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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2008Post SRT PSA
Hi guys. Thanks for always being here when I need you. I just had my 3 month post-SRT checkup where they informed me that my PSA was unchanged. I have always had very low levels of PSA (see my stats below) so actual levels and even rates are in the twilight zone as far as interpretation is concerned. However, it was undetectable for almost 5 years post RP and then it came back. My oncologist advised me to come back in another 3 months saying that, sometimes, it takes more than 3 months for the PSA to drop back to undetectable. Now, we all know that SRT is a bit of a crap shoot when there is no visible signs of recurrence beyond a rising PSA (if it has taken several years to recur, then it may be a local recurrence and SRT can have a positive effect.) so if it didn't work in my case, then I guess I'm not that surprised. But I hadn't heard anything before about it taking longer than 3 months to show. Does anyone have any experience or knowledge of this? I know that I "shed" PSA fast because I was undetectable about a month and a half after my RP. I will wait the three months on the off chance that this might be true (although I don't expect that), but I am curious. Thanks, Doug DX 10/15/02 @ age 49 PSA 1.26; Gleason 6; T2a RP 12/04/02; one nerve spared PSA 2003-6: Undetectable PSA 09/14/07: 0.13 PSA 11/05/07: 0.15 Completed SRT 01/08 PSA 04/21/08: 0.15 Blog: http://talkingaboutcancer.com On May 1, 9:23 pm, doug.gosl...@gmail.com wrote: > Hi guys. Thanks for always being here when I need you. > [quoted text clipped - 30 lines] > PSA 04/21/08: 0.15 > Blog:http://talkingaboutcancer.com Hi Doug, My guess is that no one really knows what is going on for sure after biochemical recurrence as to where the source is coming from. In my brothers case he was Gleason (3+5)=8 with extracapsular penetration, PSA 6.1. Had Open RP in 1999 followed by 36 Rad treatments and was undetectable for 7 1/2 years. Psa came back last June at 1.3 and has been doubling about 3.1 months. It's now at 7.405. He has had every scan available and all the available blood test and nothing shows any cancer. His Medical Oncologist wants to continue monitoring his PSA for a while as he states the PSA could be coming from benign prostate tissue. I know that some here will laugh at that possibility but I also know that none of the posters here are medically trained and therefore I keep that in mind when considering opinions. Ron S. > On May 1, 9:23 pm, doug.gosl...@gmail.com wrote: > [quoted text clipped - 51 lines] > > - Show quoted text - Ron...It would take something on the order of 100 gm of benign tissue to generate a PSA around 7.4 ng/ml. That's more tissue than most prostates contain while still intact...ron > > On May 1, 9:23 pm, doug.gosl...@gmail.com wrote: > [quoted text clipped - 55 lines] > to generate a PSA around 7.4 ng/ml. That's more tissue than most > prostates contain while still intact...ron I also understand that the PSA is exceptionally high and probably is cancer recurrence. I also understand that none of the imaging devices are sensitive enough to detect small tumors. However, having said that, I will have to admit that all three of his scans; MRI Thoracic Spine w/ contrast, CT Abdomen and Pelvis w/ contrast and NM Bone Scan Whole Body indicate increased accumulation of radioisotope within the T12 vertebral body, which is most likely secondary to a metastatic lesion. His new Medical Oncologist had him do the Prostacint Scan thing and everything came back normal. We understand that the test is not that reliable, however his Doc wants a few more PSA's before they go with hormone therapy. He believes the three scans are biased towards possible cancer. All three are either unremarkable or possible. It does seem like with his PSA level and doubling time that he probably has recurrence. His Doc thought it might be local but with the scan results I would think that it is systemic and probably in his spine. I think this situation with him just points out once again how difficult it is for anyone to figure out what is really going on with the test that are available once the PSA starts to rise after treatment. Most start followup treatment right away with no assurance of benefit and some will hold off until clinical symptoms occur to try and manage the symptoms. Ron S. the PSA could be coming from benign prostate > > tissue. > > Ron S. > Ron...It would take something on the order of 100 gm of benign tissue > to generate a PSA around 7.4 ng/ml. That's more tissue than most > prostates contain while still intact...ron The problem I have always had with the benign tissue thing is that, if there was something left that was creating normal PSA, then it shouldn't have been undetectable for so many years. Also, I would think that SRT would burn out anything left. There really appears to be no completely reliable test (even worse when your PSA is a strange as mine), so it's all odds and numbers and maybes. We just have to do our best with what we have. Doug On May 2, 11:59 am, doug.gosl...@gmail.com wrote...snip... > The problem I have always had with the benign tissue thing is that, if > there was something left that was creating normal PSA, then it > shouldn't have been undetectable for so many years. Also, I would > think that SRT would burn out anything left. Doug...Any residual, benign tissue would be expected to grow slowly over time (see Shinghal R, Yemoto C, McNeal JE, Brooks JD; Biochemical recurrence without PSA progression characterizes a subset of patients after radical prostatectomy; Urology 61:380-5, 2003). Perhaps after RP the amount of remaining tissue was so small that only an undetectable amount of PSA was generated, particularly if you were using a test that was only sensitive for PSA>0.10 ng/ml. Then as the tissue grows, eventually enough PSA is generated that you become detectable with the test that you are using. As to SRT killing anything left, I guess that would be the goal, but depending on where the beam was focused and where the tissue resided, I would think anything is possible. Also healthy, benign tissue is less susceptible to radiation damage than cancerous tissue or cells. Finally, it is also possible that your PSA was higher than 0.15 by the time you went in for SRT, in which case your most recent reading of 0.15 would signal a decline. Anything is possible, get that next PSA reading in 3 months as planned and see what it tells you. Hang in there!..ron > Now, we all know that SRT is a bit of a crap shoot when there is no > visible signs of recurrence beyond a rising PSA (if it has taken [quoted text clipped - 4 lines] > or knowledge of this? I know that I "shed" PSA fast because I was > undetectable about a month and a half after my RP. I don't know, Doug. Seems to me that SRT should result in an immediate drop, though not an immediate nadir. It doesn't appear you have either. But radiation is an odd thing, what with coaxing cells to kill themselves and all. I guess it's possible to have an increase, then a decrease, and appear to have not moved at all. I think you're wise in seeing what it does in three months.  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, <0.04, <0.1 2/12/08 Non Illegitimi Carborundum > <doug.gosl...@gmail.com> wrote in message > [quoted text clipped - 29 lines] > PSA <0.04, <0.05, <0.04, <0.04, <0.1 2/12/08 > Non Illegitimi Carborundum Doug, This article from Duke University Medical Center recommends not taking action on recurrent PSA until it is greater than .2ng/ml because of microscopic or focal benign prostate tissue often being left behind. http://www.cancernetwork.com/display/article/10165/63133 Also this European study showed a significant number of patients with residual benign tissue left after surgery. http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6X10-4CDJB3C-2&_user=1 0&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVers ion=0&_userid=10&md5=98645aec6f1d1275e3476372ee54168d Ron S >I just had my 3 month post-SRT checkup where they informed me that my >PSA was unchanged. snip > My oncologist >advised me to come back in another 3 months saying that, sometimes, it >takes more than 3 months for the PSA to drop back to undetectable. snip > I hadn't heard anything before about it >taking longer than 3 months to show. Does anyone have any experience >or knowledge of this? snip >I will wait the three months on the off chance that this might be true >(although I don't expect that), but I am curious. [quoted text clipped - 11 lines] >PSA 04/21/08: 0.15 >Blog: http://talkingaboutcancer.com Hi Doug, I had my first PSA test 2 1/2 months after SRT (and it was undetectable). So... it can reach nadir under 3 months. Why don't you take another PSA test straight away, to confirm that your first result it was not really a blunder? Just > I had my first PSA test 2 1/2 months after SRT (and it was > undetectable). So... it can reach nadir under 3 months. What do you mean by "undetectible" in this context? Less than 0.1 using the regular test? Or 0.000 using the ultrasensitive 3rd gen tests? Obviously, if you're using the regular test, just because you are undetectable (<0.1) after 3 months doesn't necessarily mean that you've reached nadir after 3 months; the score can drop further, but you can't tell it's dropped if it's below 0.1. I think most of the guys using ultrasensitive tests will tell you they reach nadir MUCH later than 3 months. I reached my nadir about 2 years after SRT (0.008); since then it's risen just a little, but not enough to alarm me.....yet. Doug, if I were in your socks, I agree I'd give it another 3 months at least and see what the next test shows before making any moves. Fred >> I had my first PSA test 2 1/2 months after SRT (and it was >> undetectable). So... it can reach nadir under 3 months. > >What do you mean by "undetectible" in this context? Less than 0.1 >using the regular test? Or 0.000 using the ultrasensitive 3rd gen >tests? I mean <0,02. This was in 2005. This was (and still is) the threshold of the kit used in this clinic. Just |
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