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Medical Forum / Diseases and Disorders / Prostate Cancer / October 2005Dilemma....
Hallo from Italy!! I am back in this NG for support. I underwent RPP n. sparing in Dec. 2002. The PSA threemonthly checks have been OK (undetectable) until May 2004 and since then they are scattered (from 0.11 to 5.1 ng/ml)with peacks and drops (see table on foot). Image diagnoses carried out twice from may 2004 to date all negative (abdomen-pelvicTC,endorectalEcography,TB scan, XRays). The oncologist + radio-oncologist advise for a two months IMRT,while the androlgist keeps the matter very cold and advises to keep watching the PSA trend for a longer time before starting with radio-therapy (on his opinion my PSA value do not justify RT). My previous undestanding from the posts in the NG was that the value of 0.2 ng was threshold for recurrence or receidive. I am 57 and not very willing to ...burn the few bundles I had the chance to save after RPP. I hope I can read your comments/experiences since I I have to confirm or cancel the ... barbecue, already scheduled for mid-end November.I wish the best to everybody in the NG. Grazie e ciao. --------------------------- date PSA Tot (ng/ml) 9-dic-02 RPP n. sp. 4-mar-03 0,15 6-mag-03 0 17-lug-03 0 11-nov-03 0 5-mar-04 0 4-mag-04 0,11 22-lug-04 0,27 28-ago-04 0,17 26-ott-04 0 3-dic-04 0,11 12-feb-05 0,3 12-mar-05 0,1 2-lug-05 0,51 17-ago-05 0,38 1-ott-05 0,37 MISSPRINT: sorry ! My PSA scattering is between 0.11 and 0.51 ng/ml NOT 5.1!!! My PSA has also peeped above the "unmeasurable" line, so my uro/onc discussed my case with his university onc board. Because only 48% of RP pts with 0.2 PSA ever see a further PSA increase, a) they're not alarmed and b) many institutions define biochemical failure at 0.4, not 0.2. They understandably don't want to take the time to discuss adjuvant treatment (and I won't bother to research it further) until and unless my PSA increases by another couple thousand percent (i.e. to past 0.2), and are not the least bit eager to recommend ADT or RT until well past that point because of their SEs (and I'm far more concerned about the other SEs than about potence). I.P. > Hallo from Italy!! I am back in this NG for support. I underwent RPP n. > sparing in Dec. 2002. The PSA threemonthly checks have been OK [quoted text clipped - 13 lines] > or cancel the ... barbecue, already scheduled for mid-end November.I > wish the best to everybody in the NG. Here is an article on the subject by a couple of well-known prostate cancer specialists in the US. A lot depends on your pre-op stats including pre-op PSA velocity. It is a gray area, but you have exceeded .25 which they note is a threshold. Identifying patients at risk for significant versus clinically insignificant postoperative prostate-specific antigen failure. D'Amico AV, Chen MH, Roehl KA, Catalona WJ. Brigham and Women's Hospital, Department of Radiation Oncology, Dana-Faber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA. adamico@lroc.harvard.edu PURPOSE: We evaluated whether men at risk for significant versus clinically insignificant prostate-specific antigen (PSA) failure after radical prostatectomy could be identified using information available at diagnosis. PATIENTS AND METHODS: A prospective prostate cancer screening study that enrolled, diagnosed, and treated 1,011 men with radical prostatectomy at Barnes-Jewish Hospital (St Louis, MO) from January 1, 1989, to June 1, 2002, for localized prostate cancer formed the study cohort. Preoperative predictors of a postoperative PSA doubling time (DT) of less than 3 months and more than 12 months or no PSA failure were identified using logistic regression. RESULTS: A preoperative PSA velocity more than 2.0 ng/mL/yr (P = .001) and biopsy Gleason score 7 (P = .006) or 8 to 10 (P = .003) were significantly associated with having a postoperative PSA DT less than 3 months. A PSA level less than 10 ng/mL (P = .005), a nonpalpable cancer (P = .001) with a Gleason score < or = 6 (P = .0002), and a preoperative PSA increase that did not exceed 0.5 ng/mL/yr (P = .03) were significantly associated with a postoperative PSA DT of at least 12 months or no PSA failure. Most men with these preoperative characteristics and a postoperative PSA DT of 12 months or more had a persistent postoperative PSA level of at least 0.2 ng/mL that did not exceed 0.25 ng/mL after a median follow-up of 3.6 years. CONCLUSION: A postoperative PSA DT less than 3 months is associated with a preoperative PSA velocity more than 2.0 ng/mL/yr and high-grade disease. Select men with a postoperative PSA DT more than 12 months may not require salvage radiation therapy. PMID: 16051949 [PubMed - indexed for MEDLINE] Here is an article on the subject by a couple of well-known prostate cancer specialists in the US. A lot depends on your pre-op stats including pre-op PSA velocity. It is a gray area, but you have exceeded .25 which they note is a threshold. Identifying patients at risk for significant versus clinically insignificant postoperative prostate-specific antigen failure. D'Amico AV, Chen MH, Roehl KA, Catalona WJ. Brigham and Women's Hospital, Department of Radiation Oncology, Dana-Faber Cancer Institute, Harvard Medical School, Boston, MA 02115, USA. adamico@lroc.harvard.edu PURPOSE: We evaluated whether men at risk for significant versus clinically insignificant prostate-specific antigen (PSA) failure after radical prostatectomy could be identified using information available at diagnosis. PATIENTS AND METHODS: A prospective prostate cancer screening study that enrolled, diagnosed, and treated 1,011 men with radical prostatectomy at Barnes-Jewish Hospital (St Louis, MO) from January 1, 1989, to June 1, 2002, for localized prostate cancer formed the study cohort. Preoperative predictors of a postoperative PSA doubling time (DT) of less than 3 months and more than 12 months or no PSA failure were identified using logistic regression. RESULTS: A preoperative PSA velocity more than 2.0 ng/mL/yr (P = .001) and biopsy Gleason score 7 (P = .006) or 8 to 10 (P = .003) were significantly associated with having a postoperative PSA DT less than 3 months. A PSA level less than 10 ng/mL (P = .005), a nonpalpable cancer (P = .001) with a Gleason score < or = 6 (P = .0002), and a preoperative PSA increase that did not exceed 0.5 ng/mL/yr (P = .03) were significantly associated with a postoperative PSA DT of at least 12 months or no PSA failure. Most men with these preoperative characteristics and a postoperative PSA DT of 12 months or more had a persistent postoperative PSA level of at least 0.2 ng/mL that did not exceed 0.25 ng/mL after a median follow-up of 3.6 years. CONCLUSION: A postoperative PSA DT less than 3 months is associated with a preoperative PSA velocity more than 2.0 ng/mL/yr and high-grade disease. Select men with a postoperative PSA DT more than 12 months may not require salvage radiation therapy. PMID: 16051949 [PubMed - indexed for MEDLINE] I.P. Raul is using a translator. Sarcasm and switchback sentences probably do not translate well.  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 .08 non Illegitimi carborundum > My PSA has also peeped above the "unmeasurable" line, so my uro/onc > discussed my case with his university onc board. Because only 48% of RP pts [quoted text clipped - 27 lines] > > or cancel the ... barbecue, already scheduled for mid-end November.I > > wish the best to everybody in the NG. I don't know what a switchback sentence is, but there's not a speck of sarcasm in there. Realizing English is not his first language, I tried to be specific and accurate. I wasn't aware the internet has translators. Are they a software product, or are you referring to a human friend? I.P. > I.P. > > Raul is using a translator. Sarcasm and switchback sentences probably do > not translate well. "switchback" may be less the descriptive than the word that isn't coming to mind any quicker than it was before. However, there are several translators. I use http://www.freetranslation.com/ because it was the one that came up first when I Googled a few years ago. I've used it to answer posts from people who posted in their language. I have not seen a great translator. All seem to favor short sentences with monosyllabic words. 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 .08 non Illegitimi carborundum > I don't know what a switchback sentence is, but there's not a speck of > sarcasm in there. Realizing English is not his first language, I tried to be [quoted text clipped - 9 lines] > > Raul is using a translator. Sarcasm and switchback sentences probably do > > not translate well. I use Babelfish (Altavista), but none of them translate very well, as Steve says. I do know enough French, for instance, to see how badly they muck it up, so to speak (G). http://world.altavista.com/ Google also has a translation service to the right of the main text box, (Language Tools), but I have a sneaking suspicion it is also Babelfish. I used to have a better one on my old computer and I will dig it up. Heather >I don't know what a switchback sentence is, but there's not a speck of >sarcasm in there. Realizing English is not his first language, I tried to [quoted text clipped - 9 lines] >> Raul is using a translator. Sarcasm and switchback sentences probably do >> not translate well. If you have a few spare moments, something fun to do is use one of these translators to translate something you write into another language and then translate that back into English. It will make assembly instructions from China look downright cerebral. Dave Perry That is true. Machine translating: "The spirit is willing but the flesh is weak" to Russian and then back to English yields: "The ghost is ready but the meat is raw" > If you have a few spare moments, something fun to do is use one of > these translators to translate something you write into another > language and then translate that back into English. It will make > assembly instructions from China look downright cerebral. > Dave Perry > Hallo from Italy!! I am back in this NG for support. I underwent RPP n. > sparing in Dec. 2002. The PSA threemonthly checks have been OK [quoted text clipped - 6 lines] > the PSA trend for a longer time before starting with radio-therapy (on > his opinion my PSA value do not justify RT). To me, this seems systemic. If so, I can see nothing to be gained by resort to IMRT. What, exactly, would be radiated? And why? Which is to say, why would a certain organ (seminal vesicle, lymph node, whatever) be radiated? There seems to be no reason for that, since the tests so far fail to disclose any lesions. What were Raul's PSA and Gleason score (and any other test results such as TNM score) before the RP? This could be helpful in estimating the likelihood of systemic disease. Has a nuclear bone scan been done to check for any metastases to bone? Caveat: this scan will not show micro-metastases. Has a prostatic acid phosphatase blood test been performed? Even though it should have been done during staging before treatment, that could provide useful insights into the possibility of metastases. > My previous undestanding from the posts in the NG was that the value of > 0.2 ng was threshold for recurrence or receidive. The American Society of Clinical Oncology (ASCO) has established the criterion for recurrence as three successive rises in PSA. One must, however, bear in mind that such a series from, say, 0.01 to 0.02 to 0.03 to 0.04 is tiny and probably does not require much more than observation. (snip) > I hope I can read your comments/experiences since I I have to confirm > or cancel the ... barbecue, already scheduled for mid-end November. "Barbecue" for IMRT, eh? Very good. I just might steal it. I recommend exploration of the website of the Prostate Cancer Research Institute for helpful and objective information. It is at http://prostate-cancer.org/index.html I would give serious consideration to systemic treatment, androgen deprivation therapy, in order to try to lower the PSA to <0.05 ng/mL. But that's just my viewpoint and must not be considered to be medical advice. > I wish the best to everybody in the NG. E lo stessi a voi. Regards, Steve J "We must tailor the treatment to the nature of the disease. We must listen to the biology." -- Stephen B. Strum, MD > To me, this seems systemic. If so, I can see nothing to be gained by > resort to IMRT. What, exactly, would be radiated? And why? Which is to > say, why would a certain organ (seminal vesicle, lymph node, whatever) be > radiated? There seems to be no reason for that, since the tests so far > fail to disclose any lesions. Exactly my question of my doc Friday. Answer, pending greater detail if and when my PSA gets worth worrying about, paraphrased: Unless discrete mets can be found, recurrent PSA is usually due to some leftover prostate tissue left behind, so salvage RT is a valid option. OTOH, the SEs of both RT and ADT must be especially strongly considered by doctor and patient if the only driving factor is a PSA down in the low tenths. I.P. Thanks a lot for the comments I received from You, dear friends. I will work them out and keep in touch. Some integrations: -my PCa was classified Gleson score 7. T3 NM0 (i.e. G3 for WHO), with capsular infiltration; -prostatic acid phosp. blood test scheduled next week; _ the radiation is addressed to the prostatice saddle where relict cancer cells are suspected; - one endo-rectal magnetic resonance test is scheduled in early Nov.before starting IMRT, regardless on the issues of the test. This is just aimed at marking the situations before RT in view of cheking it once again after RT. Thanks, guys (I'm trying to shift into... US/English!!)and good look. Steve Jordan ha scritto: > > Hallo from Italy!! I am back in this NG for support. I underwent RPP n. > > sparing in Dec. 2002. The PSA threemonthly checks have been OK [quoted text clipped - 58 lines] > to the biology." > -- Stephen B. Strum, MD Raul, Well then I guess there is good reason to believe you have some cancer where your prostate gland was. Since your cancer was aggressive (Gleason 7), it sounds like good advice to have local radiation. But I'm not a doctor, and I don't know how long you can wait. jimhoney > Thanks a lot for the comments I received from You, dear friends. I will > work them out and keep in touch. [quoted text clipped - 74 lines] >>to the biology." >>-- Stephen B. Strum, MD Raul, I will ask this question even though it may be stupid. If your cancer has returned, how can it be that your PSA sometimes goes down? The andrologist's advice makes the most sense to me. jimhoney > Hallo from Italy!! I am back in this NG for support. I underwent RPP n. > sparing in Dec. 2002. The PSA threemonthly checks have been OK [quoted text clipped - 32 lines] > 17-ago-05 0,38 > 1-ott-05 0,37 > Raul, > [quoted text clipped - 4 lines] > > jimhoney Prostate cancer is different from most other cancers in that its rate of cell death is almost as fast as its rate of growth. To put this in practical terms, while prostate cancer cells double every 56 days on average, the time for the population to double is 495 days for high Gleason score cells and 577 for low Gleason score cells. Numerous things can affect the rate of prostate cancer cell death. It goes up with things like lycopene, vitamin D3, or antioxidants. It goes down with things like eating phytoestrogens (e.g. soy). Depending on what an individual does, it is possible for the cell population to go down instead of continually going up, so a drop in PSA can be real and not just an artifact. However, while you may kill the cells that are susceptible to whatever treatment you just tried, those that are left will continue growing. What you need are conditions that kill all of the prostate cancer cells and not just some of them. Ed Friedman Welcome back! Your bouncing PSA does seem to be unusual. Mine is bouncing too, but between .05 and .08. But, your peaks are 10 times higher. My opinion, and I am not a doctor, is that your .37 and .38 are sufficient to warrant radiation. But, I think I would wait for one more PSA test. 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 .08 non Illegitimi carborundum > Hallo from Italy!! I am back in this NG for support. I underwent RPP n. > sparing in Dec. 2002. The PSA threemonthly checks have been OK [quoted text clipped - 32 lines] > 17-ago-05 0,38 > 1-ott-05 0,37
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