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BCR Analyzation; < Age 60
50 year old: 3/04/2019 PSA = 4.45
**Note** Was on Testosterone Therapy from age 40-50**
Currently 55 years old:
7/12/2019: Davinci Prostatectomy, Gleason 3+4, no positive margins, and no radiation.
Surgical Pathology Report:
7/12/2019: 2.4 cm. Grade group 2. Left posterolateral extension. Surgical margins and seminal vesicles are free, Stage pT3aN0
PSA trending >.02
4/11/2022 = .06 ***4/28/2023 = .13*** 5/19/2023 = < .1***7/25/2023 = .19***10/15/2023 = .18***01/15/2024 = .21
Urologist: States would not do anything until hits .4 thru .8. I do not have a genitourinary oncologist, radiologist, or oncologist.
Researching Phase: Understand not considered a reoccurrence until >.2 for (two) tests in a row but not trending in right direction.
My impression: Looking like a BCR. Urologist states I'm young enough to suffer side effects from radiation toxicity, unsure if waiting from .4-.8 is a good idea, realize PSMA test is better at detecting at higher levels, but understand sweet zone for radiation is between .2-.5?, hormone therapy seems like putting a Band-Aid on things. Looking for more input for possible treatment consideration. Will likely seek a second opinion.
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Thanks for the link!! I wonder if this information will/is integrated into the NCCN Guidelines yet.
I am very curious to hear what my Urologist may have to say.
My RO told me that after 5 hypo-fractional radiation treatments, which I finished in February of last year, that once I found my nadir, a 2 point rise in my PSA would be the indication of BCR. Before treatment, my PSA was 10.2 with a 3+4 Gleason and confined to the prostate. After treatment, at the third blood test, my Nadir of 1.4 was reached.
Thank you for your comment. Did you initially have a Prostatectomy, and did the RO give you hormone therapy as well... Did the radiation bother you in any way? Very happy to hear that it went from 10.2 to 1.4. That is excellent news, and it may go lower. - Dave
The Mayo C11 Choline scan was $8800 at the time. The PSMA scans at that time were in clinical trials, not yet approved by the FDA. At my PSA the C11 Choline scan was good enough to locate the recurrence. Kwon used the subsequent ones during treatment to assess how well the treatment was working, he does not rely solely on PSA.
I'll have to check my Medical Summary Notice on my MEDICARE account to see what the Plarify scan was billed, what the "allowed" amount was. I'll do that later today.
I'm leery of 15-20 year data given the exponential changes in radiation treatment. While I was doing chemotherapy some of the nurses were prior radiotherapy nurses, the stories they told about using lead blocks to focus the beam, then moving the lead blocks around when changing the angle or delivery location...my first thought was leaches in the Middle Ages analogy but hey, today we see why they did that. But, we're never going back to lead blocks.
It sure there is an answer to how long one can be on ADT, some guys go castrate resistant in less than a year, others are still on ADT 5-10 years.
As to what we can do to possibly "slow" our cancer. I think there is clear and convincing evidence though others may disagree on:
Exercise
Managing stress
Diet
Rest
Not surprisingly, these are also key in managing the co-morbidities which may be more fatal than the disease itself!
Kevin
Dave: I did not have a Prostatectomy. I chose a specific 2 mm margin radiation machine and did not have any hormone therapy. one out of the 5 RO's I spoke with suggested hormone therapy. My RO said 1.4 was my Nadir so I hope it stays in that range...forever.