recurrence

Hi, I have been lurking in this group since my d/x 10/2003. I had Psa
of 6.1 volume 20% capsule penetration.. Gleason 7 (4-3) path report
changed to (3-4) RP 0n 11/21/03. Psa dropped to .1 until August
2004,it raised to .2.7 and in Nov 04, to .49. I elected to Rad and
began Nov 04 38 treatments. Here is Psa after rads.
05/05 .06
08/05 .06
11/05 .06
02/06 .06
05/06 .06
08/06 .06
11/06 .04
01/07 .05
04/07 .07
My question is when should I begin thinking about Ht if the Psa
continues to rise.
I am 62 yrs old with heart disease and type 2 diabetes(under control)
and I have read on here that the SE of HT or very harsh on someone
such as myself. Steve Kramer your post have really helped me
understand this disease as my situation is similar to mine . Thanks so
much for this group.

Bill, I haven't had RT and I don't know what degree of
"undetectability" you should have post-SRT but I'm not sure you should
be worrying just yet. But FWIW when to start HT is a subject of debate
in PCa circles. The traditional and majority view is that there is no
rush, that you can wait until clinical symptoms, some relatively high
PSA, a rapid PSADT, etc. I have seen 2 med-oncs for my recurrence and
both were solidly in this camp. E.g. the one I saw Mon. at Dana Farber
said he wouldn't start until PSA 6 or so. The other view says that you
just should never let cancer grow, and should hit it as soon as a
recurrence is identified.

Bill Denton
RP 2/12/02
PSA 1.6
Memphis

Bill. P wrote:
>
> My question is when should I begin thinking about Ht if the Psa
> continues to rise.
> I am 62 yrs old with heart disease and type 2 diabetes(under control)
> and I have read on here that the SE of HT or very harsh on someone
> such as myself.

Some big names in this field say we should wait until we have symptoms
before beginning ADT (aka HT) even without pre-existing other problems.
Other big names disagree. Your "other problems" are, indeed, high
probability and high impact targets of ADT. That would make me lean
towards the "wait until symptomatic" camp, or at the very least try ADT
tentatively 28 days at a time, watching for and treating against SEs
very aggressively.

I.P.

On Apr 27, 7:40 am, "Bill. P" <siu3...@yahoo.com> wrote:

> 05/05 .06
> 08/05 .06
> 11/05 .06
> 02/06 .06
> 05/06 .06
> 08/06 .06
> 11/06 .04
> 01/07 .05
> 04/07 .07
> My question is when should I begin thinking about Ht if the Psa
> continues to rise.
> I am 62 yrs old with heart disease and type 2 diabetes(under control)

2005 to 2007, .06 to .07, that looks pretty flat.

At 62, I'd worry more about the heart disease and diabetes.

Wait a long time before trying HT because it *might* exacerbate both
heart disease and diabetes. While on Lupron, my 130 fasting blood
sugar rose to 300 and my normal triglycerides went to 800.

-kh

"Bill. P" <siu3434@yahoo.com> wrote in message
news:1177674030.758450.215660@r3g2000prh.googlegro ups.com...
> Hi, I have been lurking in this group since my d/x 10/2003. I had Psa
> of 6.1 volume 20% capsule penetration.. Gleason 7 (4-3) path report
> changed to (3-4) RP 0n 11/21/03. Psa dropped to .1 until August
> 2004,it raised to .2.7 and in Nov 04, to .49. I elected to Rad and
> began Nov 04 38 treatments. Here is Psa after rads.
> 05/05 .06
> 08/05 .06
> 11/05 .06
> 02/06 .06
> 05/06 .06
> 08/06 .06
> 11/06 .04
> 01/07 .05
> 04/07 .07
> My question is when should I begin thinking about Ht if the Psa
> continues to rise.
> I am 62 yrs old with heart disease and type 2 diabetes(under control)
> and I have read on here that the SE of HT or very harsh on someone
> such as myself. Steve Kramer your post have really helped me
> understand this disease as my situation is similar to mine . Thanks so
> much for this group.

Bill,

Your PSA is suddelnly erradic after 1½ years. I am not an expert, but I
believe some here would say that might be expected. If you take your last
three readings, it would average 0.053. That is very good. Right now, I
think your oncologist would be extremely happy with your readings of the
last two years.

To determine whether there is failure, you would have to have a rise of
three consecutive readings and by some percentage (which I keep forgetting).
But, I'd say that if your next quarter's reading is .09 and the one after
that is .13, start worrying then. That'll be November.
--
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
Non Illegitimi Carborundum

On Apr 27, 7:40 am, "Bill. P" <siu3...@yahoo.com> wrote:
> Hi, I have been lurking in this group since my d/x 10/2003. I had Psa
> of 6.1 volume 20% capsule penetration.. Gleason 7 (4-3) path report
> changed to (3-4) RP 0n 11/21/03. Psa dropped to .1 until August
> 2004,it raised to .2.7 and in Nov 04, to .49. I elected to Rad and
> began Nov 04 38 treatments. Here is Psa after rads.
> 05/05 .06
> 08/05 .06
> 11/05 .06
> 02/06 .06
> 05/06 .06
> 08/06 .06
> 11/06 .04
> 01/07 .05
> 04/07 .07
> My question is when should I begin thinking about Ht if the Psa
> continues to rise.
> I am 62 yrs old with heart disease and type 2 diabetes(under control)
> and I have read on here that the SE of HT or very harsh on someone
> such as myself. Steve Kramer your post have really helped me
> understand this disease as my situation is similar to mine . Thanks so
> much for this group.

Looking at just the last three readings, the
doubling time between the:

- 2nd and 3rd last readings, i.e. between
11/2006 and 01/2007, is 189 days and

- the last two readings, i.e. between
01/2007 and 04/2007, is 185 days

so the two doubling times are nearly identical.
That is suggestive of a consistent pattern.
This contrasts significantly with the steady level
of 0.06 which persisted until 08/2006.

On the other hand, what is particularly strange is
how the 11/2006 and 01/2007 readings were actually
lower than prior readings and how the variability increased.

Do you know
- if all these readings were done at the same lab
- if they were all done using the same assay
- what the lowest level that the assay is capable of
detecting?
- what the sensitivity of the assay is?
- specifically which assay was used?

I wonder if there was some change? Could it
be that the lowest reading that is reliable is
0.06 and the lab used 0.06 to represent anything
lower than 0.06 while a different technician or
change in methodology at the lab or a different
lab or different assay resulted in giving
the number rather than 0.06 starting in 11/2006 ?

If there are any changes then this needs to be
taken into account; or, if it has been consistently done
then I would try to get additional readings to determine
if there is continued progression at a doubling time of
around 185 days or whether this is just random variation.

---
The Palpable Prostate
http://palpable-prostate.blogspot.com

On Apr 28, 7:11 pm, "A. Black" <xuv...@gmail.com> wrote:
> On Apr 27, 7:40 am, "Bill. P" <siu3...@yahoo.com> wrote:
>
>
>
> > Hi, I have been lurking in this group since my d/x 10/2003. I had Psa
> > of 6.1 volume 20% capsule penetration.. Gleason 7 (4-3) path report
> > changed to (3-4) RP 0n 11/21/03. Psa dropped to .1 until August
> > 2004,it raised to .2.7 and in Nov 04, to .49. I elected to Rad and
> > began Nov 04 38 treatments. Here is Psa after rads.
> > 05/05 .06
> > 08/05 .06
> > 11/05 .06
> > 02/06 .06
> > 05/06 .06
> > 08/06 .06
> > 11/06 .04
> > 01/07 .05
> > 04/07 .07
> > My question is when should I begin thinking about Ht if the Psa
> > continues to rise.
> > I am 62 yrs old with heart disease and type 2 diabetes(under control)
> > and I have read on here that the SE of HT or very harsh on someone
> > such as myself. Steve Kramer your post have really helped me
> > understand this disease as my situation is similar to mine . Thanks so
> > much for this group.
>
> Looking at just the last three readings, the
> doubling time between the:
>
> - 2nd and 3rd last readings, i.e. between
> 11/2006 and 01/2007, is 189 days and
>
> - the last two readings, i.e. between
> 01/2007 and 04/2007, is 185 days
>
> so the two doubling times are nearly identical.
> That is suggestive of a consistent pattern.
> This contrasts significantly with the steady level
> of 0.06 which persisted until 08/2006.
>
> On the other hand, what is particularly strange is
> how the 11/2006 and 01/2007 readings were actually
> lower than prior readings and how the variability increased.
>
> Do you know
> - if all these readings were done at the same lab
> - if they were all done using the same assay
> - what the lowest level that the assay is capable of
> detecting?
> - what the sensitivity of the assay is?
> - specifically which assay was used?
>
> I wonder if there was some change? Could it
> be that the lowest reading that is reliable is
> 0.06 and the lab used 0.06 to represent anything
> lower than 0.06 while a different technician or
> change in methodology at the lab or a different
> lab or different assay resulted in giving
> the number rather than 0.06 starting in 11/2006 ?
>
> If there are any changes then this needs to be
> taken into account; or, if it has been consistently done
> then I would try to get additional readings to determine
> if there is continued progression at a doubling time of
> around 185 days or whether this is just random variation.
>
> ---
> The Palpable Prostatehttp://palpable-prostate.blogspot.com

All my PSA test have been conducted by the same lab however you are
right I think the test would only read <.0.06was the Bayer ACS 180,
then in Novemberof 2006 the lab went to the Bayer ADvia Centaur which
will only read to only<0.01 hope this answer your question. It would
appear to me that a continued trend of rising Psa indicates a
occurrence. Thanks to all