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Question about BCR

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Posted 2/16/2017 8:44 PM (GMT -5)
A question to which I should know the answer to, after being here for 3 years....

What is the level to which PSA must rise after successful RALP with good pathology and subsequent undetectable PSA, for one to be considered as being in BCR?

My understanding is that the establishment urological community considers it to be .2? And yet my surgeon says "we don't act until it hits .1"

Does the group here agree with either of these? Lower?

And on a related note, does anyone know at what level does Medicare consider approving SRT?

Just thinking out loud. skull
Posted 2/16/2017 9:39 PM (GMT -5)
My RO (Dr. Zietman @ MGH) initiates SRT at .10 - prefers not to see me until then though he's entirely willing if/when I have questions - quick with email too. Urologist and MO agree.

Best
Wilderness
Posted 2/16/2017 10:13 PM (GMT -5)
.2 is the definition of BCR according to " " (someone fill in the organization. I don't know the name of it)


edit: and a "fwiw"....I've had medicare for several years now and I"ve yet to have them deny ANYTHING. Maybe I"ve just been lucky....or haven't bumped against "a rule" yet....who knows.
Posted 2/16/2017 10:26 PM (GMT -5)
You can look it up yourself here: https://www.auanet.org/education/guidelines/prostate-specific-antigen.cfm
Posted 2/16/2017 10:51 PM (GMT -5)
Thnks Jack, this is helpful, I've bookmarked it. It's last update was 2013, so I suspect it's not the final word.

So no wonder I didn't know the answer to my original question. Because nobody really knows. Not even the American Urological Association.

And Wilderness and IT's doctors don't even agree.

I guess the answer to when do you have BCR, is , for many of us" when Medicare (or your insurance company) says you do. :-(
Posted 2/16/2017 10:51 PM (GMT -5)
BCR is defined as a confirmed PSA ≥ 0.2 ng/ml. But it is a definition from the turn of the century when conventional PSA tests were all that they had. On those tests, 0.1 was the lowest detectable PSA (anything lower was "undetectable"), so the urologists arbitrarily decided that 0.2 was a convincing indicator that the cancer was back. There's nothing magical about that number.

The decision about what PSA to treat at is a different decision point than when BCR occurs. I laid this out graphically:

/pcnrv.blogspot.com/2016/08/how-soon-after-surgery-should-salvage.html

Your surgeon does not act when it reaches 0.1. A patient and a radiation oncologist acts. Your surgeon knows little about this because he does not treat patients for recurrences.
Posted 2/16/2017 11:02 PM (GMT -5)

Pratoman said...
Thnks Jack, this is helpful, I've bookmarked it. It's last update was 2013, so I suspect it's not the final word.


It is. AUA has the final say following surgery. ASTRO has the say following RT. Declaration of BCR may be, however, different than when salvage treatment is triggered.
Posted 2/17/2017 8:42 AM (GMT -5)
Prato -

My RO supports the findings of the Koulikov study on when to initiate HT/SRT. Here is TA's summary of it. I found it useful to calm my nerves early on when my numbers were starting to go up.

/prostatecancerinfolink.net/2015/01/14/low-detectable-psa-after-prostatectomy-watch-or-treat/

As time went on clearly my numbers put me in the 3rd "low but unstable group" with it becoming very likely I would need salvage treatment. My RO suggested we wait for confirmation at .07 because he has a handful of patients that rose and stabilized at .07 or below. At .09 we pulled the trigger.

You are a long way from that at .02 Let's hope it stays there. For now, enjoy life. If you get another rise start a conversation with an RO and take it one step at a time.

Jon
Posted 2/17/2017 8:55 AM (GMT -5)

JackH said...

Pratoman said...
Thnks Jack, this is helpful, I've bookmarked it. It's last update was 2013, so I suspect it's not the final word.


It is. AUA has the final say following surgery. ASTRO has the say following RT. Declaration of BCR may be, however, different than when salvage treatment is triggered.

No, I mean, in that link, there is so much about not really being sure about the right number, I.e still controversy. And I meant, there will probably be another update soon. These guidelines came out in 2009, and we're last updated in 2013, so maybe due for mother update, that's what I meant.
Posted 2/17/2017 8:59 AM (GMT -5)

Tall Allen said...
BCR is defined as a confirmed PSA ≥ 0.2 ng/ml. But it is a definition from the turn of the century when conventional PSA tests were all that they had. On those tests, 0.1 was the lowest detectable PSA (anything lower was "undetectable"), so the urologists arbitrarily decided that 0.2 was a convincing indicator that the cancer was back. There's nothing magical about that number.

The decision about what PSA to treat at is a different decision point than when BCR occurs. I laid this out graphically:

/pcnrv.blogspot.com/2016/08/how-soon-after-surgery-should-salvage.html

Your surgeon does not act when it reaches 0.1. A patient and a radiation oncologist acts. Your surgeon knows little about this because he does not treat patients for recurrences.

Yes, s I stated previously, I understand the role of the surgeon. What he does and what he doesn't do. If I see serial rises, no matter what the number, I will seek out an RO for a serious discussion about when to treat/if to treat.

Thatnks for the response, I will read the link tonight, when I am not pressed for time. Although I have a feeling I've seen it/you've provided it before.
Posted 2/17/2017 9:02 AM (GMT -5)
Thanks , Greytech. I've read that piece from TA, and it calms my nerves too. Although with only one undetectable reading so far, I don't know if I am stable or not.

I'm not letting this whole think get in the way if enjoying my life, I'm just seeking education.
Posted 2/17/2017 11:54 AM (GMT -5)
All trigger points are individually decided{or should be imo}with the medico treating...combining the knowledge of both...Pca is a patient disease...my feeling is that patience of the patient is a value added by using the enemies own devices to defeat it...Patience or patience...What ever the patient does in the short term will not change in the longterm the end point. Patients determination...Edit...this apllies to the vast majority of cases imo
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