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  • Up-Date From Big Al PSA Retest

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    Old 02-10-2020, 07:35 PM   #1
    Bigalcalbisque
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    Up-Date From Big Al PSA Retest

    Hi everyone, thought I would update this PSA Re-Test result I just received today. This PSA Re-Test was just to confirm an upward movement in a PSA test that was done a few weeks before and one that was done 11-27-2019 that basically lost the equal to or less sign and came in at 0.02. My Uro at that time thought it was clerical error or a different machine analyzing the results. I do have a consult with my GP on Thursday. This latest PSA test went down to 0.06 that is a drop in 2 weeks from a 0.07. So anyway, at least it didn't go up and I am wondering if this could be something normal and possibly not a reoccurrence of my Prostate Cancer (Of Course) but thought it may lead to some discussion. I will update again after my GP appointment.

    Thanks, Al
    __________________
    7-1-2017 Biopsy. PSA 6.3 Cancer Left Apex 3+3=6 Tumor 1.5mm 5%
    Cancer Rt Base 4+3=7 Tumor 4mm(Aggregate) 25% Perineural Invasion: Not Identified.
    9-27-2017 Robotic Surgery.
    Pathology Report 10-2-2017 Gleason 7 (4-3)11 Lymph Nodes Negative/PT3A-PN0
    Positive Rt Posterior Margin Less than or = to 3mm. Urinary Bladder Neck Invasion/Not Identified. Seminal Vesicle Invasion/Not Identified. Tumor weight=48.6 Grams
    EPE Presnt Focal Right Posterior
    7 PSA tests every 3 months less than or = to .02
    PSA test 9-27-2019 .02
    PSA test 1-23-2020 .07
    PSA test 2-04 2020 .06
    PSA test 5-05-2020 .03

     
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    Old 02-10-2020, 08:05 PM   #2
    Michael F
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    Re: Up-Date From Big Al PSA Retest

    So Al, a couple of questions:

    1. What Lab drew the blood sample?

    2. What Lab analyzed the blood sample?

    3. What PSA Methodology was used?

    4. Do the answers to the above 3 questions match your previous 3 PSA tests? The Original Lab Report contains the required information.

    5. Why did you start a new Thread? It would be more logical to have added this post to your previous Thread on this specific issue?

    https://www.healthboards.com/boards/cancer-prostate/1048774-up-date-big-al-latest-psa.html

    IMO, if your answers to #1, 2 & 3 are identical for your last 3 PSA tests, it is possible that your PSA has risen. The General Rule of Thumb for post RP monitoring is: 3 Consecutive Rises. Your last 2 PSAs only count as a single data point. Thus you will need 2 more data points. i.e. 3 consecutive rises requires a minimum of 4 data points. Hoping your PSA has reached it's apex and remains stable.

    MF
    __________________
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free =13%)
    Jan '12: Biopsy: 1/12 = G7 (3+4) & 5/12 = G6
    March '12: Robotic RP: Left: PM + EPE => MD excised additional adjacent tissues
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    uPSA Range: 0.017 - 0.039 at 98 Months Post Op: Mean = 0.023 (n = 24)
    LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%) ED = present

     
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    Old 02-10-2020, 08:40 PM   #3
    Bigalcalbisque
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    Re: Up-Date From Big Al PSA Retest

    Quest every time
    Quest every time.
    No idea PSA methodology (ICMA?) although I am pretty certain it was the same every time.

    I have noticed my first PSA test after my surgery is no longer on Quest site??
    But, if my memory serves me right it was only 1 decimal point. in other words, it was less than or = to .1 after that I started getting PSA tests that used two decimal points and have since.

    I do want to talk to my URO after GP and probably then to my Radiologist.
    I am cautious.
    __________________
    7-1-2017 Biopsy. PSA 6.3 Cancer Left Apex 3+3=6 Tumor 1.5mm 5%
    Cancer Rt Base 4+3=7 Tumor 4mm(Aggregate) 25% Perineural Invasion: Not Identified.
    9-27-2017 Robotic Surgery.
    Pathology Report 10-2-2017 Gleason 7 (4-3)11 Lymph Nodes Negative/PT3A-PN0
    Positive Rt Posterior Margin Less than or = to 3mm. Urinary Bladder Neck Invasion/Not Identified. Seminal Vesicle Invasion/Not Identified. Tumor weight=48.6 Grams
    EPE Presnt Focal Right Posterior
    7 PSA tests every 3 months less than or = to .02
    PSA test 9-27-2019 .02
    PSA test 1-23-2020 .07
    PSA test 2-04 2020 .06
    PSA test 5-05-2020 .03

     
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    Old 02-11-2020, 04:47 AM   #4
    Insanus
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    Re: Up-Date From Big Al PSA Retest

    7-1-2017 Biopsy. PSA 6.3 Cancer Left Apex 3+3=6 Tumor 1.5mm 5%
    Cancer Rt Base 4+3=7 Tumor 4mm(Aggregate) 25% Perineural Invasion: Not Identified.
    9-27-2017 Robotic Surgery.
    Pathology Report 10-2-2017 Gleason 7 (4-3)11 Lymph Nodes Negative/PT3A-PN0
    Positive Rt Posterior Margin Less than or = to 3mm. Urinary Bladder Neck Invasion/Not Identified. Seminal Vesicle Invasion/Not Identified. Tumor weight=48.6 Grams
    EPE Presnt Focal Right Posterior
    7 PSA tests every 3 months less than or = to .02
    PSA test 9-27-2019 .02
    PSA test 1-23-2020 .07


    Get to a radiation onco. You have recurrence.

     
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    Old 02-11-2020, 05:04 AM   #5
    Prostatefree
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    Re: Up-Date From Big Al PSA Retest

    Losing your < counts as a rise. The jump to 0.07 is significant. Get to your doctor and on to a RO. You have recurrence.

     
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    Old 02-11-2020, 07:15 AM   #6
    Bigalcalbisque
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    Re: Up-Date From Big Al PSA Retest

    Thank you, that is what I am doing.
    __________________
    7-1-2017 Biopsy. PSA 6.3 Cancer Left Apex 3+3=6 Tumor 1.5mm 5%
    Cancer Rt Base 4+3=7 Tumor 4mm(Aggregate) 25% Perineural Invasion: Not Identified.
    9-27-2017 Robotic Surgery.
    Pathology Report 10-2-2017 Gleason 7 (4-3)11 Lymph Nodes Negative/PT3A-PN0
    Positive Rt Posterior Margin Less than or = to 3mm. Urinary Bladder Neck Invasion/Not Identified. Seminal Vesicle Invasion/Not Identified. Tumor weight=48.6 Grams
    EPE Presnt Focal Right Posterior
    7 PSA tests every 3 months less than or = to .02
    PSA test 9-27-2019 .02
    PSA test 1-23-2020 .07
    PSA test 2-04 2020 .06
    PSA test 5-05-2020 .03

     
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    Old 02-11-2020, 02:08 PM   #7
    Michael F
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    Re: Up-Date From Big Al PSA Retest

    Quote:
    Originally Posted by Bigalcalbisque View Post
    Quest every time
    Quest every time.
    No idea PSA methodology (ICMA?) although I am pretty certain it was the same every time.

    I have noticed my first PSA test after my surgery is no longer on Quest site??
    But, if my memory serves me right it was only 1 decimal point. in other words, it was less than or = to .1 after that I started getting PSA tests that used two decimal points and have since.

    I do want to talk to my URO after GP and probably then to my Radiologist.
    I am cautious.
    Hi Al! As I recall, one of your recent results was a "HAMA" treated PSA. It is important to be sure you are comparing "Apples Directly to Apples" when monitoring for a post RP increasing PSA.

    Clearly your MDs will provide the proper guidance. Your next PSA should indicate if a rising PSA is likely occurring. Have your MDs concur on a PSA that will "Trigger Treatment" IF/when reached.

    Hoping your next PSA < 0.07

    MF

     
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    Old 02-11-2020, 08:49 PM   #8
    Bigalcalbisque
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    Re: Up-Date From Big Al PSA Retest

    Hi Guys, thank you so much for your input. My URO snuck me in this afternoon for an appointment and I have been referred to my Radiologist. I am in the process of scheduling that appointment. My URO is also my surgeon and he is not overly concerned. He deferred any questions that I may have to my Radiologist. There is a Nanogram from Sloan Kettering that I have looked at in regards to salvage radiation but I cannot complete the info section as my current PSA is below the 0.10 threshold for the info required. My Uro said that I may have to go through Adjuvant Radiation depending on my Radiologist's recommendations. I do want to say however that I am a little perturbed that "Prostatefree" on this forum would specifically say I "have" a "Recurrence". I may or may not, it's not up to you to say that. It's very counter-productive emotionally! You are not my Doctor.
    __________________
    7-1-2017 Biopsy. PSA 6.3 Cancer Left Apex 3+3=6 Tumor 1.5mm 5%
    Cancer Rt Base 4+3=7 Tumor 4mm(Aggregate) 25% Perineural Invasion: Not Identified.
    9-27-2017 Robotic Surgery.
    Pathology Report 10-2-2017 Gleason 7 (4-3)11 Lymph Nodes Negative/PT3A-PN0
    Positive Rt Posterior Margin Less than or = to 3mm. Urinary Bladder Neck Invasion/Not Identified. Seminal Vesicle Invasion/Not Identified. Tumor weight=48.6 Grams
    EPE Presnt Focal Right Posterior
    7 PSA tests every 3 months less than or = to .02
    PSA test 9-27-2019 .02
    PSA test 1-23-2020 .07
    PSA test 2-04 2020 .06
    PSA test 5-05-2020 .03

     
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    Old 02-11-2020, 09:21 PM   #9
    Southsider170
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    Re: Up-Date From Big Al PSA Retest

    Your PSA is still at a very low level, and your pathology report indicated only a moderately risky case. Further, its been a while, almost 2 1/2 years, since your surgery.

    The doctors have charts figuring out what the odds are, based on those factors, and will come up with a recommendation on whether to wait or progress to further treatment. Also, your age and co-morbidities play a factor in this.

    It certainly isn't time to panic yet.

     
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    Old 02-12-2020, 04:15 AM   #10
    DjinTonic
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    Re: Up-Date From Big Al PSA Retest

    Any unexpected PSA rise needs a retest to check for lab error. Also, men do sometimes plateau at a high value. But having a plan in place is also a good thing.

    Only a portion of men with BCR go on to a clinical recurrence. But most men choose to treat to prevent that.

    Djin

     
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    Old 02-12-2020, 04:27 AM   #11
    Steve135
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    Re: Up-Date From Big Al PSA Retest

    Bigalcalbisque. I am a little surprized Prostaefree stating you have BCR! A recurrence doesn't come from a raise in PSA alone. And None of us are doctors although some posters here share a great wealth of info. BCR comes from reaching a certain level of PSA as dictated by insurance that doctors have to follow for treaments schedule's. Now this number was reached from both research and real world results. It's ashame this is the path doctors need to take. But these numbers are falling as we move forward, and some insurances are following. Its was what happen on my second BCR we just knew the psa rise from 0.006 to 0.030 indiacating a BCR. But we had to wait to 0.20 for treaments! The same holds true of the big named cancer centers, you can't be seen till your psa raies 3 consectutive test! Sometimes we are all just a number. Hang in there check out my signature it's very close to yours.
    steve d
    Diag. 56 DOB 2/59 PSA 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins NP lN's 5 neg pT3a,N0
    PSA 10/16 0.1 1yr 02/7/17 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm BCR rt. SVB Casodex + Trelstar
    04/17 SRT (42)
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34 7/19 0.06 8/19 0.08 9/19 0.056
    10/190 0.08 11/19 0.07 12/19 0.07 1/ 27 0.06
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion

     
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    Old 02-12-2020, 06:11 AM   #12
    Steve135
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    Re: Up-Date From Big Al PSA Retest

    Quote:
    Originally Posted by Prostatefree View Post
    Losing your < counts as a rise. The jump to 0.07 is significant. Get to your doctor and on to a RO. You have recurrence.
    While this may be an indicator of an future issue, most of us are at the
    constraints of the insurance companies. .07 is not nearly near a BCR dictated by insurance. I've come to find the patient doesn't tell the doctor or insurance what to do unless he or she is footing the bill 100%. My case in point, psa raise from base of 1.5 for years to 2.0 then 2.4 in six months was call for alarm for URO but insurance refused to Biopsy till 4.0 I offerd to pay out of pocket to get it done. $2500. cash! The biospy showed PCa and the submitted bill was indeed paid for by my insurance. In the nearly 5 years I have been blocked of treatments and drugs.
    steve d

    _________________
    Diag. 56 DOB 2/59 PSA 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins NP lN's 5 neg pT3a,N0
    PSA 10/16 0.1 1yr 02/7/17 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm BCR rt. SVB Casodex + Trelstar
    04/17 SRT (42)
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34 7/19 0.06 8/19 0.08 9/19 0.056
    10/190 0.08 11/19 0.07 12/19 0.07 1/ 27 0.06
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion

     
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    Old 02-12-2020, 06:46 AM   #13
    Michael F
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    Re: Up-Date From Big Al PSA Retest

    PCa Forums are like Politicians => full of opinions and uncertainties. None of us are qualified to make any medical diagnoses. The input from expert MDs who specialize in PCa must be your best source of guidance.

    If your RO suspects BCR, discuss how they can determine the exact location(s) of remnant/recurrent PCa.

    At this point, no one can say that BCR has occured. Aditional PSA(s) will be required to confirm BCR.

    Stay optimistic!

    MF

    Last edited by Michael F; 02-13-2020 at 08:02 AM. Reason: change "only" to "best"

     
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    Old 02-12-2020, 06:48 AM   #14
    Insanus
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    Re: Up-Date From Big Al PSA Retest

    Quote:
    Originally Posted by Steve135 View Post
    While this may be an indicator of an future issue, most of us are at the
    constraints of the insurance companies.
    .07 is not nearly near a BCR dictated by insurance. I've come to find the patient doesn't tell the doctor or insurance what to do unless he or she is footing the bill 100%. My case in point, psa raise from base of 1.5 for years to 2.0 then 2.4 in six months was call for alarm for URO but insurance refused to Biopsy till 4.0 I offerd to pay out of pocket to get it done. $2500. cash! The biospy showed PCa and the submitted bill was indeed paid for by my insurance. In the nearly 5 years I have been blocked of treatments and drugs.
    steve d

    _________________
    Diag. 56 DOB 2/59 PSA 01/14 2.0 6/15 2.4
    Biopsy 6/15 5 Gleason Score 8
    RP 10/15 Path 54g 5x4.2x2.8cm 4+3=7 Tumor location quadrants Bilateral
    Extra-capsular extensions present,SV no invasion
    Vascular invasion none, PNI ,Multicentricity multifocal
    Margins NP lN's 5 neg pT3a,N0
    PSA 10/16 0.1 1yr 02/7/17 0.4 02/15/17 0.5
    Pet Scan 2/17 Neg PSA 03/17 0.6 Axumin trial 17.4mm BCR rt. SVB Casodex + Trelstar
    04/17 SRT (42)
    08/17 PSA 0.1 Last 6 uPSA 0.006 uPSA 2/19 0.030 2nd BCR 5/19 0.235 5/30 0.32 6/19 0.34 7/19 0.06 8/19 0.08 9/19 0.056
    10/190 0.08 11/19 0.07 12/19 0.07 1/ 27 0.06
    7/19 Trelstar, Xtandi, Zoledronic Acid
    12/19 (3) SBRT Iliac bone liasion
    That statement is totally false. Adjuvant radiation is a standard of care when there is detectable PSA, positive margin or pT3 in noted in the pathology report. You can qualify for ART even with < PSA value for insurance or with a very low and increasing PSA. If you are with one of the larger insurance companies you can find this online. Here are two examples.

    “Post-prostatectomy for dose escalation greater than or equal to 64 Gy, and at least one of the following is met:
    1. Serum prostate-specific antigen (PSA) detectable at 6 months post-op; or 2. PSA is detectable and increases with ≤2 laboratory test results; or
    3. Post-operative staging of T3 to T4; or
    4. Post-operative pathology result documents positive surgical margins;

    “Request is for Intensity Modulated Radiation Therapy (IMRT) for: (check all that apply)
    Prostate cancer
    ​ Localized prostate cancer
    ​ Post-prostatectomy for dose escalation greater than or equal to 64 Gy (check all that apply)
    ​ PSA remains detectable at 6 months after surgery
    ​ PSA is detectable and increases on two or more lab determinations
    ​ Individual has post-operative stage T3b to T4
    ​ Individual’s post-operative pathology reveals positive surgical margins”


    While I realize some people have crap insurance that requires you to argue for every nickel, that has not been my experience. Everything requested that was a standard of care was approved in a timely manor.

     
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    Old 02-12-2020, 08:11 AM   #15
    IADT3since2000
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    Re: Up-Date From Big Al PSA Retest

    Quote:
    Originally Posted by Insanus View Post
    That statement is totally false. Adjuvant radiation is a standard of care when ....While I realize some people have crap insurance that requires you to argue for every nickel, that has not been my experience. Everything requested that was a standard of care was approved in a timely manor.
    My experience is in line with what Insanus stated if not more so. I have had very good insurance since before my diagnosis, but it is not an extremely expensive policy, but rather one covering a very large group of people.

    Not only has the insurance covered "standard of care" items, some of which have been extremely expensive, such as my radiation that cost just over $100K, but also unusual items that were not cheap. One is the drug thalidomide, which I was on three times, at a low dose (50mg) plus vitamin B6, to successfully extend the vacations I took from ADT, helping implement my strategy of gaining time for radiation technology to improve (and for me to realize that it had). Thalidomide was and still is expensive, and I was using it "off label" as it is not FDA approved for prostate cancer. Other off-label drugs I was on at times for prostate cancer included Celebrex, Proscar/finasteride, Avodart/dutasteride. At one point when there was a serious question about Celebrex safety, insurance coverage was withdrawn for that reason, and I stopped the drug. Later, when the safety issue was substantially downgraded, coverage resumed.

    Many of us are aware that in the US there are now so-called health insurance policies that offer bare bones protection that is grossly inadequate for serious health needs. That kind of policy is not what most of us prostate cancer patients are going to need!

    Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

     
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