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Recurrence? - Start Avodart?

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Posted 4/17/2014 10:10 AM (GMT -5)
Just got the results of my third PSA test since finishing IMRT/IGRT in June of 2013. First PSA test in November, 2013 was .06. Second PSA test in January, 2014 was .54. And now my third PSA test just done is .69.

Have read (here on HW) that if your PSA goes up two consecutive times after radiation you have a BCR. Is that right? Also have read that the PSA SHOULD have been going DOWN for up to a year following radiation instead of going up like mine. Is that also right?

Just read a post about the use of Avodart. A couple of answers by two of the most knowledgeable guys on here said it would help kill off any remaining PCa by depriving it of DHT thereby halting a rise in PSA.

Should I start taking Avodart right away or WHAT should I do next? Isn't it recommended that you start something immediately after a BCR? Will be seeing the MED/ONC next week and will use any input
I get here on starting Avodart (and/or whatever else you recommend.)

Thanks,
PhilC
Posted 4/17/2014 12:52 PM (GMT -5)

PhilC said...
Have read (here on HW) that if your PSA goes up two consecutive times after radiation you have a BCR. Is that right?

No that's not right. There is as much misinformation here on HW as anywhere else on the net. I know I have had several misconceptions changed by more informed members.

The definition of BCR after RT is the "Phoenix definition" which was adopted in 2005. PSA has to go up 2 points above the nadir value. So in your case, 2.06 would be a biochemical recurrence.

Your rises in PSA are most likely the result of the ADT getting out of your system. Bounces are common after RT, and are associated with a good prognosis. It can take several years for PSA to bottom out after radiation.

- Allen
Posted 4/17/2014 1:51 PM (GMT -5)
Hi PhilC,
Tall Allen gave you a good representation of your current situation. Slow down!
You are currently 8 months down the road from aggressive treatment and as your testosterone rebounds the prostate gland (whatever is left of it) is regenerating.

You had a very elevated PSA at diagnosis and according to the T3 MRI and C-11 Choline PET a SVI. For this reason you are presently concerned, but it seems reasonable to continue to monitor your PSA for a while longer to fully determine your recent treatment results. Have you had your testosterone measured? That would be an important data point to verify that you are hormonally recovering from ADT3. Adding Avodart at this point can cloud your Tx results. Continue to monitor PSA closely in case recurrence is indicated. The risk of not adding Avodart at this point should be minimal.

Wish you the best possible outcome!

RalphV
Posted 4/17/2014 2:28 PM (GMT -5)
Phil, my psa went from .27 to .40 after the end of SRT.  Mayo waited until PSA hit 2.0 to start HT and never suggested Avodart.  Now on Zytiga which seems to be working, last two PSA have been undetectable.

Did MEDICARE pay for the Choline C-11.  MEDICARE would not pay for my F18 Pet scan at Mayo Jacksonville.  Take care.  The Old Sailor

 

Posted 4/17/2014 3:03 PM (GMT -5)
Tall Allen,
What a relief to hear that the PSA has to be 2 points above the nadir value before I have a biochemical recurrence!

So these 2 PSA increases are a result of the ADT getting out of my system. My second Lupron shot was a 3 month one which I received on May 28th, 2013. Since it was only a 3 month shot shouldn't if have been out of my system by August 28th? Or does the effect linger for quite awhile after the 3 months is up? Although hardly anyone gets RT without ADT, would you NOT get a bounce if you didn't receive any ADT?

You say it takes several years for PSA to bottom out after radiation.
Does this mean my PSA may STILL go lower after these bounces?

We are very fortunate to have your intelligent replies here on HW.

ralfinaz,
My testosterone measured 425. Before the ADT3 it was 826. So it is 51% back to where it was. Believe I have read where it never gets back as high as it was originally, is that correct? Anyway I do notice I have more energy now and am starting to feel lots better.

Glad you informed me to not start Avodart at this point which would cloud my TX results. Not sure where you get me currently 8 months down the road from aggressive treatment? That would take it up to January, 2015 which would be 18 months after I finished the RT. I suppose you are referring to some study done on this.

You and Tall Allen really know a lot about PCa! Thank you both!

PhilC
Posted 4/17/2014 5:01 PM (GMT -5)
PhilC,

I hope you are asking these very good questions of your oncologist. He or she has seen a lot of such cases as yours and can speak from their years of experience. It takes a while for T to rebound after the ADT - I think it varies from person to person. Bounces happen with or without ADT. Yes, your PSA can go lower, but anything below .5 has an especially good prognosis.

- Allen
Posted 4/17/2014 5:34 PM (GMT -5)
Hi PhilC,
Maybe I am interpreting your profile wrong. According to the profile your last shot of Lupron was 5/28/13. That depot would be exhausted by or around 8/28/13. I assumed you also stopped Casodex and Proscar. That is where the 8 months came from. Sorry if I misinterpreted the data. As far as the RT it could be still working and your PSA nadir could be still lower. My definition of aggressive treatment includes ADT3 and RT. Based on your Dx PSA and SVI I think your aggressive treatment was proper. Again, wish you the best outcome!

RalphV
Posted 4/18/2014 7:00 PM (GMT -5)
Old Sailor,

You ask: "Did MEDICARE pay for the Choline C-11. MEDICARE would not pay for my F18 Pet scan at Mayo Jacksonville."

The bill for the C-11 Choline Pet-CT scan was $7,200. I have Medicare A & B plus Federal Employees Health Insurance. Not sure if Medicare paid anything on it. Believe Tall Allen said that Medicare does not pay for it.

They did the test on me because the 12-core biopsy they did only found a small amount of cancer which couldn't produce the very high PSA of 164.

I believe in most cases it is only performed on men with PCa recurrence to find out where in the body any metastasis is located.
Men from all over the country were coming up to Mayo to have it done.

How did they know WHERE in your body to do the SRT and what
is used to do it? I may have to have it done at some later point.

Next year Mayo's new Pencil Beam Proton Treatment Center will be finished. Hopefully this can pin-point radiation to wherever they find a recurrence.

The MED/ONC are sure that the Zytiga they are having you take is preferred over Avodart.

I take you were a Sailor in the U.S. Navy? Did you serve during the VietNam War? My brother was killed in July of '68 in the Mekong Delta. Also a young guy I worked with was drafted and killed and an Air Force Pilot I went to high school with was killed on the very same day as my brother and they are buried about 50 yards apart in the same cemetery.

Good luck,
Phil
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