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slow rise 21 months post RRP

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Posted 9/23/2013 5:51 PM (GMT -5)
'just received my PSA post RRP 21 months ago, although I'm happy that my PSA only raised .03, I'm aware that my PSA is slowly rising. I have an appointment with my uro tomorrow at 12:20 and am a little nervous about our conversation. In our last meeting he did mention possible therapies which would include both radiation and hormone. Currently at .11. After having blood drawn for PSA Thursday, I walked across the street to the Cancer Center and was impressed at first glance.
Posted 9/23/2013 8:09 PM (GMT -5)
SRT would normally be the first choice. But only if they thought it might still be in the prostate bed. Depending on your gleason score after surgery you might want to be aggressive and hit it with both a round of radiation and a bit of HT.

Radiation isn't that bad but it can be a bit of an endurance test.

The good news is that you still have options even though I am sure you'd rather not have to do more now.

Hang in there and lets know what the doc says.
Andrew
Posted 9/23/2013 8:56 PM (GMT -5)
EagleKeeper, sounds like you and your team are really staying on top of things, and as Andrew just mentioned you'll have lots of options should the need be.

Continued best to you brother, will keep you in my thoughts. . . let us know how it goes tomorrow.
Posted 9/23/2013 8:59 PM (GMT -5)
You could be on a slow rise to BCR, hope not. Might be worth reviewing your options just in case. As far as SRT, only useful if they strongly feel its still in the prostate bed. My oncologist strongly feels that too many men jump the gun on SRT. You would want a strong confirmation on any BCR before considering pulling the radiation trigger.

Definitely need to keep a close eye on the next 2-3 PSA readings

Personally, I hope you can continue to dodge the bullet.

David
Posted 9/23/2013 10:25 PM (GMT -5)
Thanks for the help. I don't know why my signature didn't go through, but my PSA was 9.6 when diagnosed and I was staged T3b. My first PSA post RRP was .008 in May 2012 and most recent .11 today. I see where some here have had SRT only and some have had adjuvant therapy. I think my uro is leaning toward adjuvant. Does BCR mean non curative? I think my uro gave me a 70% chance cure rate.
Posted 9/23/2013 10:29 PM (GMT -5)
Can you give us all your post-RRP PSA readings?
Posted 9/23/2013 10:53 PM (GMT -5)
You can have BCR more than once. After my surgery failed, BCR was declared. SRT was considered my last "curative" hope, so yes, in that context, BCR can still mean a cure is possible, assuming your secondary treatment method works.

In my case, had SRT, and it failed fast, so oncologist considers my current situation BCR for the 2nd time, but it is no longer curative.

David
Posted 9/24/2013 12:18 AM (GMT -5)
Thanks again for the help. I have my appointment today now but can't sleep, anxiety. Phenom, from memory, I know my first post RRP was .008, 3 months after I'm pretty sure it was .004, I think it was .04, then .08 6 months ago, .08 3 months ago and now .11. I'll try and get more accurate numbers at my appointment.
Posted 9/24/2013 12:26 PM (GMT -5)
It does look like you are on the path to BCR. FWIW, my PSA rise was not a straight line. When I hit 0.1 I actually stayed there for a couple of years before it started rising again. Though when the rise resumed it quickly accelerated to 0.4, which was when I opted for SRT. My SRT was three years ago and and I've been lucky so far. As of last April my PSA was still reading 0.00. I have another PSA test coming up tomorrow and will know how that one goes in a couple of days.

As for cure - no one every really knows, but there are ways to calculate probabilities. If you end up having SRT you can use this nomogram to estimate the probability of being PCa-free six years after your salvage radiation.

rcc.simpal.com/692O71
Jim
Posted 9/24/2013 3:46 PM (GMT -5)
thanks again. I just had my uro meeting, he feels I should talk to the RO and start SRT soon. He said that at the rate of increase of my PSA rise it would take a long time to cause any concern but thinks it would be a good idea for a RO consult at this time. He felt that the slow rise possibly shows something in the prostate bed. Again, thanks for your input. Wishing all well! Bohemond, I'm praying that you have a good outcome tomorrow brother!
Posted 9/24/2013 4:30 PM (GMT -5)
My reading suggests that the longer the time between surgery and a "higher" PSA the more likely the problem is confined to the prostate bed.

We decided I'd experienced biochemical failure at 18 months and pulled the trigger on SRT at 24 months. Our stats are fairly similar Eaglekeeper so it'll be interesting to see how things pan out.
Posted 9/24/2013 4:41 PM (GMT -5)
Eagle,
What was it that gave you a T3b staging? And shouldn't you have a consult with a medical oncologist to confirm the uro's opinion about the need to start SRT? As I understand it, the RO isn't involved in treatment decisions. I hope you don't mind the questions, but, like with a possible BCR occurring, I'm really interested in the subject and trying to learn all I can. Thanks.
Posted 9/24/2013 5:18 PM (GMT -5)
I wasn't sure if I should start a new thread but I was wondering how much SRT might cost and if BCBS covers it
Posted 9/24/2013 6:00 PM (GMT -5)
Eaglekeeper,

My SRT was fully covered by my then-employer's Aetna plan, other than the annual deductible which under that plan came to $3,500 out of pocket. I was still working then (I'm now retired) so I had the $3,500 withheld from my pay over the course of a year through my company's Section 125 plan -- so at least I was able to pay my deductible with tax-free dollars. I'd expect your BC/BS plan would be similar, but you should check just to be sure.

Based on the flood of statements I received in the mail from Aetna, the total cost of my SRT was I believe somewhere around $60k.

Also in my case, my RO was very much a part of the treatment decision. Because he spotted an enlarged lymph node on a pre-treatment x-ray he was kind of on the fence as to the chances that my PCa was still confined to the prostate bed and discussed with me and my wife the risk that SRT wouldn't be appropriate if the PCa was already systemic. We collectively decided to go for it and the RO had part of each treatment targeted directly at the suspicious lymph node. It has now been over three years and so-far-so good.
Jim
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