concerns about doubling time and aggressiveness

Hi, Tigre

Welcome to the site, though sorry you have to be here.

It would be helpful if you could post more about your post-surgical path report, margin status, seminal vesicles, capsule confined, and staging, etc. It is unusual to have PSA rising so soon after RP for a gleason 3+3. But not impossible.

Did you have your diagnosis and RP/RT done at a major cancer center? If not, (and perhaps even if so) I'd recommend getting a second opinion. You can have the pathology work reviewed by one of the top labs and see if you really have a 3+3 and not something more aggressive.

But at this point if I understand your post correctly, you have already had the RP and RT so you are in a position of watching the PSA and deciding what to do if/when it rises.

The odds of success of salvage RT are complex to figure and I think the projections would certainly depend on factors such as doubling time, gleason, PSA levels, and not be a single number. IF you want to research the literature on this (it's complicated) you can go search on pubmed.com. You might find something useful here: www.mskcc.org/applications/nomograms/prostate/. Good luck.

Welcome Tigre,
Without knowing the post surgery pathology it is a somewhat difficult to comment other than to say your doc's anxiousness to pull the salvage radiation trigger is a little unusual at .02-.05. Most urologists would not seem to concede there has been a failure of surgery till a figure of 0.2 has been reached. There are no shortage of members here who after surgery have had readings at the 0.02 and a little higher indefinitely.

Whoops------now I re-read your post am I correct in assuming that you have already had the salvage therapy? If this is the case then stay with the ultrasensitve test ------ you have always been <0.1 since surgery so getting tested at the standard level now is not helping with seeing if the salvage had any effect on your PSA. It is important to stay with the same lab using the same testing protocols. As to your question about aggressiveness------normally a quick doubling time of PSA indicates that the tumour cells are more aggressive. But given the figures you spoke about i.e. 0.02 and 0.05 ...... there is a bit of variability at this very low level (particularly if different labs are involved) so I would not automatically assume that your PSA actually doubled in that time frame, despite the apparent figures.
Bill

tigre,

You have been treated at two well renowned centers in Atlanta. My wife has just completed her radiation for breast cancer at RCOG with Dr. Levitt. I didn't use them because I went the HDR route. I have a good friend that just completed his primary treatment at St. Josephs. All I can say is to stick with your doctors and add a medical oncologist that specializes in PCa as your lead advisor.

It is interesting you would say that John re. ultrasensitive. Tigre's doc certainly did adopt an unusually aggressive approach pulling the trigger at 0.05 which is probably understandable given Tigre's age. He obviously thought post surgery that ultrasensitve testing was appropriate in order to detect early signs of surgical failure. However failure would not have been apparent so early using the standard test ie <0.1 (undetectable) following surgery. Given the remaining canon in the arsenal is HRT and his doctor is pro early intervention then why not apply the same ultrasensitive testing logic to the success or otherwise of SRT (again for early intervention) rather than changing to standard testing.
Bill

Post Edited (BillyMac) : 1/9/2011 9:12:12 PM (GMT-7)

 

1^st you did not have recurrence.  You had a positive margin.  Surgery did not remove all your cancer.

 

2^nd I was diagnosed at 42 with 3+3=6.  I had surgery at Johns Hopkins had they told me several times that my age has absolutely nothing to do with the how aggressive PCa is in younger people.  There have been many studies that show this to be true.  G6 in a younger person is not more aggressive then in an older person.  This was straight from Dr. Epstien.  You simply had a positive margin not more aggressive cancer.

 

You Dr. is mis-guided about that notion.

chrisR,
thanks for the reply. i agree completely that the positive margin was just that and not recurrence. at least i sure as heck hope so. i think my uro was just trying to tie in higher testosterone levels in younger men with potentially more aggressive cancer. in any event, i think i feel pretty good about treatment decisions to this point. maybe we jumped the gun a little bit with rt and i may rue that one day down the road, but for now the only real unpleasant side from rt isimpotence. after surgery and before rt i was just starting to make a little progress too.