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Doubling times

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User

Posted 20 Jan 2019 at 20:48

As per my previous post ( which i cant find due to site issues). My PSA in Nov had risen from <0.01 to 0.08 in approx 6 months. I had RP and ART in 2013.

Something i have not really looked into or got my head around is the relevance of doubling times So ive had a look around good old google. Some research suggests that a doubling time less than 6 months significantly increases the chance of death within 5 years. Now i know at my last test i had not hit the 0.2 to be officially classed as a relapse. But my PSA has far more than doubled in 6 months. The same research also suggests early aggressive intervention for high risk men had more favourable outcomes. Baring in mind one oncol told me they would not intervene until my PSA hits 20 I can see a quandry on the horizon.

Does anyone have a good understanding about this as i would like to have an idea what im talking about at my appt in early Feb

Cheers Bri

User

Posted 20 Jan 2019 at 23:22

Bri, why don’t you contact the pathology department to ask whether they have got new machines or have started outsourcing the PSA testing?

You can’t work out a doubling time yet; you need three test results and a ‘less than’ result isn’t an ideal starting point but you would still need another one after this. Even if you could work out your doubling time now, you are mixing up two things - doubling time and longevity is about men who are castrate resistant or have stopped treatment. If you did have a problem you would eventually go back on HT and your doubling time would slow down.

The thing that you will need to weigh up is if (if) the onco says “yep Bri, it’s back” you will move into the incurable stage with lifelong HT ... but you probably wouldn’t want to start HT straight away because the sooner you start, the sooner it will stop working. I guess that’s why most oncos wait until 5, 10 or 20 before restarting treatment.

Mr B said that if John goes over 0.1 again he will have an FCA scan - if there is any sign of lone hotspots away from the pelvis then a zap of RT might be possible. Otherwise, it will be about delaying the HT as long as we dare.

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

User

Posted 21 Jan 2019 at 00:52

One other point I believe the doubling time at UPSA levels (<0.1) is not reliable for prognostic forecasts so don't go there.

User

Posted 21 Jan 2019 at 04:40

Matron, what’s an FCA scan?

I Googled it and the nearest it came up with was Financial Conduct Authority!

Cheers, John.

User

Posted 21 Jan 2019 at 08:41

I looked it up too. Could it be an FAC scan?

See below:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5138124/pdf/nihms813209.pdf

Ido4

User

Posted 21 Jan 2019 at 11:00

An interesting paper. I was especially looking for the comparison with Choline PET CT and Ga68 PSMA scans.

Ulsterman

User

Posted 21 Jan 2019 at 11:40

Hi Ulsterman,

What about this https://reader.elsevier.com/reader/sd/pii/S1879850017302060?token=4A7477F8C2B045B7ED25EA8EC00BF3D9D5AB7F79A39F42F705F8B1B09A421365CB06E72E98E5179B92B3C97224AF4391

https://euoncology.europeanurology.com/article/Shttp://jnm.snmjournals.org/content/59/2/230.full.pdf2588-9311(18)30170-6/

http://jnm.snmjournals.org/content/early/2018/03/08/jnumed.117.204032.full.pdf

https://www.researchgate.net/profile/Frederik_Giesel/publication/259633680_Comparison_of_PET_imaging_with_a_68Ga-labelled_PSMA_ligand_and_18F-choline-based_PETCT_for_the_diagnosis_of_recurrent_prostate_cancer/links/0f31752ff63fbee270000000/Comparison-of-PET-imaging-with-a-68Ga-labelled-PSMA-ligand-and-18F-choline-based-PET-CT-for-the-diagnosis-of-recurrent-prostate-cancer.pdf?origin=publication_detail

Lots of reading and like much to do eith PC no straightforward answers.

Ian

Edited by moderator 06 Jul 2023 at 13:18 | Reason: Not specified

Ido4

User

Posted 21 Jan 2019 at 12:19

Originally Posted by: Online Community Member

Bri, why don’t you contact the pathology department to ask whether they have got new machines or have started outsourcing the PSA testing?

You can’t work out a doubling time yet; you need three test results and a ‘less than’ result isn’t an ideal starting point but you would still need another one after this. Even if you could work out your doubling time now, you are mixing up two things - doubling time and longevity is about men who are castrate resistant or have stopped treatment. If you did have a problem you would eventually go back on HT and your doubling time would slow down.

The thing that you will need to weigh up is if (if) the onco says “yep Bri, it’s back” you will move into the incurable stage with lifelong HT ... but you probably wouldn’t want to start HT straight away because the sooner you start, the sooner it will stop working. I guess that’s why most oncos wait until 5, 10 or 20 before restarting treatment.

Mr B said that if John goes over 0.1 again he will have an FCA scan - if there is any sign of lone hotspots away from the pelvis then a zap of RT might be possible. Otherwise, it will be about delaying the HT as long as we dare.

Thanks Lyn but at 0.08 I doubt that there is really a chance its going to be a result of new testing equipment.

Its a minefield isn’t it. You hope that the oncologists are up to date with all the latest research but they are dealing with so many types of cancer it is probably not realistic. I get it about the delaying HT so it can work for longer but the downside is the PCa is probably spreading while you wait. Ive no idea if HT works for longer when there is less cancer to fight or not. The research I read suggested early intervention for high risk men .....then where does Chemo fit in. I appreciate that i will probably need another test in April/May to definitely determine what may or may not be happening. Really hoping there is no further significant rise

Bri

User

Posted 21 Jan 2019 at 12:39

Originally Posted by: Online Community Member

I looked it up too. Could it be an FAC scan?

See below:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5138124/pdf/nihms813209.pdf

Damned autocorrect :-(

Yes, this is the one although the more interesting research was done in Italy and it has been trialled at St James for a couple of years now. I posted about it on my 'my 3 men' thread when Mr B first suggested it for John although as it turned out, he didn't meet the criteria for the trial at the time.

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

User

Posted 21 Jan 2019 at 12:59

Despite Psa now 82 they aren’t offering me any fancy scans now. Got a full bone and CT scan in next 8 days. He said that would be enough.

User

Posted 21 Jan 2019 at 15:01

Hi Chris, that's because you and a small percentage of men don't conform!! It would be interesting to know what research is being done to develop alternative scans for men such as you. (This has even extended to your Profile. I clicked on it to update myself, twice but each time it says I have to sign in and get an account when I am already signed in and allowed to post this!)

Barry

User

Posted 21 Jan 2019 at 15:58

I think it is generally considered that the 68 Gal PSMA is the best advanced scan that is presently available in the UK and this is only available at a few facilities. The scan Lyn suggested is possibly the next best and is available at several other places. However, before getting too deeply into scans on this thread, I think it would be helpful and appropriate if references on the development and assessment of scans could be added to the thread on 'Advances in scans ' as here :- https://community.prostatecanceruk.org/posts/t13379-Advances-in-scans

Edited by member 21 Jan 2019 at 16:53 | Reason: Not specified

Barry

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