Post SRT PSA

Hi guys. Thanks for always being here when I need you.

I just had my 3 month post-SRT checkup where they informed me that my
PSA was unchanged. I have always had very low levels of PSA (see my
stats below) so actual levels and even rates are in the twilight zone
as far as interpretation is concerned. However, it was undetectable
for almost 5 years post RP and then it came back. My oncologist
advised me to come back in another 3 months saying that, sometimes, it
takes more than 3 months for the PSA to drop back to undetectable.

Now, we all know that SRT is a bit of a crap shoot when there is no
visible signs of recurrence beyond a rising PSA (if it has taken
several years to recur, then it may be a local recurrence and SRT can
have a positive effect.) so if it didn't work in my case, then I guess
I'm not that surprised. But I hadn't heard anything before about it
taking longer than 3 months to show. Does anyone have any experience
or knowledge of this? I know that I "shed" PSA fast because I was
undetectable about a month and a half after my RP.

I will wait the three months on the off chance that this might be true
(although I don't expect that), but I am curious.

Thanks,

Doug
DX 10/15/02 @ age 49
PSA 1.26; Gleason 6; T2a
RP 12/04/02; one nerve spared
PSA 2003-6: Undetectable
PSA 09/14/07: 0.13
PSA 11/05/07: 0.15
Completed SRT 01/08
PSA 04/21/08: 0.15
Blog: http://talkingaboutcancer.com

On May 1, 9:23 pm, doug.gosl...@gmail.com wrote:
> Hi guys. Thanks for always being here when I need you.
>
> I just had my 3 month post-SRT checkup where they informed me that my
> PSA was unchanged. I have always had very low levels of PSA (see my
> stats below) so actual levels and even rates are in the twilight zone
> as far as interpretation is concerned. However, it was undetectable
> for almost 5 years post RP and then it came back. My oncologist
> advised me to come back in another 3 months saying that, sometimes, it
> takes more than 3 months for the PSA to drop back to undetectable.
>
> Now, we all know that SRT is a bit of a crap shoot when there is no
> visible signs of recurrence beyond a rising PSA (if it has taken
> several years to recur, then it may be a local recurrence and SRT can
> have a positive effect.) so if it didn't work in my case, then I guess
> I'm not that surprised. But I hadn't heard anything before about it
> taking longer than 3 months to show. Does anyone have any experience
> or knowledge of this? I know that I "shed" PSA fast because I was
> undetectable about a month and a half after my RP.
>
> I will wait the three months on the off chance that this might be true
> (although I don't expect that), but I am curious.
>
> Thanks,
>
> Doug
> DX 10/15/02 @ age 49
> PSA 1.26; Gleason 6; T2a
> RP 12/04/02; one nerve spared
> PSA 2003-6: Undetectable
> PSA 09/14/07: 0.13
> PSA 11/05/07: 0.15
> Completed SRT 01/08
> PSA 04/21/08: 0.15
> Blog:http://talkingaboutcancer.com

Hi Doug,

My guess is that no one really knows what is going on for sure after
biochemical recurrence as to where the source is coming from. In my
brothers case he was Gleason (3+5)=8 with extracapsular penetration,
PSA 6.1. Had Open RP in 1999 followed by 36 Rad treatments and was
undetectable for 7 1/2 years. Psa came back last June at 1.3 and has
been doubling about 3.1 months. It's now at 7.405. He has had every
scan available and all the available blood test and nothing shows any
cancer. His Medical Oncologist wants to continue monitoring his PSA
for a while as he states the PSA could be coming from benign prostate
tissue. I know that some here will laugh at that possibility but I
also know that none of the posters here are medically trained and
therefore I keep that in mind when considering opinions.

Ron S.

On May 2, 5:42*am, ronju99 <rjsp...@verizon.net> wrote:
> On May 1, 9:23 pm, doug.gosl...@gmail.com wrote:
>
>
>
>
>
> > Hi guys. *Thanks for always being here when I need you.
>
> > I just had my 3 month post-SRT checkup where they informed me that my
> > PSA was unchanged. *I have always had very low levels of PSA (see my
> > stats below) so actual levels and even rates are in the twilight zone
> > as far as interpretation is concerned. *However, it was undetectable
> > for almost 5 years post RP and then it came back. *My oncologist
> > advised me to come back in another 3 months saying that, sometimes, it
> > takes more than 3 months for the PSA to drop back to undetectable.
>
> > Now, we all know that SRT is a bit of a crap shoot when there is no
> > visible signs of recurrence beyond a rising PSA (if it has taken
> > several years to recur, then it may be a local recurrence and SRT can
> > have a positive effect.) so if it didn't work in my case, then I guess
> > I'm not that surprised. *But I hadn't heard anything before about it
> > taking longer than 3 months to show. *Does anyone have any experience
> > or knowledge of this? *I know that I "shed" PSA fast because I was
> > undetectable about a month and a half after my RP.
>
> > I will wait the three months on the off chance that this might be true
> > (although I don't expect that), but I am curious.
>
> > Thanks,
>
> > Doug
> > DX 10/15/02 @ age 49
> > PSA 1.26; Gleason 6; T2a
> > RP 12/04/02; one nerve spared
> > PSA 2003-6: Undetectable
> > PSA 09/14/07: 0.13
> > PSA 11/05/07: 0.15
> > Completed SRT 01/08
> > PSA 04/21/08: 0.15
> > Blog:http://talkingaboutcancer.com
>
> Hi Doug,
>
> My guess is that no one really knows what is going on for sure after
> biochemical recurrence as to where the source is coming from. In my
> brothers case he was Gleason (3+5)=8 with extracapsular penetration,
> PSA 6.1. Had Open RP in 1999 followed by 36 Rad treatments and was
> undetectable for 7 1/2 years. Psa came back last June at 1.3 and has
> been doubling about 3.1 months. It's now at 7.405. He has had every
> scan available and all the available blood test and nothing shows any
> cancer. His Medical Oncologist wants to continue monitoring his PSA
> for a while as he states the PSA could be coming from benign prostate
> tissue. I know that some here will laugh at that possibility but I
> also know that none of the posters here are medically trained and
> therefore I keep that in mind when considering opinions.
>
> Ron S.- Hide quoted text -
>
> - Show quoted text -

Ron...It would take something on the order of 100 gm of benign tissue
to generate a PSA around 7.4 ng/ml. That's more tissue than most
prostates contain while still intact...ron

On May 2, 9:45 am, ron <oit...@yahoo.com> wrote:
> On May 2, 5:42 am, ronju99 <rjsp...@verizon.net> wrote:
>
>
>
> > On May 1, 9:23 pm, doug.gosl...@gmail.com wrote:
>
> > > Hi guys. Thanks for always being here when I need you.
>
> > > I just had my 3 month post-SRT checkup where they informed me that my
> > > PSA was unchanged. I have always had very low levels of PSA (see my
> > > stats below) so actual levels and even rates are in the twilight zone
> > > as far as interpretation is concerned. However, it was undetectable
> > > for almost 5 years post RP and then it came back. My oncologist
> > > advised me to come back in another 3 months saying that, sometimes, it
> > > takes more than 3 months for the PSA to drop back to undetectable.
>
> > > Now, we all know that SRT is a bit of a crap shoot when there is no
> > > visible signs of recurrence beyond a rising PSA (if it has taken
> > > several years to recur, then it may be a local recurrence and SRT can
> > > have a positive effect.) so if it didn't work in my case, then I guess
> > > I'm not that surprised. But I hadn't heard anything before about it
> > > taking longer than 3 months to show. Does anyone have any experience
> > > or knowledge of this? I know that I "shed" PSA fast because I was
> > > undetectable about a month and a half after my RP.
>
> > > I will wait the three months on the off chance that this might be true
> > > (although I don't expect that), but I am curious.
>
> > > Thanks,
>
> > > Doug
> > > DX 10/15/02 @ age 49
> > > PSA 1.26; Gleason 6; T2a
> > > RP 12/04/02; one nerve spared
> > > PSA 2003-6: Undetectable
> > > PSA 09/14/07: 0.13
> > > PSA 11/05/07: 0.15
> > > Completed SRT 01/08
> > > PSA 04/21/08: 0.15
> > > Blog:http://talkingaboutcancer.com
>
> > Hi Doug,
>
> > My guess is that no one really knows what is going on for sure after
> > biochemical recurrence as to where the source is coming from. In my
> > brothers case he was Gleason (3+5)=8 with extracapsular penetration,
> > PSA 6.1. Had Open RP in 1999 followed by 36 Rad treatments and was
> > undetectable for 7 1/2 years. Psa came back last June at 1.3 and has
> > been doubling about 3.1 months. It's now at 7.405. He has had every
> > scan available and all the available blood test and nothing shows any
> > cancer. His Medical Oncologist wants to continue monitoring his PSA
> > for a while as he states the PSA could be coming from benign prostate
> > tissue. I know that some here will laugh at that possibility but I
> > also know that none of the posters here are medically trained and
> > therefore I keep that in mind when considering opinions.
>
> > Ron S.- Hide quoted text -
>
> > - Show quoted text -
>
> Ron...It would take something on the order of 100 gm of benign tissue
> to generate a PSA around 7.4 ng/ml. That's more tissue than most
> prostates contain while still intact...ron

I also understand that the PSA is exceptionally high and probably is
cancer recurrence. I also understand that none of the imaging devices
are sensitive enough to detect small tumors. However, having said
that, I will have to admit that all three of his scans; MRI Thoracic
Spine w/ contrast, CT Abdomen and Pelvis w/ contrast and NM Bone Scan
Whole Body indicate increased accumulation of radioisotope within the
T12 vertebral body, which is most likely secondary to a metastatic
lesion.

His new Medical Oncologist had him do the Prostacint Scan thing and
everything came back normal. We understand that the test is not that
reliable, however his Doc wants a few more PSA's before they go with
hormone therapy. He believes the three scans are biased towards
possible cancer. All three are either unremarkable or possible. It
does seem like with his PSA level and doubling time that he probably
has recurrence. His Doc thought it might be local but with the scan
results I would think that it is systemic and probably in his spine.

I think this situation with him just points out once again how
difficult it is for anyone to figure out what is really going on with
the test that are available once the PSA starts to rise after
treatment. Most start followup treatment right away with no assurance
of benefit and some will hold off until clinical symptoms occur to try
and manage the symptoms.

Ron S.

the PSA could be coming from benign prostate
> > tissue.

> > Ron S.
>

>
> Ron...It would take something on the order of 100 gm of benign tissue
> to generate a PSA around 7.4 ng/ml. That's more tissue than most
> prostates contain while still intact...ron


The problem I have always had with the benign tissue thing is that, if
there was something left that was creating normal PSA, then it
shouldn't have been undetectable for so many years. Also, I would
think that SRT would burn out anything left.

There really appears to be no completely reliable test (even worse
when your PSA is a strange as mine), so it's all odds and numbers and
maybes. We just have to do our best with what we have.

Doug

On May 2, 11:59*am, doug.gosl...@gmail.com wrote...snip...
> The problem I have always had with the benign tissue thing is that, if
> there was something left that was creating normal PSA, then it
> shouldn't have been undetectable for so many years. *Also, I would
> think that SRT would burn out anything left.

Doug...Any residual, benign tissue would be expected to grow slowly
over time (see Shinghal R, Yemoto C, McNeal JE, Brooks JD; Biochemical
recurrence without PSA progression characterizes a subset of patients
after radical prostatectomy; Urology 61:380-5, 2003). Perhaps after
RP the amount of remaining tissue was so small that only an
undetectable amount of PSA was generated, particularly if you were
using a test that was only sensitive for PSA>0.10 ng/ml. Then as the
tissue grows, eventually enough PSA is generated that you become
detectable with the test that you are using. As to SRT killing
anything left, I guess that would be the goal, but depending on where
the beam was focused and where the tissue resided, I would think
anything is possible. Also healthy, benign tissue is less susceptible
to radiation damage than cancerous tissue or cells. Finally, it is
also possible that your PSA was higher than 0.15 by the time you went
in for SRT, in which case your most recent reading of 0.15 would
signal a decline. Anything is possible, get that next PSA reading in
3 months as planned and see what it tells you. Hang in there!..ron

<doug.gosling@gmail.com> wrote in message
news:b9104bf6-60c1-4b2b-a1d0-e31e42203d3b@m3g2000hsc.googlegroups.com...

> Now, we all know that SRT is a bit of a crap shoot when there is no
> visible signs of recurrence beyond a rising PSA (if it has taken
> several years to recur, then it may be a local recurrence and SRT can
> have a positive effect.) so if it didn't work in my case, then I guess
> I'm not that surprised. But I hadn't heard anything before about it
> taking longer than 3 months to show. Does anyone have any experience
> or knowledge of this? I know that I "shed" PSA fast because I was
> undetectable about a month and a half after my RP.

I don't know, Doug. Seems to me that SRT should result in an immediate
drop, though not an immediate nadir. It doesn't appear you have either.

But radiation is an odd thing, what with coaxing cells to kill themselves
and all. I guess it's possible to have an increase, then a decrease, and
appear to have not moved at all. I think you're wise in seeing what it does
in three months.


--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05, <0.04, <0.04, <0.1 2/12/08
Non Illegitimi Carborundum

On May 2, 3:39 pm, "Steve Kramer" <skra...@cinci.rr.com> wrote:
> <doug.gosl...@gmail.com> wrote in message
>
> news:b9104bf6-60c1-4b2b-a1d0-e31e42203d3b@m3g2000hsc.googlegroups.com...
>
> > Now, we all know that SRT is a bit of a crap shoot when there is no
> > visible signs of recurrence beyond a rising PSA (if it has taken
> > several years to recur, then it may be a local recurrence and SRT can
> > have a positive effect.) so if it didn't work in my case, then I guess
> > I'm not that surprised. But I hadn't heard anything before about it
> > taking longer than 3 months to show. Does anyone have any experience
> > or knowledge of this? I know that I "shed" PSA fast because I was
> > undetectable about a month and a half after my RP.
>
> I don't know, Doug. Seems to me that SRT should result in an immediate
> drop, though not an immediate nadir. It doesn't appear you have either.
>
> But radiation is an odd thing, what with coaxing cells to kill themselves
> and all. I guess it's possible to have an increase, then a decrease, and
> appear to have not moved at all. I think you're wise in seeing what it does
> in three months.
>
> --
> PSA 16 10/17/2000 @ 46
> Biopsy 11/01/2000 G7 (3+4), T2c
> RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
> PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
> EBRT 05-07/2002 @ 47
> PSA .34 .22 .15 .21 .32 PSAD .056 years
> Lupron 07/03 (1 mo) 8/03 and every 4 months there after
> PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
> Casodex added daily 07/06
> PSA <0.04, <0.05, <0.04, <0.04, <0.1 2/12/08
> Non Illegitimi Carborundum

Doug,

This article from Duke University Medical Center recommends not taking
action on recurrent PSA until it is greater than .2ng/ml because of
microscopic or focal benign prostate tissue often being left behind.
http://www.cancernetwork.com/display...le/10165/63133

Also this European study showed a significant number of patients with
residual benign tissue left after surgery.
http://www.sciencedirect.com/science...476372ee54168d

Ron S

On Thu, 1 May 2008 18:23:21 -0700 (PDT), doug.gosling@gmail.com wrote:


>I just had my 3 month post-SRT checkup where they informed me that my
>PSA was unchanged.
snip
> My oncologist
>advised me to come back in another 3 months saying that, sometimes, it
>takes more than 3 months for the PSA to drop back to undetectable.
snip
> I hadn't heard anything before about it
>taking longer than 3 months to show. Does anyone have any experience
>or knowledge of this?
snip
>I will wait the three months on the off chance that this might be true
>(although I don't expect that), but I am curious.
>
>Thanks,
>
>Doug
>DX 10/15/02 @ age 49
>PSA 1.26; Gleason 6; T2a
>RP 12/04/02; one nerve spared
>PSA 2003-6: Undetectable
>PSA 09/14/07: 0.13
>PSA 11/05/07: 0.15
>Completed SRT 01/08
>PSA 04/21/08: 0.15
>Blog: http://talkingaboutcancer.com


Hi Doug,

I had my first PSA test 2 1/2 months after SRT (and it was
undetectable). So... it can reach nadir under 3 months.

Why don't you take another PSA test straight away, to confirm that
your first result it was not really a blunder?

Just

> I had my first PSA test 2 1/2 months after SRT (and it was
> undetectable). So... it can reach nadir under 3 months.

What do you mean by "undetectible" in this context? Less than 0.1
using the regular test? Or 0.000 using the ultrasensitive 3rd gen
tests?

Obviously, if you're using the regular test, just because you are
undetectable (<0.1) after 3 months doesn't necessarily mean that
you've reached nadir after 3 months; the score can drop further, but
you can't tell it's dropped if it's below 0.1.

I think most of the guys using ultrasensitive tests will tell you they
reach nadir MUCH later than 3 months. I reached my nadir about 2 years
after SRT (0.008); since then it's risen just a little, but not enough
to alarm me.....yet.

Doug, if I were in your socks, I agree I'd give it another 3 months at
least and see what the next test shows before making any moves.

Fred

On Sun, 4 May 2008 18:36:54 -0700 (PDT), fred <ndaviesruckrnd@aol.com>
wrote:

>
>> I had my first PSA test 2 1/2 months after SRT (and it was
>> undetectable). So... it can reach nadir under 3 months.
>
>What do you mean by "undetectible" in this context? Less than 0.1
>using the regular test? Or 0.000 using the ultrasensitive 3rd gen
>tests?

I mean <0,02. This was in 2005. This was (and still is) the threshold
of the kit used in this clinic.

Just