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    Old 11-17-2021, 06:54 PM   #1
    mhammes
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    PSA 3rd data point

    Hi all, I posted a while back but here again as just got my uPSA result and it was .049. Tested previously last January with result .03 and in July .045 so with these three data points feel that I’m looking at early recurrence.

    Long story but prior to January my primary care was only doing PSA not uPSA so I don’t know when PSA rose above .01.

    I had radical prostatectomy in May 2017 so will be 5 years this May. I was 3+4 at the time of surgery with no positive margins, seminal vesicles negative.

    PSA pre surgery never reached 10, I believe the highest it got was 6.5. My urologist suggested that I could either talk to a RO now or wait another 3-6 months and see if there is further increase.

    We talked about PSMA scans but not sure at what PSA levels those are helpful? Insurance coverage could be an issue as well. So I am seeking advice in terms of whether SRT is something I should consider at this stage or do I have time to wait?

    Will a scan be useful at this PSA level? My general thinking is I would want to act if I reach .1 but would really value thoughts on this.

    Also, what is the likelihood of spread outside the prostate bed in my case? I had my surgery at the NIH and hope to talk to them this week, though I believe they don’t take patients back until PSA hits .1.

    I would like to think there is some possibility that my PSA won’t continue to rise but with 3 data points I fear that is unlikely. Thanks for any advice or thoughts I might consider.

    Last edited by HighlanderCFH; 11-18-2021 at 02:59 AM. Reason: White space added for easier reading

     
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    Old 11-17-2021, 08:03 PM   #2
    music4ever
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    Re: PSA 3rd data point

    Sorry to hear your PSA is rising. Although it does seem to be rising very slowly. I would continue to monitor uPSA every 3 months and see where it goes.

    With your PSA below 0.1 I doubt they will give you a PSMA Pet scan as it’s unlikely anything would show up at such a low level. I’ve heard 0.3 is the average minimum for a PSMA. However, I would seek out a RO now so that you will have one that you are comfortable with should you need radiation in the future and you won’t feel rushed into anything.

    How old are you? Anything else from post surgery pathology you can share? Did you happen to get a genomic test like Decipher or Polaris as part of your surgery/pathology to know your risk?

    Good luck - like me it sounds like you don’t need to rush into anything quite yet - gather all of the info that you can first.
    __________________
    1/2021 - 53 y/o Dx Prostate cancer Gleason 7 (3+4) over 6 cores on right side. Prolaris report "Unfavorable Intermediate" risk - PSA 3.9. 2019-PSA 3.51, 2017-PSA 2.55
    3/2021 - Radical Prostatectomy (robotic).
    3/2021 - Post-op pathology provided – pT3a pN0 MX, Stayed Gleason 7 but moved up to 4(70%) + 3. Small positive focal margin on right side. EPE. Decipher genomic test (.97) suggests "high risk" prostate cancer.
    4/2021 - PSA 0.08 - 6 week follow-up
    6/2021 - PSA 0.06 - 12 week follow-up
    9/2021 - PSA 0.09 - 6 month follow-up
    10/2021 - PSA 0.07 - Annual Physical (different lab)

     
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    Old 11-17-2021, 10:29 PM   #3
    Insanus
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    Re: PSA 3rd data point

    As with most things BCR related, it is your call to treat or wait and I sure can’t tell you the direction you should take.

    Early salvage radiation appears to have measurable advantages vs waiting. The problem is the cancer may not be in the radiation field. I would discuss both options and weigh the few facts you will be given.

     
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    Old 11-18-2021, 07:09 AM   #4
    mhammes
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    Re: PSA 3rd data point

    Quote:
    Originally Posted by music4ever View Post
    Sorry to hear your PSA is rising. Although it does seem to be rising very slowly. I would continue to monitor uPSA every 3 months and see where it goes.

    With your PSA below 0.1 I doubt they will give you a PSMA Pet scan as it’s unlikely anything would show up at such a low level. I’ve heard 0.3 is the average minimum for a PSMA. However, I would seek out a RO now so that you will have one that you are comfortable with should you need radiation in the future and you won’t feel rushed into anything.

    How old are you? Anything else from post surgery pathology you can share? Did you happen to get a genomic test like Decipher or Polaris as part of your surgery/pathology to know your risk?

    Good luck - like me it sounds like you don’t need to rush into anything quite yet - gather all of the info that you can first.
    Thanks very much for your reply. I'm 56 (57 in March) so young enough that I'm concerned about needing follow up treatment. I have not gotten a Decipher genome test - I spoke with someone at NIH who said they don't place a lot of stock on those, but I'm seeing an RO from Johns Hopkins next week and will ask about this. In terms of pathology, percent of prostate involved was 15%, tumor size 15mm, no extraprostatic extension, no urinary bladder invasion, no positive margins or seminal vescicles. Organ confined pT2. Not panicking at this point but of course three positive increases concerns me. I'll see what the RO has to say. I normally would want to treat aggresively but as you've noted the PSA is likely too low to identify how/where to treat, so I'll probably need to watch and wait. Do patients ever go with SR before being able to have a PSMA scan? I'm wary of side effects of radiation as well.

     
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    Old 11-20-2021, 02:15 AM   #5
    music4ever
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    Re: PSA 3rd data point

    Very smart to see a RO at John Hopkins. Please let us know what he says in your case as it will be helpful to others.

    A couple of questions you may consider asking him (I usually write them down and bring them with me):
    1) Does he consider going from 0.045 to 0.049 an actual rise or statistically the same?
    2) Would he have you do radiation + ADT? And how long is the ADT treatment for?
    3) Does he favor monitoring or treatment now at this point? And why?
    4) Are there any scans or other tests that can help you make a decision at this point?

    As far as radiation side effects - they say the better physical shape you are in, and eating healthy helps with side effects. Along with weight training for ADT side effects.

    Good Luck!
    __________________
    1/2021 - 53 y/o Dx Prostate cancer Gleason 7 (3+4) over 6 cores on right side. Prolaris report "Unfavorable Intermediate" risk - PSA 3.9. 2019-PSA 3.51, 2017-PSA 2.55
    3/2021 - Radical Prostatectomy (robotic).
    3/2021 - Post-op pathology provided – pT3a pN0 MX, Stayed Gleason 7 but moved up to 4(70%) + 3. Small positive focal margin on right side. EPE. Decipher genomic test (.97) suggests "high risk" prostate cancer.
    4/2021 - PSA 0.08 - 6 week follow-up
    6/2021 - PSA 0.06 - 12 week follow-up
    9/2021 - PSA 0.09 - 6 month follow-up
    10/2021 - PSA 0.07 - Annual Physical (different lab)

     
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    Old 11-20-2021, 06:52 AM   #6
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    Re: PSA 3rd data point

    I'm not as young as you. I'm post RP 5 years and currently testing at <.02. I had no adverse conditions after RP. Their protocol is to continue to monitor me and test for BCR at least for 10 years post RP understanding BCR can occur after even longer times.

    My urologist said no one will touch me now until my PSA reaches .2. The question came about when considering if I should change from ultra-sensitive testing to less sensitive treating after 5 years testing <.02.

    Without adverse conditions (margins, epe, seminal vesicles, lymph nodes, volume) at the time of the pathology they have no evidence of where it might be. Other adverse conditions can aid in predicting BCR such as a PSA over 10, but it doesn't help identify where it might be now.

    The risk in random SRT to the prostate bed for us now is the potential of over treating by 40 - 50% men in our category who's cancer has already metastasized.

    Where to treat us now relies on the state of the art (sensitivity) of metastasized PCa detection technology at the time.

     
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    Old 11-20-2021, 12:23 PM   #7
    OldTiredSailor
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    Re: PSA 3rd data point

    I had my RALP in August 2018 and have had an µPSA every three months since then. You can see from my signature that my µPSA went down, went up, went way up, and has now gone way down. My highly experienced urologist/oncologist (retired surgeon) says the wide variability is not common but does occur occasionally.

    He and the surgeon who did my RALP initially wanted be to do SRT but now are telling me to wait and watch the µPSA. They do not want to make any decisions until the PSA is over 0.1 for two consecutive tests at least three months apart.
    __________________
    DOB: July 1947
    RALP 8/23/18 pT3a, G7 (3+4), 20% involvement, SM+ (Focal 2mm G6), EPE(Focal G6)+, PNI+, LNI-, SVI-, LVI-
    7g Tumor 20x size in MRI & biopsy report & in BOTH lobes not just L as biopsy reported
    Decipher RP = 0.47, which is .01 above a LOW risk of metastasis (4% chance in 5-years)

    Post-RP PSA
    10/3/18 0.021 01/4/19 0.018 04/03/19 0.022 06/26/19 0.028 10/1/19 0.035 3/14/20 0.050 4/16/20 0.055 7/8/20 0.060 10/6/20 0.069
    01/06/21 0.052 4/7/21 0.045

     
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    Old 11-21-2021, 12:33 AM   #8
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    Re: PSA 3rd data point

    Thank you Old Tired Sailor.

    Not to make a point but to make a distinction for the OP, OTS's PSA was detectable on his first uPSA test. You may want to know more about his post RP regimen.

     
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    Old 11-26-2021, 10:49 AM   #9
    mhammes
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    Re: PSA 3rd data point

    Hello all,

    A quick update as I saw the RO on Wednesday. He is not overly concerned and indicated my PSA is still very low. Despite the 3 increases in the last 3 PSA readings, he said it is not at all a given that I will have BCR. That said, he suggested as a next step getting a Decipher test and then of course monitoring with tests every 4-6 months (I plan to do every 4 unless/until the numbers stabilize.) We will then see what comes back in terms of the Decipher test, and perhaps consider radiation once the PSA approaches .2 especially if there is a consistent rise. I was actually quite impressed with the RO but will try to get other opinions as well between now and my next PSA test in February. Hope all had a nice Thanksgiving and thanks for the support and comments.

    Mike

     
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    Old 11-27-2021, 01:17 PM   #10
    IADT3since2000
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    Re: PSA 3rd data point

    Hi Mike,

    I've read all the posts through your update on your visit to the RO. What he or she said makes good sense to me.

    Many good points have already been addressed, so I will just supplement what has been posted with a few more thoughts.

    In addition to the RO's thinking about not needing to treat now, the more time that passes before you might have to make a timely move to get treatment, the more time for technology to improve. That would not be a big deal for many diseases and cancers as the pace of improvement is often slow, but it is key for prostate cancer because so much progress is being made so rapidly on so many fronts! Those advances are being made, for example, in radiation technology - ever improving aiming (already amazingly precise) and decreasing side effects, in imaging that has meant now available benefits in targeting radiation or other treatment, in molecular and other testing to guide decision making, in managing ADT in support of radiation while reducing side effects, and in supportive drugs like metformin, whose anticipated usefulness may well be proven by clinical trial results by the time you might need treatment. A specific example of rapid progress is the availability of PYL imaging that appears to be on the verge of equaling or eclipsing Ga68 PSMA testing that itself has only recently been approved. If you do happen to have one of those recurrences that needs treatment and you can wait a couple of years or more for timely treatment, as is highly likely in your circumstances, it is almost a certainty that you will benefit from significant advances that will have been made between now and then.

    Johns Hopkins' prostate cancer doctors and researchers, putting their very large data base of patient case histories to work, has actually pioneered assessment of the range of mildness to seriousness ofrecurrences after surgery. Moreover, because some of the surgeons who did many of the prostatectomies in the data base unfortunately did not favor early ADT where appropriate (specifically famed surgeon Patrick Walsh, but also some others), their research that was published some years ago, well before the impact of modern, new drugs and other technologies, gives us a look at the natural history of prostate cancer recurrences that was mostly not affected by timely ADT or other modern technology. The effect is that we kind of see the worst case scenarios by today's standards for recurrences in their database, and the encouraging result is that the outcomes for the vast majority of patients with mild recurrences are very good! The reality, even back then, was that a substantial majority of patients with mild recurrences were outliving their cancer, and, if you do have a recurrence, it looks like a mild one using the Johns Hopkins findings as a yardstick.

    You can check some of the research yourself if you go to the original paper and perhaps follow-up with later papers. You can view an abstract of the complete paper at Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy - PubMed (nih.gov), which was published in 2005. (If you use the search string - freedland s [au] AND prostate cancer AND recurrence after prostatectomy - at www.pubmed.gov, a US government website for medical research, you will be able to view abstracts and sometimes links to complete papers for many related topics. The same research team took a different look at their data and published again in 2007: Death in Patients With Recurrent Prostate Cancer After Radical Prostatectomy: Prostate-Specific Antigen Doubling Time Subgroups and Their Associated Contributions to All-Cause Mortality | Journal of Clinical Oncology (ascopubs.org) . The neat thing about this paper is that it is available, complete and free, via the link.

    PSA doubling time (PSADT) during recurrence turned out to be a key factor in predicting odds of surviving prostate cancer. For you, using the three values you provided, calculated for the middle of each month, PSADT is 13.7 months (MSKCC PSADT nomogram, multiplying each value by 10 to fit the requirements), reflecting a desirable lengthening over PSADT calculated based on just the first two values (10.2 months). (PSADT can vary a bit for very low values with ultrasensitive tests, so your true PSADT, assuming you are recurring, is still approximate at this point.) Figure 1, graph E would probably be the most informative for you as it covers survival for men like you with a PSA doubling time of 15 or more months, and your figure of 13.7 might easily increase to that figure with another small increase.

    Basically, the Freedland paper found that the range of mildness to seriousness of recurrences could be assessed, allowing survival forecasts with odds, based on just three factors: PSA doubling time (PSADT) after surgery, whether the pathological (post-surgery) Gleason score was less than 8 (good, your case) or greater than 8, and whether the length of time before an "official recurrence", meaning the PSA rose (and stayed) to .2 or higher was 3 years or fewer or more than 3 years (good, your case). Your circumstances will likely be at the best level for PSADT (greater than 15 months), assuming there is a real recurrence (not yet certain) and not another explanation. Graph E covers PSADT only for all men with a PSADT of 15 months or more, the best category they looked at. It indicates that a projected 90% of such recurring patients were surviving prostate cancer at the 15 year point; also, as most of these men were older than you, some were dying of other causes, and the graph shows that about twice as many patients were dying of other causes as were dying from prostate cancer. For the next most favorable category, a PSADT of 9.0 to 14.9 months, about 70% of patients were projected to be surviving at the 15 year point, and that's without putting your two other favorable key characteristics into the picture. So you can see that chances for survival of a mild recurrence were excellent, even back then. All this means that you have an outstanding chance of surviving the disease for at least ten more years, during which time there is going to be great progress from which you would benefit if you are having a recurrence.

    Good luck!

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. 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, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 11-28-2021, 06:21 AM   #11
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    Re: PSA 3rd data point

    Surviving is not a meaningful measure in prostate cancer. While statistically significant it can not alter the fact that a slow growing terminal cancer is a long and painful death. A 10 to 15 year survival statistic will be consumed with a significant loss of quality of life due to treatment and a painful death taking years off that statistic.

    Early detection and early treatment is the most effective path. After that, it's luck and hope.

    The idea that it is a slow growing cancer and you will die of something else is a myth that has misled many men who have died and still invades the medical community today tempting men and their doctors to deny and delay.

    None of it makes much of a difference for a young man. Continue to do what you've been doing. Stay on top of it and you have an excellent medical team.

    Continue to work on your general health. Most importantly, get your BMI to acceptable.

    Ask your doctor about statins. Continue to use the ultra-sensitive testing. There is peace and strength in the knowing and acceptance of it. It doesn't mean surrendering to it.

     
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    Old 11-29-2021, 09:44 AM   #12
    mhammes
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    Re: PSA 3rd data point

    Thanks Jim, this is very helpful additional info! I will take a look at this study. When I discussed doubling time with the RO I got the impression that he felt PSADT was quite a bit less reliable with numbers in my range. That said, will see where the numbers head when I'm tested in February. Do you have any information or thoughts on the Decipher test to potentially detect how aggressive the tumor is likely to evolve? I have reached out to the NIH to get that test and am hoping I don't get stuck in governmental protocols and paperwork. Finally, as you note I've taken a degree of optimism from my post-surgery pathology and length of time it has taken to see this increase, but at the same time do ideally want to be in a position to have the possibility of curse so will likely consider taking action if I continue to see increases, and especially if/as the number hits .1 and above. Thanks again for your response. Mike

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi Mike,

    I've read all the posts through your update on your visit to the RO. What he or she said makes good sense to me.

    Many good points have already been addressed, so I will just supplement what has been posted with a few more thoughts.

    In addition to the RO's thinking about not needing to treat now, the more time that passes before you might have to make a timely move to get treatment, the more time for technology to improve. That would not be a big deal for many diseases and cancers as the pace of improvement is often slow, but it is key for prostate cancer because so much progress is being made so rapidly on so many fronts! Those advances are being made, for example, in radiation technology - ever improving aiming (already amazingly precise) and decreasing side effects, in imaging that has meant now available benefits in targeting radiation or other treatment, in molecular and other testing to guide decision making, in managing ADT in support of radiation while reducing side effects, and in supportive drugs like metformin, whose anticipated usefulness may well be proven by clinical trial results by the time you might need treatment. A specific example of rapid progress is the availability of PYL imaging that appears to be on the verge of equaling or eclipsing Ga68 PSMA testing that itself has only recently been approved. If you do happen to have one of those recurrences that needs treatment and you can wait a couple of years or more for timely treatment, as is highly likely in your circumstances, it is almost a certainty that you will benefit from significant advances that will have been made between now and then.

    Johns Hopkins' prostate cancer doctors and researchers, putting their very large data base of patient case histories to work, has actually pioneered assessment of the range of mildness to seriousness ofrecurrences after surgery. Moreover, because some of the surgeons who did many of the prostatectomies in the data base unfortunately did not favor early ADT where appropriate (specifically famed surgeon Patrick Walsh, but also some others), their research that was published some years ago, well before the impact of modern, new drugs and other technologies, gives us a look at the natural history of prostate cancer recurrences that was mostly not affected by timely ADT or other modern technology. The effect is that we kind of see the worst case scenarios by today's standards for recurrences in their database, and the encouraging result is that the outcomes for the vast majority of patients with mild recurrences are very good! The reality, even back then, was that a substantial majority of patients with mild recurrences were outliving their cancer, and, if you do have a recurrence, it looks like a mild one using the Johns Hopkins findings as a yardstick.

    You can check some of the research yourself if you go to the original paper and perhaps follow-up with later papers. You can view an abstract of the complete paper at Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy - PubMed (nih.gov), which was published in 2005. (If you use the search string - freedland s [au] AND prostate cancer AND recurrence after prostatectomy - at www.pubmed.gov, a US government website for medical research, you will be able to view abstracts and sometimes links to complete papers for many related topics. The same research team took a different look at their data and published again in 2007: Death in Patients With Recurrent Prostate Cancer After Radical Prostatectomy: Prostate-Specific Antigen Doubling Time Subgroups and Their Associated Contributions to All-Cause Mortality | Journal of Clinical Oncology (ascopubs.org) . The neat thing about this paper is that it is available, complete and free, via the link.

    PSA doubling time (PSADT) during recurrence turned out to be a key factor in predicting odds of surviving prostate cancer. For you, using the three values you provided, calculated for the middle of each month, PSADT is 13.7 months (MSKCC PSADT nomogram, multiplying each value by 10 to fit the requirements), reflecting a desirable lengthening over PSADT calculated based on just the first two values (10.2 months). (PSADT can vary a bit for very low values with ultrasensitive tests, so your true PSADT, assuming you are recurring, is still approximate at this point.) Figure 1, graph E would probably be the most informative for you as it covers survival for men like you with a PSA doubling time of 15 or more months, and your figure of 13.7 might easily increase to that figure with another small increase.

    Basically, the Freedland paper found that the range of mildness to seriousness of recurrences could be assessed, allowing survival forecasts with odds, based on just three factors: PSA doubling time (PSADT) after surgery, whether the pathological (post-surgery) Gleason score was less than 8 (good, your case) or greater than 8, and whether the length of time before an "official recurrence", meaning the PSA rose (and stayed) to .2 or higher was 3 years or fewer or more than 3 years (good, your case). Your circumstances will likely be at the best level for PSADT (greater than 15 months), assuming there is a real recurrence (not yet certain) and not another explanation. Graph E covers PSADT only for all men with a PSADT of 15 months or more, the best category they looked at. It indicates that a projected 90% of such recurring patients were surviving prostate cancer at the 15 year point; also, as most of these men were older than you, some were dying of other causes, and the graph shows that about twice as many patients were dying of other causes as were dying from prostate cancer. For the next most favorable category, a PSADT of 9.0 to 14.9 months, about 70% of patients were projected to be surviving at the 15 year point, and that's without putting your two other favorable key characteristics into the picture. So you can see that chances for survival of a mild recurrence were excellent, even back then. All this means that you have an outstanding chance of surviving the disease for at least ten more years, during which time there is going to be great progress from which you would benefit if you are having a recurrence.

    Good luck!

    ….Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. 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, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 11-29-2021, 09:46 AM   #13
    mhammes
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    mhammes HB User
    Re: PSA 3rd data point

    Thanks for this response - I agree on early detection and treatment. And appreciate your comments on health - I am in reasonably good shape but plan to up my exercise regime. Interesting comment on statins - is there some evidence that statins can suppress prostate cells?

    Quote:
    Originally Posted by Prostatefree View Post
    Surviving is not a meaningful measure in prostate cancer. While statistically significant it can not alter the fact that a slow growing terminal cancer is a long and painful death. A 10 to 15 year survival statistic will be consumed with a significant loss of quality of life due to treatment and a painful death taking years off that statistic.

    Early detection and early treatment is the most effective path. After that, it's luck and hope.

    The idea that it is a slow growing cancer and you will die of something else is a myth that has misled many men who have died and still invades the medical community today tempting men and their doctors to deny and delay.

    None of it makes much of a difference for a young man. Continue to do what you've been doing. Stay on top of it and you have an excellent medical team.

    Continue to work on your general health. Most importantly, get your BMI to acceptable.

    Ask your doctor about statins. Continue to use the ultra-sensitive testing. There is peace and strength in the knowing and acceptance of it. It doesn't mean surrendering to it.

     
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    Old 11-29-2021, 10:28 PM   #14
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    Re: PSA 3rd data point

    Quote:
    Originally Posted by mhammes View Post
    Thanks for this response - I agree on early detection and treatment. And appreciate your comments on health - I am in reasonably good shape but plan to up my exercise regime. Interesting comment on statins - is there some evidence that statins can suppress prostate cells?
    For many years, my urologists at Johns Hopkins have reviewed my medications, which include decades of atorvastatin, atenolol, and aspirin, and commented that all three retard prostate cancer. Since I have less PCa now than I had when diagnosed in 2009, I tend to believe that is the case.

     
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