die of PC as a result of not doing ART? Only time will tell!.

Most important of all should midcentury have ART with that PSA? IMHO not without a second test (never do anything on the basis of 1 test!) . But if it's still over 0.1 he should certainly be consulting with an oncologist.

Edited by member 16 Sep 2018 at 09:26  | Reason: Not specified

Agreed francij but that’s because Gleason is no measure of aggressiveness. So in the absence of risk stratification there will be variability. The category you mention are most likely sitting on very low risk PCa. Does anyone know the NHS position on ART/SRT are there levels at which they won’t permit you to have RT?

Fresh

Hi All

Just an update to this thread. Second PSA now one month apart as of 11 October is 0.16.  On 12 Sept it was 0.11, which shows it advancing fairly rapidly post operation in April.

So end May <0.03

September 12 - 0.11

October 11 - 0.16

We are living in Germany currently so it is always a challenge to speak to Doctors or challenge the tests and our insurances doesn't seem to cover the PSMA/PET scans so have to pay for that.  Anyway we have a tentative PSMA/PET scan in Heidelberg on Oct 29. I believe they will use some test which is 18F as prefix, so that means it should be more sensitive to finding where this new growth is. The Prostate Bed, the lymph nodes or further out. They took out 32 lymph nodes from the pelvic region in the RP which all of them showing negative. But it takes only one to be positive I guess to cause this, it is like hyper worrying why it is going up so fast.  Thanks again all for your comments.  I had to take a breather to relax before but now I am back on this journey again.  take care all

I was commenting on the pattern rather than the actual numbers. Generally, if the first post-op PSA is undetectable / less than 0.1 and then it rises fairly steadily, this is a classic sign of cancer left behind in the prostate bed and RT has a good chance of sorting it out. If the first post-op PSA is high (like ChrisJ with his 0.15) this is indicative of mets or oligomets and RT is unlikely to be successful. The benefit of RT is less clear when the post-op PSA is low but then rises rapidly.  

Cheers, John.