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PSA Halves

User
Posted 05 Mar 2020 at 14:12

I've been on Hormone Therapy for three months - in November '19 my PSA was 11.9. My oncologist recently said it had fallen to 0.8 - I mentioned that I was on Finasteride and that it Halves your Real count - an embarresd silence  - she didn't know (!) 

User
Posted 05 Mar 2020 at 22:40

The difference between us and the onco is that we are obsessed about our disease and learn everything about it because it has a drastic effect on our lives. For an onco it is just a job.

I often come across experts mainly in accounting and fiance who know less than me about obscure tax legislation, because it effects only a few percent of their clients, but it affects me 100%. I know you might expect an onco dealing with PCa to have come across finasteride before, but it really isn't that important to them. Assuming you were on finasteride for both psa tests the 93% drop in psa is good; even if you were only on finasteride for the second test it would still be an 84% drop which is reasonable in three months. 

Dave

User
Posted 06 Mar 2020 at 08:15

In this case, not knowing about the Finasteride could have caused the wrong treatment.

If you were PSA 10-19.9, you might be a medium risk patient (depending on other factors, gleason < 8 and T1 or T2). A medium risk patient would normally have radiotherapy to the prostate only.

However, if you are PSA 20 or higher (which you are when you correct for the Finasteride), you would have radiotherapy to the seminal vesicles and sometimes, pelvic lymph nodes too, in other words, a different radiotherapy regime (and would rule out a brachytherapy-only option).

By the way, with PSA coming down so fast, I would ask if you can wait another month or two, to get it to 0.1 before starting RT. Getting the pre-RT PSA down to 0.1 or lower has been shown to improve outcomes. You mustn't unduly delay to get there, but as yours is coming down fast, that shouldn't be an issue. Some centres are now routinely waiting up to 6 months on HT before RT for this reason.

Edited by member 06 Mar 2020 at 08:17  | Reason: Not specified

User
Posted 06 Mar 2020 at 08:54

Russell, 

Andy makes a very good point about whether you are now in the wrong group as far as treatment is concerned. Definitely worth pursuing with Onco. I would probably write a letter, detailing dates of PSA test and results and explaining Finasteride and its known effect on PSA, also include Gleason and TNM, ask what risk level this puts you in, and how this affects your treatment plan.

A written letter implies you expect a written reply, and people start thinking very carefully before they are prepared to put anything in writing.

Dave

User
Posted 06 Mar 2020 at 12:54

I think there is some misunderstanding here. Russell refers to his 'real' PSA as 12 on his profile which suggests that the actual reading was about 6? He has also been aware of the 'halving' effect right from the start. He took a number of weeks to choose the appropriate treatment based on the whole raft of diagnostics and following discussions with his own oncologist and other specialists regarding SpaceOar etc - I doubt very much that the matter of whether the PSA is 6 or 12 will make any difference to the treatment plan for RT/HT. 


"If you were PSA 10-19.9, you might be a medium risk patient (depending on other factors, gleason < 8 and T1 or T2). A medium risk patient would normally have radiotherapy to the prostate only.

However, if you are PSA 20 or higher (which you are when you correct for the Finasteride), you would have radiotherapy to the seminal vesicles and sometimes, pelvic lymph nodes too, in other words, a different radiotherapy regime (and would rule out a brachytherapy-only option)." I think this is simply not true - oncologists don't make decisions on the target zone based simply on PSA

Edited by member 06 Mar 2020 at 12:55  | Reason: Not specified

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

 
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