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← Return to BCR Analyzation; < Age 60
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Thank you for your thorough and detailed response, Kevin. Very much appreciated. You have been through a lot. Stay strong. Love the BS Flag statement 😊. I viewed the image, EXCELLENT. I also had Dr. Montgomery. I’m curious as to who came up with the chart. I have an IT background so great interest.
I note the BCR at .3 vs. .2 so wondering about that. I keep reading that 2+ consecutive PSA’s over .2 most Drs. consider BCR vs .3 It appears your radiation was started at .7
I have read a very common place of BCR is in the bladder neck as well as the back of the bladder itself. I wonder if a whole Pelvic Radiation includes those areas, albeit I do believe it would include pelvic lymph nodes. Easy enough to find the answer too.
My post Radical Prostatectomy Urologist is different than my original. The later, pioneered Perineal Prostatectomy (of which I never heard about prior to my prostatectomy; I had the DaVinci) In general, he seems to be a very non-conventional thinker.
He states that Radiation Toxicity almost always presents itself 15-20 years later. To me, Radiation Toxicity is subjective. In other words, not exactly sure what it means to those affected so not quite sure how to interpret. He seems to lean towards waiting to see the cancer via imaging. I have mixed feelings on this because my belief is if f you wait too long, you miss the opportunity of cure via radiation and/or hormone therapy as well as the risk of metastasis.
I sure wish the PSMA scan was more accurate with a lower PSA score because it would seem you could zero in on the area of BCR, if detected. Albeit the downfall is it may not detect “everything” and a whole Pelvis Radiation would have a better chance of coverage.
Re: Hormone Therapy, I wonder if it suppresses or actually eradicates. If it suppresses only, then I see the benefit of using it along with radiation. However, if the goal is to “see” the disease via advanced imaging, like a PSMA, I would lean towards not using in prior too, hence the band aid comment.
It really is a lot to think about. If I could find a study that compares the (2) as it relates to my Gleason and post pathology report, it may benefit in decision making. I’m definitely seeking a 2nd and possibly 3rd opinion and look forward to further comments from anyone. Thanks again.
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It's a chart I created to provide a quick visual image of my clinical history, useful when new members of my medical team and I meet for the first time, or providing my clinical history on this or other forums, a picture is worth a thousand words...
After my surgery, PSA was undetectable using standard tests to a single decimal point every three months,. Then in September 2015, Dr. Emmott hesitated before turning away from his screen and said your PSA is .2, it doesn't mean your PCa is back. He was not wrong, but I knew. In December, roughly 90 days later, he turned quicker and said your PSA has risen to .3, you need SRT...I started that in March 16, 39 IMRT, 70.2 Gya. It was in July 16, 90 days after finishing my SRT that my radiologist hesitated after looking at her screen and said your PSA is now .7, the SRT did not work.
If one has decided to image, then decide on treatment, ADT is definitely off the table.
My take is it's not that the PSMA imaging cannot detect at levels below .5, it is the issue of statistically less chance of locating it then depending on one's insurance, may run into difficulties getting the next one above .5 "approved." Same for imaging while on treatment, my oncologist was hesitant to order one with PSA undetectable fo concerns about approval. That happened with one of my four C11 Choline scans at Mayo, TRICARE denied, Mayo said I was on the hook for it, I appealed and won, cited the NCCN guidelines. Thus the questions, will waiting change the treatment plan and does it entail progression that has risk to management of the PCa?
It's an interesting discussion about "killing" PCa cells vice suppressing, we generally agree that radiation and chemotherapy kill, ADT suppresses though given the drop in PSA with ADT, don't some of the PCA cells die...? We know that the longer one is on ADT, the cells which can survive in a low T environment are generally the minority population in the heterogenous mix but as the T dependent cells "die" off, the T "independent" cells move to the forefront and can become the dominate ones, then it's trouble.
I've seen studies which talk to different grade of toxicities associated with radiation treatment, usually in the context of 5-10 years. Statistically, the chances are in your favor...there is a statistical chance that when I leave my house to go to the grocery store, I will be involved in an accident, albeit a manageable risk. My dad hated flying, I said ok, but you have a greater chance getting in an accident on the way to or from the airport, so...
Kevin