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Supposed to start SRT next week but latest PSA is DOWN.

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Posted 7/12/2013 9:19 AM (GMT -5)
Hey folks,
I just received my latest PSA results and am in a quandary about where I go from here.

Reviewing my signature below, you'll note that I had surgery two years ago. I was deemed a G6 with a focal positive margin and extensive PNI. My uro has been saying all along that he thinks SRT would be needed sometime in the future. Since my surgery, I've been dealing with a slowly rising PSA.

Today, I just received my latest PSA results to find my PSA has gone DOWN to .06. Reviewing the lab results in more detail, I found that my doc is now using a different lab which uses a different assay method. Previously, testing was performed using the DPC Immulite 2000 method. The new lab uses the Roche ECLIA methodology. I know that different testing methods cannot be used interchangeably but it would appear my PSA is at least remaining stable.

Now the tough part. I am scheduled to begin SRT this coming Tuesday.

Based on what my PSA appears to be doing, should I hold off with SRT? My thinking was to start SRT as soon as possible to increase my chances of success but now I'm wondering if I'm pulling the gun too soon.
Posted 7/12/2013 9:40 AM (GMT -5)
I'd be reconsidering. .06 is about as close to zero as you can get. SRT is no fun and I'd be wondering if the SEs are worth it.

If it were me, I'd be on the phone to the doc asking a lot of questions.

Andrew
Posted 7/12/2013 9:48 AM (GMT -5)
I concur with Andrew, you can wait!

Mel

Posted 7/12/2013 10:31 AM (GMT -5)
I am always a fan of holding off as long as it is safe to do so, so that the medical advances can outpace our PCa.
Posted 7/12/2013 11:18 AM (GMT -5)
i'm no doctor (electrical engineer), but i've always heard the threshold for thinking about SRT is in the 0.2-0.3 area. you're not even close. if you're a G7 downgraded to a G6, i don't see the rush. just my humble opinion
bob
Posted 7/12/2013 11:29 AM (GMT -5)
At those levels velocity trumps volume as an indicator of when to pull the trigger. Your numbers show no reason to muster the troops in either camp. I agree with a previous poster. New approaches are coming out of the woodwork now. Cool your heels until you have a genuine reason to initiate a major option like SRT. Watch your numbers, watch your diet and get plenty of exercise. Bounce these opinions off your Uro and see how he responds. Get another opinion. There's no rush here.

Jim
Posted 7/12/2013 1:56 PM (GMT -5)
Weld the trigger down, you are never going need it . An edumacated guess. Enjoy your cruise.
Posted 7/12/2013 2:47 PM (GMT -5)
John, this is a tough call. I can sympathize with your inclination to hit it hard and early but you still have a really low number. I guess if it was me, I would be at least temporarily holding off until I got another medical opinion -- from a medical oncologist who specializes in PCa.

Jim
Posted 7/12/2013 3:03 PM (GMT -5)
HD_Rider, I posted this reply in another thread earlier today, but everything there is also relevant to you.  I hope that you don't mind, but rather than re-typing, I will simply copy/paste:     The AUA is the definitive source of the definition for post-surgery biochemical recurrence (BCR).   The AUA has an easily-readible, free online document which would be of direct interest to your thread.  The document is titled:  "Prostate Specific Antigen BEST PRACTICE STATEMENT:  2013 Revision of the 2009 Update" , and is found HERE . It reads: The AUA defines biochemical recurrence as an initial PSA value =0.2 ng/mL followed by a subsequent confirmatory PSA value =0.2 ng/mL.   However, a cut-point of 0.4 ng/mL may better predict the risk of metastatic relapse.   This cut-point was selected as a means of reporting outcomes, however, rather than as a threshold for initiation of treatment.      Your numbers are far below this.  The purpose of the ultrasensitive test is to give those with higher risk of recurrence (like positive margins) an opportunity to monitor more closely whether it crosses the BRC threshold or not.  As you can tell from the AUA statement, they do not recommend action prior to BCR.  Your tests may be picking up naturally occuring variation.  Relax   I hope that this information adds value...        
Posted 7/12/2013 4:25 PM (GMT -5)
I also just posted in another thread titled "Radiate or Wait" and suggest you check out that thread for comments that I think may also apply to your situation. In short, I wouldn't be going forward with SRT with readings like yours unless my doctor could give me a very persuasive explanation of why it was warranted -- and then I'd want to have a second opinion also.
Posted 7/12/2013 4:37 PM (GMT -5)

HD Rider said...
I know that different testing methods cannot be used interchangeably but it would appear my PSA is at least remaining stable.

It is an unwarranted conclusion that it is stable when the test kit is so different. You can wait a month and re-test, but your history of steadily rising PSA remains. Dr. King found that treatment before PSA gets to .2 is beneficial.
Posted 7/12/2013 4:42 PM (GMT -5)
HD Rider - to me you are still in the zero club -PSA<0.10 with your latest being only 0.06. Granted it is moving around but on a slow rate - which may ( as per another thread and DR Snuffy Myers) stabilize and go nowhere.

If it were me ( since this is patient-to-patient forum) and my numbers were slowly moving around, I would watch them every 3-6 months ( with the same lab - same methodology).
But with my numbers on the rise exponentially, I am choosing to go the SRT route.

Whatever your decision, to SRT or POAS ( post-op active surveillance) you have the time to decide.
wishing you peace and contentment.
hugs,
Bronson
Posted 7/12/2013 4:55 PM (GMT -5)
Well, it seems you really have gotten many answers and a clear direction: NO SRT for now.

Tattman -- were you going to start SRT?

Mel

Posted 7/12/2013 5:53 PM (GMT -5)
HD, my friend.

My answer is simple. I would hold off on the SRT at this time. The radiation center can certainly reschedule it one day if you still need it.

Based on what I have learned from a few high level doctors the past year, they would feel strongly that
you would be pulling the trigger too soon, especially with your latest reading.

Good luck, I know its another tough situation to answer

david
Posted 7/13/2013 6:50 AM (GMT -5)
Thanks, everyone, for the advice. After sleeping on it, I think I'm going to ask my radiation oncologist to hold off for two months, have a PSA retest, and go from there.
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