Interesting PSA Discussion...from '04 but...

Thread view:

Enable EMail Alerts

Start New Thread

Thread rating:

Ron B - 13 Jul 2008 15:48 GMT

http://mediwire.skyscape.com/main/Default.aspx?P=Content&ArticleID=257098

Reply to this Message

Ron B - 13 Jul 2008 17:20 GMT

I know that '04 is AGES ago in medical work...but I'd still appreciate
your thoughts on this thing. I KNOW the PSA levels are totally different
now...but otherwise...?

Thanks,

Ron B.

Chicago

Reply to this Message

skeptic - 14 Jul 2008 03:23 GMT

> I know that '04 is AGES ago in medical work...but I'd still appreciate
> your thoughts on this thing. I KNOW the PSA levels are totally different
[quoted text clipped - 5 lines]
>
> Chicago

My god...i read every word in that discussion and never heard so many
conflicting and contradictory and vague opinions.
Everyone was afraid to go down on record to really answer any of the
questions with any conviction at all. It's no wonder this disease can
drive us crazy.
I relate to all of the questions/hypothetical cases presented as they
reflect my status (rising psa after RP) and came away with absolutely
no conclusion at all. But thank you for posting it Ron, it was
interesting to read so many different views on the same subject.

Reply to this Message

Alan Meyer - 14 Jul 2008 23:09 GMT

>> I know that '04 is AGES ago in medical work...but I'd still appreciate
>> your thoughts on this thing. I KNOW the PSA levels are totally different
[quoted text clipped - 11 lines]
> questions with any conviction at all. It's no wonder this disease can
> drive us crazy.

I read about halfway through and had the same reaction.
It seemed like all of the urologists danced around the
tough questions. Or, to put it a different way, they
just don't know what it means when a patient's PSA rises
a little after surgery and just hangs around there.

> I relate to all of the questions/hypothetical cases presented as they
> reflect my status (rising psa after RP) and came away with absolutely
> no conclusion at all. But thank you for posting it Ron, it was
> interesting to read so many different views on the same subject.

The one thing I carried away from the discussion was that there
are some men for whom PSA is detectable, but doesn't seem to
grow. The number of such men can be significant.

Will they eventually get systemic cancer? Nobody knows. Should
they be treated with radiation or HT? No one knows that either.

In spite of the fact that salvage radiation is only effective
before cancer has become systemic, and in spite of the fact
that you have to catch it early before it becomes systemic,
I think if I were a surgery patient I would consider holding
off at least until the PSA reached 0.2, and maybe even 0.4,
before going for radiation. Alternatively, if I saw it
going up every month for several months I might go for the
radiation even before it reached 0.4.

Maybe. Maybe not. It's one of those agonizing decisions that
you will
These are very, very tough decisions. We can ask the experts
what to do, but as that web page shows, the experts don't
know either. The science just isn't far enough advanced yet.

Alan

Reply to this Message

Alan Meyer - 14 Jul 2008 23:17 GMT

I had some problems posting that last message and it got
a little garbled. Sorry about that.

The last paragraph should have read: ---

Maybe. Or maybe not. It's one of those agonizing decisions for
which there just isn't enough information to make an informed
choice. We can ask the experts what to do, but as that web page
shows, the experts don't know either. The science just isn't far
enough advanced yet.

Alan

Reply to this Message

Ron B - 15 Jul 2008 18:33 GMT

Alan wrote:

"In spite of the fact that salvage radiation is only effective before
cancer has become systemic, and in spite of the fact that you have to
catch it early before it becomes systemic, I think if I were a surgery
patient I would consider holding off at least until the PSA reached 0.2,
and maybe even 0.4, before going for radiation. Alternatively, if I saw
it going up every month for several months I might go for the radiation
even before it reached 0.4."

Great comments...cuz those guys were wish-washy.

One of the reasons that some docs don't like the sensitive PSA's is that
it causes undo PSA Anxiety. (in ME!)

(Walsh is one who thinks that.)

AND...Catalona told me that he didn't think that any doctor would
consider salvage radiation until the PSA reached .2

I asked about the 'doubling time'...like 0.02 to 0.04 to 0.07...and he
said that there are too many variables (artifacts) in the tests...and
since nothing would be considered until a rise to .2 ANYWAY...this is
the way we go.

My recent .1 's after 3 years...(no LESS THAN sign) worried me enough to
call him and get the above info.

I also said...that my 0.0's for 3 years could have been 0.09...and it
would be reported as 0.0...he agreed...but the bottom line is that now
I'll take a PSA each month and see what happens.

He said...it may be 0.0 again (which could really be 0.09)

I have to trust him...I don't HAVE to...but I do.

A final question...has anyone heard of salvage radiation BELOW 0.2?

Thanks and best to all,

Ron B.

Chicago

Reply to this Message

skeptic - 18 Jul 2008 21:32 GMT

> Alan wrote:
>
[quoted text clipped - 39 lines]
>
> Chicago

I have a hard time understanding how a 0.1 psa could worry you?

Reply to this Message

Steve Kramer - 19 Jul 2008 12:11 GMT

<< I have a hard time understanding how a 0.1 psa could worry you?

Tony,

If I might answer this, I imagine it was very much like your news when you
got your post-op report. In January, before your surgery, your doctor told
you that the hopeful outcome is that they get all the cancer and your PSA
falls to below 0.10 for the rest of your life. Bang!! Three weeks later,
you find your cancer is in your lymph nodes and your PSA is 0.80.

For Ron, his doctors told him the same thing in 2005. If he's cured, he'll
have a PSA of less than 0.10 for the rest of his life. After 3¼ years, the
PSA is no longer less than 0.10. That likely means the doctor did not get
all the cancer OR all the prostate tissue.

Hoping for prostate tissue is a thin thread between your knowing you still
have cancer and him almost knowing.

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 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
Illegitimati non carborundum

Reply to this Message

Ron B - 20 Jul 2008 13:30 GMT

skeptic said to me:

"I have a hard time understanding how a 0.1 psa could worry you?"

I understand.

After 3 years of receiving 0.0's...they called the next day and said
that it was .1 and I should come back the next day or so and repeat it
to see if it was an error.

Being worried and anxious about EVERYTHING...this change causes me
concern that 'something's changing.'

Which makes me MORE anxious and worried.

And yes, I already TAKE plenty of meds. :-)

Best to everyone,

Ron B.

Chicago

Reply to this Message

rosbif - 22 Jul 2008 09:17 GMT

>I know that '04 is AGES ago in medical work...but I'd still appreciate
>your thoughts on this thing. I KNOW the PSA levels are totally different
[quoted text clipped - 5 lines]
>
>Chicago

I thought this a really worthwhile head-to-head. Perhaps it raises
more questions than it answers, but until we have all the answers
that's no bad thing. At least the discussion was honest, with a range
of common-sensical points of view from professionals who are happy to
admit we're still hounded by unknowables.

Since we're all engaged in risk assessment there can't possibly be a
one-size-fits-all strategy. I had logged PSA =/>0.2 as the point at
which to consider SRT but in the light of this article and other
murmurings here would now consider waiting for higher figures - I
think Alan's suggestion of a not-too alarming rate of climb to 0.4
would be a fair bet.

Now put abiraterone as a potentially reliable backstop into the
equation and we have a dizzying range of possibilities. If it turns
out to be even half as successful as mooted it will certainly give
additional weight to WW as a rational option, and generally allow us
to treat ourselves to a wider margin of risk-taking.

Reply to this Message