I finally found this group again

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Love2camp5@cs.com - 26 Jul 2005 17:03 GMT

After not being able to access newsgroups through my Compuserve main
screen at all, I finally found this group again through a Yahoo search.
It looks totally different on my screen, but I recognize some of your
names, so it must be the same group.

I had posted for a while. My hubby was diagnosed spring of 2003 with a
PSA of 4.2. He had the surgery May 23 2003 and the doc said the cancer
had spread outside of the prostate gland. Yet his post op PSA's came
back at undetectable for three readings over the first year post op.
So the doc said that perhaps he had been able to cut it all out.

But then the PSA started rising again:

Surgery: May 2003
Undetectable PSA's: July, Sept., and Dec. 2003

Then May 2004: .12
Sep 2004: .20
Oct 2004: .22
Nov 2004: .18
Dec 2004: .24
Jan 2005: .27
Feb 2005: .30
Mar 2005: .22
Apr 2005: .25
May 2005: .27
Jun 2005: .35

We don't have the July results yet. Jim sees the doc next Tuesday.
His advice all along is that as long as further treatment is begun
prior to .4 the results are the same. That agrees with what I've
investigated; some even say as long as its under 1.0.

Doc has said that at the .4 mark, he would do any necessary scans to
look for any evidence of the spreading of the cancer. Barring that, he
will do radiation.

Questions:
1. Comments on the above?
2. Are the scans (bone, CT, Etc.) reliable?
3. Is the radiation just a shot in the dark, not really knowing
where the cancer could be?
4. Is the .4 mark when they consider this an official reoccurence
of the cancer?
5. Should we insist on seeing an oncologist, or is that just for
cancers that show evidence of spreading?
6. Should doc advise hormone treatment along with the radiation?

I know, alot of questions. But I'm the investigator in our marriage
and I want as much input as possible before our appointment next week.

Thanks,
Linda
Pennsylvania

Reply to this Message

ron - 26 Jul 2005 19:06 GMT

Hi Linda...I've posted some comments within the body of your
post...Best wishes and good health, Ron

Love2camp5@cs.com asked...snip...

> I had posted for a while. My hubby was diagnosed spring of 2003 with a
> PSA of 4.2. He had the surgery May 23 2003 and the doc said the cancer
[quoted text clipped - 30 lines]
> Questions:
> 1. Comments on the above?

Plotting the data, there is a clear upward trend. There is too much
scatter / not enough data to determine whether the trend is linear or
exponential. It looks like the PSA has doubled-tripled in about a
year, so you're right to be acting on it.

> 2. Are the scans (bone, CT, Etc.) reliable?

It takes about a billion cancer cells to show up on these scans, so
they are not too reliable for early recurrence. They often fail to
show evidence of cancer even though the PSA is clearly increasing.

> 3. Is the radiation just a shot in the dark, not really knowing
> where the cancer could be?

There are papers in the literature that suggest later recurrences have
a higher probability of being due to local rather than systemic
disease, but basically it has been hard to separate local versus
systemic recurrence. Two imaging tools that may be of interest include
Combidex and MRI imaging. Combidex can find small amounts of PCa cells
in the lymph nodes. This is not yet FDA approved in the US, but I
suspect that Dr. Harisinghani in Boston is still running tests. You
can Google his name and get his conatct info and then call him and see
if he is still examining patients with this apparatus (N Engl J Med.
2003 Jun 19;348(25):2491-9; Noninvasive detection of clinically occult
lymph-node metastases in prostate cancer; Harisinghani MG, Barentsz J,
Hahn PF, Deserno WM, Tabatabaei S, van de Kaa CH, de la Rosette J,
Weissleder R.). MRI imaging can also be used with reasonable success to
distinguish between local and systemic disease (Radiology
2004;231:379-385; Suspected Local Recurrence after Radical
Prostatectomy: Endorectal Coil MR Imaging1; Tamar Sella, MD, Lawrence
H. Schwartz, MD, Peter W. Swindle, MD, MS, FRACS, Chinyere N.
Onyebuchi, MPH, Peter T. Scardino, MD, Howard I. Scher, MD and Hedvig
Hricak, MD, PhD).

> 4. Is the .4 mark when they consider this an official reoccurence
> of the cancer?

For surgery, different docs use different cutpoints for "officially"
dtermining recurrence. Many use PSA>0.2 ng/ml, but some (like Dr.
Zincke at the Mayo Clinic, a very noted surgeon) use PSA>0.4. I'm sure
other cutpoints are used as well.

> 5. Should we insist on seeing an oncologist, or is that just for
> cancers that show evidence of spreading?

Probably not a bad idea to bring one on board (two heads are better
than one). Make sure he/she specializes in PCa. I see you are in
Pennsylvania, Dr. Charles "Snuffy" Myers is in Charlottesville, VA. He
has PCa himself and is a widely recognized PCa oncologist.

> 6. Should doc advise hormone treatment along with the radiation?

This would be a good question for the oncologist. Typically, such
combined treatments are used in aggresive cases. My suspicion is that
it helps in milder cases as well. It becomes a question of where you
fit on the "amount of life versus quality of life" continuum.

> I know, alot of questions. But I'm the investigator in our marriage
> and I want as much input as possible before our appointment next week.
>
> Thanks,
> Linda
> Pennsylvania

Reply to this Message

Alan Meyer - 27 Jul 2005 23:17 GMT

Linda,

There's not much I can add to Ron's excellent reply but here are
a few thoughts:

As far as I know, doctors cannot precisely identify the spots where
tumor cells may be growing. Some of the spots may well be microscopic
and there may be microscopic bits of tumor growth in more than one
area.

I believe what they do with the radiation is target the general
area around the prostate. My doctor told me she was radiating one
centimeter all around the prostate.

I have read that, when cancer escapes the prostate, it is often
found in just the first few millimeters around the prostate bed,
taking some time to get from there to anywhere else. So radiation
has a decent chance of getting it.

I have also read that radiation is more likely to be effective
sooner than later - which makes obvious sense.

To my mind, the key issue is: does the gradual increase in PSA
indicate a growth of cancer? If it does, and there is no evidence
of metastasis (which there apparently is not) then it seems to me
that radiation should be tried.

With the prostate gone, I don't know how to account for the rise
in PSA except by assuming that prostate cancer cells have escaped
the surgery. But I'm not a doctor and not qualified to say.

I recommend that you see another specialist and, if he or she
concurs, go ahead and schedule radiation. You will get your July
result before the radiation begins and if the PSA goes down, you
can cancel the treatment. If it goes up, you'll be very near or
above the .4 mark.

Try your best to find a good center for prostate cancer
radiation treatment. Ideally you want a place that is experienced
and well regarded, and not so busy that they're running
patients through a mill like cattle.

Alan

Reply to this Message

Steve Kramer - 30 Jul 2005 16:47 GMT

Hi, Linda. Great to hear from you again!

I see you've already gotten some good advice so I'll just try to help you
through the fear factor. Jim's PSA is definitely rising. But, for a PCa
patient with a poor post-op biopsy, going from 0.12 at RRP + 1 month to 0.35
at RRP plus 2 years is better than anyone could have hoped for. Especially
for a man 48 years old (now 50 I guess).

I think I would get a 2nd opinion on the radiation. My doc started
radiation after 3 up ticks on the PSA. At that time, my PSA was .37.
Combined with your poor biopsy, I think I'd go for the rads.

Signature

PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA .1 .1 .1 .27 .37 .75
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32
Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05
PSA .07 .05 .06 .05
non Illegitimi carborundum

> After not being able to access newsgroups through my Compuserve main
> screen at all, I finally found this group again through a Yahoo search.
[quoted text clipped - 50 lines]
> Linda
> Pennsylvania

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Love2camp5@cs.com - 02 Aug 2005 03:42 GMT

Thanks to all who replied to my post.

My feeling is that it's time for radiation barring any evidence of
spreading beyond the pelvis. The PSA is clearly going up and has been
for over a year, and I cannot see the sense in waiting any longer and
giving the cancer any further time to spread. I guess when the doc had
told us post-op that the cancer had escaped, I knew then it wasn't
over. So this is not a surprise to me; however hubby may have other
feelings.

Linda

> Hi, Linda. Great to hear from you again!
>
[quoted text clipped - 73 lines]
> > Linda
> > Pennsylvania

Reply to this Message

Steve Kramer - 02 Aug 2005 13:57 GMT

> I guess when the doc had
> told us post-op that the cancer had escaped, I knew then it wasn't
> over. So this is not a surprise to me; however hubby may have other
> feelings.

This is common, I think. Doctor's rarely dwell on the negative, usually
emphasize the barely possible positive outcomes and we patients hear only
the latter. I consider myself pretty pragmatic, yet have found myself
thinking I might beat the odds.

Of course, it doesn't help you (him) that the doctor is also ignoring the
steady rise in PSA.

But, I don't think it's an emergency. I think there is time for both of
them to come around. And, as you said, some doctors wait for 0.4, some for
1.0 and some for 2.0. No one knows for sure which is correct.

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