Updated psa

Are you on 6 monthly testing? The next couple of tests will give you more idea of what’s happening.

I put your figures in the nomogram here:

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

You came out at 80% chance of NO progression 6 years after salvage RT, if you had had a positive margin this rises to 85% so you have a very good chance of successful RT even with negative margins.

BTW I had to inflate your PSA to 0.2 as the nomogram won't take anything less than that because of course you can't have BCR officially until it gets to 0.2! Interestingly they now count 0.05 as the "undetectable level".

So if you had had your tests at either of those you wouldn’t have anything to worry about!

I have spoken to two oncologists and one surgeon about ‘super-sensitive assay’ i.e. multiple decimal points in PSA results, and two said it was a waste of time, and one said it could be useful in some cases. Probably not in yours.

What is of concern is consistent rises over a number of tests over months or years. Bear in mind biochemical recurrence is not officially classed as being present until the reading is over 0.2.

Best of luck.

Cheers, John

Just read your post and see you have CKD5, tony has this his egfr is at 10% , he is a lot further along than you are on his journey. last year his oncologist was thinking about rt if his psa remained steady unfortunately it continued rising so decided not to, he is now on chemo and is doing quite well on it. Tony is not yet on dialysis but has had a fistula done in readiness, it is so hard when you have both these diseases together and having to weigh up the treatments one against the other. Have they said that you cannot have a transplant ?, tony has been told he can't because of active cancer. Do your renal specialist and oncologist lease with each other ? it is good if they do, his renal specialist has said he would rather Tony carries on with the chemo even if it makes the ckd worse as he thinks the cancer treatment is more important than staying off dialysis for longer.

good luck with what you decide about RT

regards barbara

Lyn I was trying to reassure him that even with a much worse PSA salvage RT was worthwhile as that is what his onco has recommended, the nomogram shows this clearly. He seemed to be under the impression that it was a waste of time if you have negative margins, clearly it isn't.

I also pointed out that even the nomogram said he was undetectable.

However unlike you I believe there is value in the supersentive assay for post RP surviellance even when it doesn't say "less than".

I suggested a second opinion because he is worrying about going against his oncos advice, a second opinion may or may not reassure him and help him come to terms with his decision. I did this because it has helped me many times on my journey and I wish I had done for my late father.

Sometimes you can be rather cutting and self righteous Lyn and there should be space for more than one opinion on this forum - that is after all the point of it.

Thanks everyone , please dont fall out. opinions are differing and thats fine. my own view is that as i had clear margins , no seminal vessel involvement and no node (13taken out) involvement it would be like playing ”spot the ball” radiation! hoping to get lucky when it realistically could be growing in an entirely different area. im more than happy to wait until my next appointment (July) before i commit to anything. wishing you all well.....Andy.

Lyn my view hasn't changed? No need to apologise to me you are a legend!!

Blackball your theory regarding negative margins is not supported by the statistics. Negative margins do reduce the success rate for SRT but with your stats and assuming you waited until 0.2 to pull the trigger the likely hood of being in remission at 6 years reduces to by a few percent to 80%

Edited by member 14 Jan 2019 at 23:41  | Reason: Not specified

BUT

They increase the risk associated with salvage therapy because it means that with an increasing PSA post op whatever is producing the increase is at least a surgeons margin further away from the prostate. This is why the stats on salvage therapy with negative margins are slightly worse than those associated with positive margins.

Hence Blackballs nomogram figure is 80% with and 85% without ie 4 out of 5 guys with his stats and negative margins will still have remission at 6 years with negative margins.

I was positive  pni ........  ANDY 

WELL , who are you addressing here? if its me , although it does not read like you are , my   name is obviously NOT ”blackball”!!!

Not ”they” . only franci! and why start the coversation with ”well” ? trying to be a smart guy maybe? like you perhaps. no need to be rude. ....Andy. 

He was talking about me in a third party . it is my post after all. i could sense an undertone of something i didnt quite like. thank you for continually addressing me by my name and for your kind , helpful words , as always. maybe franci could p.m. you  to continue your conversation? 🙂......Andy

PS I think that you are doing francij a disservice - all I see is a member that was trying to help you.

I don't engage with private messages; I don't like that PCUK added this facility so francij knows that there is no point sending me one :-/ 

Hopefully, other members will be along to give you their perspective on your situation. 

Edited by member 16 Jan 2019 at 15:57  | Reason: Not specified