......From time of BCR

AUA/ASTRO said...
Clinicians should define biochemical recurrence as a detectable or rising PSA value after surgery that is ≥ 0.2 ng/ml with a second confirmatory level ≥ 0.2 ng/ml.

www.auanet.org/guidelines/radiation-after-prostatectomy-(astro/aua-guideline-2013)

The vast majority of studies use that arbitrary cut-off. It's used for research purposes - not necessarily for patient guidance. Some advocate for a higher cutoff that more reliably predicts metastases. That would be useful for research purposes as a surrogate endpoint over waiting for detectable metastases or death. Some advocate a lower cutoff that more reliably prevents patients from reaching the higher cutoff (i.e., metastases and death) while still preventing overtreatment. Probably they will move to two cutoffs - one for a surrogate endpoint and the other to protect patients.

This nomogram gives the probability that SRT will be successful if given at various PSAs, but they did not have a lot of sample size below 0.2. That's a problem with nomograms - they usually have about 60-70% reliability overall, but in subgroups that have small sample size, they aren't very reliable.

/pcnrv.blogspot.com/2016/08/probability-of-remaining-recurrence.html

NKinney said...
.....Not hard to have treatment "success" with someone who didn't need treating.

AMEN...

IMHO the hysteria of minuscule PSA reading fluctuations causing some of us to RUSH into ill advised and unneeded RT is a terrible miscarriage of medicine. Read the studies carefully and understand both your own pathology, and the definition of 'high risk', which most of these studies target.

"From time of BCR"

sounds like a 1950's science fiction movie

The problem, no the issue I have, is my "low risk" pathology , needs quotes. I don't really know if I'm low risk. I had positive intraoperative margins AT THE APEX, and negative final margins after further resection.
Dr Zelefsky at MSKCC stated that my "negative margin, is questionable"

So I'm not sure if I should be acting like a low risk or high risk pathology guy.
My decision-her score was .37, low risk according to my surgeon, but high end of low risk.

I echo what Weight loss said. You can wait to confirm whether you really have BCR, but at 0.2 you're at a good point for SRT success. You don't want to let it rise too much above that. Also, from what i recall, positive margins are actually a good indication for SRT success because they explain where the PSA may be coming from.

Pratoman, your signature doesn't indicate: was your final pathology pT2+ ?

The "+" portion of this designation indicates intraprostatic incision.

NKinney said...
Pratoman, your signature doesn't indicate: was your final pathology pT2+ ?

The "+" portion of this designation indicates intraprostatic incision.

My husbands pathology is a pT2+ with his margin at the bladder neck. When PSA starts to increase can you help me understand how the intraprostatic incision is meaningful? I was hopeful after learning about that rihgt after surgery that that meant the cancer cells may die due to being cauterized, but it looks like maybe that's not the case since there's a rise in his PSA. Is that an accurate thought?

garyi said...

Pratoman said...


@Gary, there's a difference between thinking about it and worrying about it. Trust me, I'm much better than I used to be, I'm just trying to prepare myself. I'm still hopingbPSA stalls around this level. Tonight's fried chicken will not help my cause though.

A distinction without a difference for me Ken. I know you’re better at it, and I don’t think your eating enjoyment will impact your next LOW PSA

<LIKE>

TA, you must be a Logical Positivist

To paraphrase Dick Butkus, the past is gone, the future isn't here, and the present is all we have. That's why it's called a present.

Pratoman said...
I had positive intraoperative margins AT THE APEX, and negative final margins after further resection.
Dr Zelefsky at MSKCC stated that my "negative margin, is questionable"

I agree with Dr Zelefsky. It seems that you described pT2+. This is not the first time I've heard of pT2+ being mislabeled as pT2...perhaps it is not as uncommon for hospital staff pathologists as it seems it should be (see example next paragraph). All of the "official" prostate pathology specimen examination documentation (from the College of American Pathologists; latest 2017, but also the 2009 and 2012 version which was the latest when your surgery took place) specifies this designation for an intraoperative, intraprostatic incision (iatrogenic; or the PSM created by an accidental slip of the knife) to include the "+" sign. The apex, btw, is the most common location (along with the "backside" or posterior) for a PSM caused by knife slip—the apex contains the least amount of capsule.

Here's a great example of what I'm talking about as far as "mislabeling." The American Joint Committee on Cancer published THIS Prostate Staging Form—it was obviously made for hospital pathologists to fill-in—and it doesn't even include the "+" designation anywhere on the sheet.

Jack & Diane said...
My husbands pathology is a pT2+ with his margin at the bladder neck. When PSA starts to increase can you help me understand how the intraprostatic incision is meaningful? I was hopeful after learning about that rihgt after surgery that that meant the cancer cells may die due to being cauterized, but it looks like maybe that's not the case since there's a rise in his PSA. Is that an accurate thought?

It is meaningful because the outcomes are not as good as if this hadn't occurred. pT2+ frequently gets compared to outcomes with EPE, but for the primary reason that tumors are typically significantly more extensive and with higher Gleason score in patients with EPE, those (EPE) outcomes are typically worse.

Post Edited (NKinney) : 2/7/2018 11:06:17 AM (GMT-7)