10-16-2009, 01:58 PM
Senior Veteran (male)
Join Date: Nov 2007
Location: Annandale, VA, USA
Re: Post Op Radiation therapy - More Questions
I'm responding to your first post. Facing a rising PSA after surgery has got to be unnerving, and I'm glad your mind was eased after Lionel gave some reassuring information about his experience with radiation side effects.
But some recurrences after surgery are really mild, some not requiring any major follow-up action. Could you give us the details - dates and PSA values? Also, some docs still rely on conventional PSA tests that only measure to <0.1 or so, rather than the ultrasensitive tests that are a hundred times more sensitive, measuring reliably to <0.01, so it's not clear what "undetectable" means in your case.
Johns Hopkins has done some very interesting work on classifying recurrences after surgery. Basically, they found that three main factors are highly informative about the seriousness of a recurrence. The most useful piece of information was the PSA doubling time PSADT, which they broke into four groups from worst to best (<3.0 months; 3.0-8.9 months; 9.0-14.9 months; and =or>15.0 months). The other two factors were whether the recurrence had occurred <= 3 years after surgery (not as good) or more than three years after surgery (better), with the period ending when the PSA hit or exceeded 0.2, and whether the surgical pathology Gleason Score was =>8 (not as good) or <8 (better). Those with all good characteristics had a chance of surviving prostate cancer ("prostate cancer specific survival") of 100% at the five year point and an impressive 94% at the 15 year point. In contrast, those in the worst case group had a 51% chance of survival at 5 years and a <1% chance at 15 years.
Originally Posted by mewhit
After 3 years at undetectable PSA values, now I find the numbers rising , so it looks like the doc will want to go the radiation therapy route soon.
However, it is very important to note that this study's usefulness is in enabling us to gauge the seriousness of disease - not to make predictions for outcomes for patients recently treated and recurring. A key point is that Johns Hopkins was quite reluctant to use hormonal blockade therapy until very late for such recurring patients. Now we know that it it better to use it fairly early if the recurrence looks serious. Outcomes should therefore be much better.
Another fairly recently learned factor is your PSA velocity in the year before you were diagnosed, if you know it. The key question: was it rising at a rate of more than 2.0 per year, or 2.0 or lower (and the lower, the better, but with 2.0 being the key threshold). This is based on research led by renowned researcher Anthony D'Amico, MD, that was published for surgery in 2004 in the New England Journal of Medicine.
If you can't find either publication or you want further detail or explanation, I have both studies and can tell you what they say.
Also, while we are still crossing our fingers and hoping for a favorable confirming report next year, a well-regarded study of quality pomegranate juice or extract (8 oz of PomWonderful juice daily in the study) showed stunning success in slowing PSA doubling times for post-surgery prostate cancer patients. On average, their times lengthened from 15 months to more than 50 months, and a follow-up study of the same men showed an even greater lengthening (to an average of 88 months! ) for those who stayed with the program. I started a thread on that on 9/16/2009 - "Pomegranate juice/extract - great results from update of earlier study." Dr. Myers has been informally reporting similar success with recurring men in his practice, and other doctors are echoing those reports. Something like that might be all you would need.
The mild drugs finasteride or Avodart might also be all that you need for success in turning around a recurrence.
There are also other lifestyle tactics that you could use.