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Medical Forum / Diseases and Disorders / Prostate Cancer / October 2005PSA Post RT
 SignatureJuly 2005 Prostate cancer diagnosed. Age 75 PSA 26.5 Gleason 7 (4+3) Stage T2a No evidence that the cancer was not confined to a single nodule in the prostate. I am sure that many of you have seen this--I obtained it through a Google alert. http://www.cancerpage.com/news/article.asp?id=8924 It really pertains to my immediate situation: I will be going for my 4-month post HBRT in a couple of weeks. I gather that this means that if the PSA has doubled (or at any time up to six months), then there is a very great likelihood the PCa has travelled, and with a predictably very poor prognosis. I'd appreciate any comment. August 2004 ADT First injection (2 drugs-Lupron + ?) Dec 2004 PSA 4 ADT Second injection April 2005 PSA 2.6 May 2005 HBRT 33 treatments August 2005 Six weeks after radiation PSA 2.9, (went up instead of down) Next PSA at the end of October (at my request) and also three months later.. Stavros posted...snip... I gather that this means that if the PSA has doubled (or at any time up to six months), then there is a very great likelihood the PCa has travelled, and with a predictably very poor prognosis. ------------------------------------------------------------------------------------------------------------- Hi Stavros...While that (important) statement / experimental observation is generally true, I don't think you can apply it yet to your situation with confidence. In other words, if your upcoming PSA turns out to be more than 5.8, I don't think you should get too worried. For one thing, your last reading of 2.9 may still have been influenced by your second ADT injection (was it a 90 day injection?) . ADT aside, another factor that could cause misinterpretation of the PSA doubling concept is PSA bounce. I don't know how PSA bounce timing and frequency manifest themselves for HDR BT (Alan Meyer might know about this), but it is very common for PSA to rise and then return to baseline (bounce) at various post-treatment times for other forms of RT...Best wishes and good health, Ron > -- > July 2005 Prostate cancer diagnosed. Age 75 [quoted text clipped - 19 lines] > August 2005 Six weeks after radiation PSA 2.9, (went up instead of down) > Next PSA at the end of October (at my request) and also three months later.. Stavros, Was December 2004 your last ADT injection? I was under the impression that you were still on ADT. I think it makes a significant difference in interpreting the numbers. Alan It was the last. I had 2 of them altogether over 8 months, and that period was followed by the HBRT. >> -- >> July 2005 Prostate cancer diagnosed. Age 75 [quoted text clipped - 30 lines] > > Alan >>> August 2004 ADT First injection (2 drugs-Lupron + ?) >>> Dec 2004 PSA 4 ADT Second injection [quoted text clipped - 13 lines] > It was the last. I had 2 of them altogether over 8 months, and that period was followed > by the HBRT. I hadn't realized that you were completely off ADT. In that case, your small rise in PSA may not be as significant as I previously thought. Your PSA in April 2005 was probably the last one for which the ADT held it low. After that, it was presumably on the way back to your pre-treatment value in the 20's. When you got a PSA of 2.9, that may be due entirely to the radiation rather than the ADT. 2.9 after radiation is not a great number. We'd like it to be lower. But it's still possible that it will continue to drop. Radiation doesn't kill cancer all at once. It damages the DNA in the nucleus of the cancer cells, making it harder for them to divide and grow. They die off over a long period of time, as much as several years. My PSA has gone up and down a number of times since radiation about 21 months ago. But so far (knock on wood), it hasn't jumped up and galloped away. You may still be okay. If the PSA does climb, then you can go back on ADT, but so far, I presume your doctor thinks it's not time for that yet. Hopefully it will never be. Good luck. Alan Thanks so much, You're interpretation is exactly that of my oncologist, but I am really glad to hear it from you because he is always so cheerful and optimistic that I tend to discount some of what he tells me. Anyway, I am not really at all stressed about this, although I must admit that being two weeks away from my next PSA makes me a bit edgy, try as I do not to be. When I get it. I know I'll feel better, whatever it is, because with me my main problem has been from the very beginning (from my first posting here) wanting to know where I stand. I can accept anything that's in store; It's just not knowing that bothers me at times. Thanks. . >>>> August 2004 ADT First injection (2 drugs-Lupron + ?) >>>> Dec 2004 PSA 4 ADT Second injection [quoted text clipped - 42 lines] > > Alan Hi Stavros. We all wish you the very best and feel things will turn out OK. You mentioned worrying, and that YOUR doc is cheerful and optimistic. Interesting because SOME docs never are that way. They're not negative...just neutral. Some docs say "you're cured!", while others are 'cautiously optimistic.' What's the best way to be? I guess it depends upon the psyche of the patient. My doc gives me the facts, says it's good, but doesn't click his heels or promise anything. :-) Hang in there buddy. We're all with you. Ron B. Chicago Well, it's not that I worry, although I know it looks that way. And my doc thinks I am a "worrier" because I ask so many questions. It's just that I want to know what is going on, and not feel that I am being kept in the dark. Actually I certainly like having a cheerful and optimistic doctor and I like mine very much. .At my last visit, he had a resident see me first and he really did upset me by practically saying that I am ready for chimo Now that did upset me. Maybe I am one of those people who are never satisfied. > Hi Stavros. > [quoted text clipped - 24 lines] > > Chicago > Well, it's not that I worry, although I know it looks that way. And my doc > thinks I am a "worrier" because I ask so many questions. It's just that I [quoted text clipped - 4 lines] > Now that did upset me. Maybe I am one of those people who are never > satisfied. I don't know that anyone ever knows what's going on with PCa. Certainly not until you're not happy with the knowledge. Hmmmmmmmm. Just got a flashback to Adam's apple. SignaturePSA 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 > Well, it's not that I worry, although I know it looks that way. And my doc thinks I am > a "worrier" because I ask so many questions. It's just that I want to know what is > going on, and not feel that I am being kept in the dark. ... I'm with you on that one. My doctor wanted to give me monthly PSA tests so he could plot the results for the clinical trial I'm in. He said that the law required him to tell me the results if I wanted them, but he recommended that I not look at them since there was nothing to be done anyway. I told him that I was a big boy, and I would deal with the news, good or bad. I wanted the results. When (there's really no "if" about it), my time comes, I hope to be able to deal with it straightforwardly and without undue anxiety or depression. I'd rather do that than live in a fool's paradise, thinking that I'm okay when I'm not. It seems to me that one of our tasks as human beings is to try to live a graceful life. Ultimately, I think it's also one of our tasks to make our deaths as graceful as we can - by facing the facts bravely and with equanimity, thinking about others and living as best we can right to the end. Well, who knows if we can do it. It's not an easy task. But it's one I'm going to try to carry out. Alan Yes, we are both together on this. If I am not told the truth, I feel a kind of betrayal, a surrender of my very being to who are really total strangers, not even loving family. We have to live our lives with consciousness (whatever our beliefs or values), and when the facts of our condition are taken away, we are deprived of our essential humanity, and at the end of our life, just at the time when we need that consciousness to fulfill and complete our life. It is as if our life is being cut short, as if our life (our conscious life) is ending prematurely and denied the finale of it: meeting the end with awareness and dealing with that. I have seen numerous people die, and from that I know that facing death--if it is really faced with awareness and fullness of self--is not a dreadful thing to be avoided or feared. From what you write, Alan, I know that you will face it just as you want to. >> Well, it's not that I worry, although I know it looks that way. And my >> doc thinks I am a "worrier" because I ask so many questions. It's just [quoted text clipped - 27 lines] > > Alan > It seems to me that one of our tasks... Amen brother, amen. SignaturePeter Headland Stavros posted...snip... I gather that this means that if the PSA has doubled (or at any time up to six months), then ---------------------------------------------------------------------------------------------------------------------------- Stavros...I don't think this is what the article is saying. In my reading of the article it is saying that 8 months is the PSA doubling time cutpoint (if the PSADT is > 8 months then the prognosis is better than if the PSADT is < 8 months). The time frame for the determination is not just the 8 month post-treatment timeframe. This PSADT concept has been widely examined and validated for many PCa therapies in the past year or two, now it is being extended to RT+HT. This is a separate point and does not alter the comments I posted earlier...Best wishes and good health, Ron |
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