Biochemical Recurrence After Prostatectomy

Hmmm, not sure I agree.

Generally we know upwards of 30% if men go on to develop BCR after surgery. Those are the high risk, GS, pathology reports that are unfavorable.

We also generally know BCR within 18 months are an ominous sign.

So, decide based on clinical data. In my case, GS8, < 18 months to BCR then a PSADT < 3 months....time to do something!

Kevin

This article contains some interesting statistics:
68% of the database at UCSF (a center of excellence) had RALP.
14% of the sample had detectable PSA in less than 6 months (at or after the nadir/low point).
19% of the sample had delayed detectable PSA after 6 months.
33% had detectable PSA (total) within 10 years.
A separate table shows the proportions by a number of correlated variables. For instance, intermediate CAPRA-S scores had 178< 6mo, 312>6mo, and 750 no BCR. Putting myself in that category, and not having recurrence within 6 mo, I now could say that people in my category have a risk of (delayed) BCR < 30%. That's an encouraging takeaway, since the overall BCR for my category would be around 50% by some other measures.
Excluding the < 6mo group for positive margins give me a similar figure, 33%.
Since my previous best estimate was 50-70% recurrence, I find 1/3 odds quite encouraging ;-).

But my guess is that the line you quote is NOT advocating against salvage therapy. Rather they were attempting to predict salvage therapy (based on clinical multi-factorial judgment.)

One thing I noted is that they define BCR aggressively. .03 is the most aggressive definition, used most in clinical research settings. My urologist plans to treat when/if I reach 0.1. Of course, I would prefer to reach NEITHER :-). One way of reading the line quoted in the initial post is that my urologist might be right, imagine that!

Forgive my ignorance but what is BCR? I did not have surgery just radiation which may explain my lack of knowledge on BCR.
jc76

No need to apologize...when I was diagnosed in January 2014 I didn't even know what a prostate was, it's function...

BCR is biological chemical recurrence...for those who have had surgery one criteria is after PSA has been undetectable , < .1 with a standard PSA test, you have consecutive readings of .2 or higher typically spaced 90 days apart.

For those who chose radiation the criteria is different, it is a reading based on the nadir .

There is a not well agreed upon definition when using an ultra sensitive PSA test.

Also, understand that BCR may not be the only piece of clinical data you want in making a treatment decision, imaging is an important piece of that clinical data.

Kevin

I'll just add to Kevin's explanation that "biochemical recurrence" is by definition PSA related. Prostate-specific antigen (PSA) is the biochemical marker that is being referred to. BCR emerged as a thing because it is observable much sooner than death by prostate cancer, etc., so it is frequently used as a proxy (replacement measure) for cure or not cure to evaluate success or failure of treatments in the research.
Historically (and I think presently) removal of the prostate is the most common first step in treatment when prostate cancer is identified as a problem requiring intervention. This results in PSA going near or close to 0. (Before ultrasensitive PSA tests emerged, under 0.1 was "undetectable." BCR means that the cancer has reemerged, since the prostate itself is no longer there to generate PSA.
Now that ultrasensitive PSA tests are available, exactly what reading (lower than 0.2 and more precise) should be considered BCR varies in the research, but two readings of 0.2 would still be a top boundary--specific to people without a prostate.

I had my targeted minimal margin radiation completed in February. I have had 3 PSA tests since then. I started at 10.2 before radiation. My last one was 1.4. My RO told me if my number goes up 2 points that it would be an indication of BCR and we would do a psma pet scan if that happened.

That sounds about right, after the nadir when doing radiation, an increase of 2.0 is the trigger to decide on treatment.

You are correct! I lived it!

In May of this year, 2024, I had the hoLEP laser enucleation of the prostate. I had to wait 1 year and 9 months with a urethral catheter for this procedure. They enter through the urethra, cut the prostate itself into sections, push those pieces into the bladder and then go in with another tube called a morcellator to flush with liquid and suck the pieces out. The CAPSULE, or shell, of the prostate, is left intact. The pieces of prostate, "the ultimate biopsy," is sent off for pathology.
Previously, I had an MRI that showed no presence of tumor. However the pathologist did discover a malignancy, rated at Group 2 with a 7 (3x4).
Two weeks ago, I had a PSA, the first one post op six months after, it came in at 0.911
I have been reading that anything above .2 is a biological recurrence. I am in Barcelona Spain, public health system, where the doctors are "accountants first" doctors later, i.e., bottom line.
My uro surgeon says you're fine, point 9. I mentioned that it should be .2 or less. He says, point 2, point 9, could be anything. I couldn't believe what I was hearing. He says: you're cured! I said, really? Well, that must explain the lower back and sacral pelvic bone pain I have been experiencing since a little before the surgery.
He shrugs it off. Then, he says that I'll need to come back again in six months for another PSA. (I already knew he was going to say this btw), so I asked why? He said to know for sure that we got all the cancer. Then I said, but if I am cured, why do I have to have anther PSA? He said it was routine for all men. So then I remarked that if I'm "cured" yet you need to make sure, then the cure statement is moot. You really don't know, hence the follow-up. I asked him to write out a partial prognosis that doesn't specify I'm cured, but doesn't diagnose me with cancer. He also added in discussion that it could be some "other" cancer, but either way, I will attend the follow-up- then he sends by email an invitation to prostate cancer seminar / group at the foundation where I had the surgery. I never asked for that, I signed up for it.
Is it time for a second opinion? From who? They all know each other. Opinions?

I’m on my second recurrence. I personally don’t believe that anyone is “Cured”. I believe that cancer goes into remission. I was in remission for 7 years the first time and then 2 years the second time. Now my cancer is growing again. The cancer cells are so small , that they can be anywhere and they could start growing again, which is what happened in my case. Just my opinion.