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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2007One year post RP and zero PSA
Well, the subject line says it all. I had a prostatechtomy in June, 2006 and just got the results of my last PSA test done in late July- zero, zip, nada. I still have to have what I expect is a final consultation with my uro, but it is my understanding that I can now consider myself cured of PCa. So, how is life now about 18 mo after being diagnosed with PCa and 14 months after surgery. Pretty good, not as good as before surgery, but pretty good nonetheless. I am healthy and totally dry and have been for 12 mo. But I can only get a usable erection with bimix injection. This works pretty good, but sex isn't what it used to be. I would say that my sexual satisfaction is at best half of what it was before surgery. But I am rid of the PCa and that is great!!! So, this is my last post to this group unless things turn to s****. But I will keep monitoring the group (it is useful to know what can happen and how to deal with it) and of course my PSA. David Marchand > Well, the subject line says it all. I had a prostatechtomy in June, 2006 and > just got the results of my last PSA test done in late July- zero, zip, nada. [quoted text clipped - 5 lines] > after surgery. Pretty good, not as good as before surgery, but pretty good > nonetheless. > But I am rid of the PCa and that is great!!! > [quoted text clipped - 3 lines] > > David Marchand I don't understand what your uro is telling you at all. I had an RRP in Oct '04. My uro onc says I'll be debatably cured if and when my PSA is still essentially zero in the year 2014, more definitely cured with zero in 2019. For the foreseeable future -- certainly several years -- he is measuring my PSA every three months. And, no, he gets not one cent for my PSA tests. I've never heard of anyone being considered cured in five years, let alone one. I.P. > > Well, the subject line says it all. I had a prostatechtomy in June, 2006 and > > just got the results of my last PSA test done in late July- zero, zip, nada. [quoted text clipped - 24 lines] > > - Show quoted text - It sounds like David is going to continue to monitor his PSA. In the current literature, most doctors won't approach the word "cure" unless there have been 15 consecutive years of undetectable PSA levels post surgery. In this world of PCa, we either "have it or we don't." So you can't worry about it every day or you'll go crazy. Every time we do see an undetectable reading after a test, it is cause for a celebration. If we do find that cancer has returned, then we make a game plan and move forward. I know it is not that simple, but I'm trying to "box it" a little :-) All the best to you guys, Idaho -------- Age: 54 PSA: 4.3 Biopsy: T1c, 3+3=6, 2 pos. samples in one side Da Vinci 31 Jul 2007: saved nerve bundle on non-cancerous side Final pathology: Confined to prostate, T2a, 3+3=6 Please visit my web site: http://pca-info.blogspot.com I rejoice with you that after one year your PSA is undetectable. Mine has been the same for 2 years now, and I hope it will be after a third. Rather than consider myself cured, I prefer to look at the numbers. After every test my surgeon told me the percentage chance of a recurrence. After 2 years undetectable PSA the percentage he says is now 2%. That's close to 'cured' but not 100%. Good enough for me, but still worth being watchful and continuing the tests. Invicta >>> Well, the subject line says it all. I had a prostatechtomy in June, 2006 and >>> just got the results of my last PSA test done in late July- zero, zip, nada. [quoted text clipped - 42 lines] > Final pathology: Confined to prostate, T2a, 3+3=6 > Please visit my web site: http://pca-info.blogspot.com Invicta...Congratulations on your undectable PSA, I wish you many, many more. It intrigues me that your doctor says that, at 2 years post-treatment, your remaining chance of biochemical failure is 2%, or thereabouts. Do you have any idea how he arrives at this estimate? Swanson has studied the biochemical failure rate over extended periods of time (>20 years) for both RT and RP. He has found that the cumulative recurrence rate increases in a roughly linear fashion over time. In other words, if we had an initial cohort of 1,000 men with similar GS, PSA and TNM staging, and they were treated similarly and then followed over time, and the ultimate number of men who recurred was say 100 at 20 years post-op, then we would expect roughly 5 men to fail each year. Biochemical recurrence rates are not strikingly different for low-risk men treated either surgically or with RT. Using the Hopkin's nomogram (M. Han, A. W. Partin, M. Zahurak, S. Piantadosi, J. Epstein and P. C. Walsh; J. Urol., 169, 517-523, 2003; the paper can be found at http://www.prostate-help.org/download/jhnomo.pdf), we see that for T1c, PSA=4-10, GS=6 men, they have a 5% failure rate at 10 years. Extending this trend linearly would suggest a cumulative failure rate around 10% at 20 years. So an individual's estimated chance for biochemical recurrence depends upon initial staging and life expectancy. On average, a man with GS=5, PSA<4 and T1c staging would have a 2% chance of failure at 20 years. Slighly after treatment it could be said that he had a 2% chance of failing if he expected to live another 20 years. Most other groups, like the GS=6 example above, would have higher expected failure rates at 20 years. Again, I am intrigued by your doctor's statement and would like to know how he arrived at it. Were you in a low risk group and / or are you older with a shorter remaining life expectancy?..Best wishes and good health, ron >I rejoice with you that after one year your PSA is undetectable. Mine has >been the same for 2 years now, and I hope it will be after a third. [quoted text clipped - 4 lines] > 'cured' but not 100%. Good enough for me, but still worth being watchful > and continuing the tests. Hi, Invicta. Is this your first foray into our little group or are you merely using a different handle? If the former, please let us know your history and stats.  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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04 (06/12/2007) Non Illegitimi Carborundum > Well, the subject line says it all. I had a prostatechtomy in June, 2006 > and just got the results of my last PSA test done in late July- zero, zip, > nada. Congratulations! I hope you have many more undetectable PSAs in your future. > I still have to have what I expect is a final consultation with my uro, > but it is my understanding that I can now consider myself cured of PCa. My understanding is that guys like you and me -- post-RP -- should continue to monitor PSA levels for several years following the surgery. We've both read many accounts on this NG of men who were undetectable for two or more years before their PSA started to rise again. After my September PSA check, which I hope to be another "<0.01," I expect to go to having it checked every 6 months for the next couple of years, and then back to once a year. But we're still watching. My docs and I do not know if I'm cured or not. I hope it's all gone. I think it's all gone. But I do not know it's all gone. And that's probably where your head should be, too. Sorry to be a wet blanket; after all, another undetectable *is* good news. But please keep checking. If it's still there, the sooner you know, the better your prognosis. And don't be surprised if your uro wants to see you again in six months. As far as the ED: you might still be healing, so continued visits to a doc with some ED expertise might be worth your while. Again, we've both read stories on this NG from men who've regained full sexual function but only after more than a year without erections. All the best, charlie Signature6/2006 PSA 5.2, DRE suspicious 7/2006 Biopsy: 2 of 10 positive, Gleason 7(3+4) 11/2006 LRP: Clear margins PSA < 0.01 on 1/2007, 3/2007, 6/2007 so far, so good ... > Well, the subject line says it all. I had a prostatechtomy in June, 2006 > and just got the results of my last PSA test done in late July- zero, zip, > nada. Dave, I implore you to continue to feed us your PSA data. We need the good with the bad. 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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04 (06/12/2007) Non Illegitimi Carborundum On August 24, David wrote: > Well, the subject line says it all. I had a prostatechtomy in June, 2006 and > just got the results of my last PSA test done in late July- zero, zip, nada. > > I still have to have what I expect is a final consultation with my uro, but > it is my understanding that I can now consider myself cured of PCa. (snip) /Activate wet-blanket mode/ No. Roughly 30% of prostatectomies result in biological failure within five years. Keep checking. It will never be over. Regards, Steve J > On August 24, David wrote: > [quoted text clipped - 13 lines] > > Keep checking. It will never be over. /Activate blanket-dryer mode/ Yes, but a significant number of those fail in the first year. Since you made it past that, you're now looking at something less than 30%, maybe 25% or even 20%. And each year that you hold your low PSA, your odds keep getting better. Also, be aware that the 30% includes cases with Gleason 8-10, with positive margins, and with other signs of poor prognosis. Your odds were probably much better than 30% to begin with and now, a year later, have improved still further. The blanket is always a little damp, but hopefully you can sleep under it without too much tossing and turning. Best of luck. Alan As Alan indicates, the percentage failure rate should be quoted based on an individual's particular case. The 2% chance of failure after more than 2 years undetectable PSA was quoted to me by my surgeon as a measure of the actual potential failure using the statistics based on my Gleason, negative margins, age, more than 2 years undetectable PSA, and other factors personal to my case. The wet blanket approach is of course important. No one should be lulled into a false sense of security. On the other hand, quoting a 30% chance of failure can be misleading for the reasons Alan rightly suggests. There are graphs published which give the likely chance of failure, and that was presumably the source for the 2% I was quoted. 2% is not zero. But I rejoice in the success of the operation and the very low chance of it all now going wrong. Invicta. >> On August 24, David wrote: >> [quoted text clipped - 33 lines] > > Alan Baesed on my Gleason, containment, neg margins, etc. my surgeon quoted my chances of biological failure of 7%. So it does vary from indivdual to individual... That was almost 4 years ago, and still PSA is zero!! > As Alan indicates, the percentage failure rate should be quoted based on > an individual's particular case. [quoted text clipped - 55 lines] > > > > Alan |
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