PSA rising to 0.11, 5 months after RP Surgery

Midcentury

Within a year post RP, my psa went from 0.014 to 0.023.  I had a PSMA scan for which I had to pay, but it found the remaining cancer.  I was pT3b, Gleason 9, positive margins, pni etc

I've now had SRT and am on bicalutimide.

Lyn - is there a link to any of the UK nomogrammes?  The US ones rate my chances as 65%, with which my oncologist agreed.

ulsterman

Fresh

I wrote my post in haste. It was not my intent to take a pop at your research. I'm sorry if I offended you.

All I was trying to say was what you said was that we have to be diligent with what we read because there is a lot of conflicting information out there and not all papers are equal.

Pete

I don’t know. Mr P showed it to us on his screen - first the % on the MSK and then the result when adapted for local data. With a PSA of 3.1, small soft prostate, clear scan, assumed T1 and age 50 the nomogram predicted a 55% chance of biochemical recurrence. 

After SRT, Mr B put the stats in and got an 80% chance of J still being here in 10 years. 

And they don’t take any account of the skill of a surgeon during a prostatectomy. I hope I backed the right horse - so far - so good!

Yes of course, that's why the medics that use them then adapt the results for local trends. 

As regards more advanced scans, I did post a link sometime ago wherein the course of a lecture a Professor said that in Australia they only used the Choline one for about 6 months before adopting the better 68 Gallium PSMA one. As has been mentioned elsewhere, even this scan does not work for 5 -10 % of men with PCa as member Chris will attest. However, research into scans continues and one developed by Marty Pomper and his team at John Hopkins termed 18FDCFPyL showed more mets than the 68 Gallium in on in a small trial. Larger trials are now underway mostly in the USA and Canada.

I have posted this before but for those who have not seen it, I like the reasoning of Eugene Kwon to treat early while the cancer is small and before it mutates. It is principally about oligometastic disease. It should be pointed out that this lecture was made before the 68 Gallium PSMA began to be widely adopted. Bear with the credits at the beginning. This Dr has been widely praised on an American forum and look at the comments beneath the video. https://www.youtube.com/watch?v=NkqizmvqJPo

What do you think?

Edited by member 15 Sep 2018 at 21:41  | Reason: Not specified

Thats because the RADICALS trial is not complete. The trial is a confirmation study on US data that is very compelling. The risk factors that predict biochemical reocurrance seem to be;

a) Detectable PSA and a value of 0.03 is used, however I think that number is just the first reliably observed number above the commonly used “undetectable” (<0.02) in the same way that 0.1 and <0.1 were used historically. A post operative detectable PSA is hugely significant. 

d) Pathology staging of T3 (any T3)

c) Positive surgical margins

d) PNI invasion

e) Extra capsular extension

Put simply. Any positive margin means your not likely to get that post operative remission period. The sad bit is that it seems that it’s only the aggressive cancer that tends to breach the nerve bundle. So the less aggressive gets bagged and binned leaving a 40% or 80% chance (depending on uni lateral or bi lateral sparing) of a stiffy but a 100% chance of PCa.

Fresh

Edited by member 16 Sep 2018 at 06:25  | Reason: Not specified

Fresh what you are saying simply isn't that black and white.

There are guys with positive margins who don't progress, guys with high grade T3 who don't progress and guys with low and stable PSA who don't progress.

That's the problem with ART medics know they overtreat.

What radicals will ultimately report (I beleive) will be in line with the original US research it's the only sensible outcome.

So should Fresh have ART? possibly but there is probably only a small risk waiting to get a PSA trend to be sure.

Should Bollinge have a supersensitive test? Yes IMHO life would then be less of a gamble because if it comes back as "less than" he can have greater faith in a full remission. BTW if the "professor" really mentioned the cure word he needs re-educating!!!

Should I have ART? Well I was offered the radicals trial but I didn't want a flip of a coin to decide if I had RT so I declined. So far I think the decision was correct, I have recovered my erections, I am continent and my PSA is still very low 3 years on. So I think I have, will I die of PC as a result of not doing ART? Only time will tell!.

Most important of all should midcentury have ART with that PSA? IMHO not without a second test (never do anything on the basis of 1 test!) . But if it's still over 0.1 he should certainly be consulting with an oncologist.

Edited by member 16 Sep 2018 at 08:26  | Reason: Not specified

Agreed francij but that’s because Gleason is no measure of aggressiveness. So in the absence of risk stratification there will be variability. The category you mention are most likely sitting on very low risk PCa. Does anyone know the NHS position on ART/SRT are there levels at which they won’t permit you to have RT?

Fresh