Originally Posted by richarda123
G8 RP 2/31/08
PSA 4/1 -- .1
PSA 5/3 -- .11
PSA 9/2 -- .14
I thought I read here, ideally, one should hope for an 18 month to 24 month
doubling time. Looks like I won't be so fortunate. Will probably start radiation this fall and there is some debate if they will add the Lupron shortly thereafter (or before?). Just looking for some info here if I'm interpreting the numbers correctly.
Thank you all
I'm sorry you don't have better and clearer news at this point!
The doubling time figures you are thinking of probably are from the study led by Dr. Stephen Freedland, then in the famous urology group at Johns Hopkins (and now at Duke) to predict the degree of seriousness of recurrences based on whether the doubling time (PSADT) is greater than 15 months or less, whether the Gleason in the post RP pathology is less than 8 or 8 to 10, and whether it takes less than three years or more for the PSA to rise to .2 (which you can estimate from the doubling time if the PSA trend is stable). The primary driver in the tables is the PSADT. I notice signs that the tables are coming into wider use. They are based on the rigorous, carefully monitored surgery results from Johns Hopkins.
I don't recall your Gleasons well and haven't checked the archives. Was the GS 8 a post RP or pre RP Gleason, or both? Maybe it doesn't make much difference for the Freedland tables as it's clear you are dealing with at least a Gleason 8 case.
I just ran your RP recurrence PSA numbers through the software published by Memorial Sloan Kettering, and this is what it calculated:
based on the first two results (.1, .11): 7.65 months PSADT
based on all three results (.1, .11., .14): 10.71 months PSADT
based on the latter two results (.11, .14): 11.52 months PSADT
It's obvious that your PSADT is lengthening as time goes by, and I don't know enough to suggest where it will settle down to a more or less steady PSADT, and particularly whether it will steady at greater than 15 months. My layman's view - just looking at the figures, is that you have a shot at exceeding 15 months. At least your recurrence PSADT is greater than 10 months, which is a figure often used in discussions of very aggressive counter tactics.
Are you using the lifestyle and dietary tactics that appear to give us better outcomes? I'm thinking of quality vitamin D3 and quality pomegranate juice or extract in particular. That promising study of the juice done by the highly regarded UCLA team documented an average PSADT increase from about 15 months to over 50 months. (I'm now using a quality pomegranate extract capsule - 2 a day.) If you are on a Dairy State diet, you may be wise to try something new. Personally, one of my regrets from having this damn disease is giving up cheese!
The program of follow-up radiation plus hormonal blockade for a couple of years looks sound to me, as suggested by our fellow board participant. We now know that hormonal blockade makes it easier for radiation to do its work on the prostate cancer stem cells. That makes me think it is wise to do the blockade during and after the RT and not just afterward. (I'm basing that in part on what Dr. Myers wrote in a Prostate Forum newsletter earlier this year. If you wish, I think I can find the issue.) Fairly recent research shows that the RT/blockade combo does not add value for low risk cases, but does add a lot of value for higher risk cases, and a recurrence like yours probably fits that definition in my layman's view.