Hi Yank, - Nearly all the men who have had a form of EBRT and with whom I have had contact, have continued to work while undergoing the Radiation Therapy that you describe. Without complications, the most common side- effect reported has been some tired feelings towards the end of the regimen. Good luck! = John@newPCa.org (aka) az4peaksView Thread
To Yank, - Yes, a confirmed PSA of 44 ng/ml would usually trigger a suggested Biopsy by most Urologists.
To Floridaboy - Your comment that an "enlarge(d) prostate has a tendency to eventually develop cancer" suggests that benign enlargement can be a direct cause of Prostate Cancer (PCa).
In the 16 years that I have been "researching" the disease in the Medical literature, it has consistently been shown that enlargement, known as "Benign Prostate Hyperplasia or Hypertrophy (BPH) is NOT directly related to any increased PCa risk,
The fact that BPH and PCa are both diseases that increase in incidence with a man's aging means that they are both often found in increased numbers in older males, but no "cause and effect" factor has ever been established, to my knowledge.
This is quite different than Chronic Prostatitis (persistent inflammation) which although NOT PROVEN, is often SPECULATED to be a POTENTIAL pre-cancerous contributor to increased PCa incidence. - Hope this helps to clarify! - John@newPCa.org (aka) az4peaks
Hi steve, - It all depends on whether the recurrence you are very likely experiencing, is thought to be "localized"/ "regionalized" or "systemic". The first is recurring in the Prostate Bed or in the immediately surrounding tissue, where there remains a reasonable target for Salvage Radiation Therapy (SRT). Systemic has already invaded the blood/lymph systems and is circulating malignant cells throughout the body.
Unfortunately it cannot always be determined exactly where the recurrence is present and so you may have to decide, in consultation with your Physician(s), which is most likely the case by all clinical evidence. GENERALLY speaking, if you attained an undetectable PSA and held it stable for a prolonged period of time and it has now started to rise at a relatively slow rate over time, that statistically favors a more localized recurrence for which SRT has a more favorable percentage of success.
OVERALL, SRT has about a 50/50 chance of once again making you Cancer free, with "undetectable" PSA readings. It is one last shot at actually "curing" your disease.
Systemic disease, on the other hand, is considered to be incurable and the treatment goal changes from one of curative intent to one of delaying disease advance with prolonged control usually with Hormone Therapy (HT) as the initial treatment. This can control disease advance for prolonged periods of time with often prolonged or at least temporary periods of remission, in what will now be treated as a chronic disease (much like Diabetes or Hypertension).
I wish you the best in your decision making, which will depend on numerous factors known only to you and your Doctor(s), such as your age, co-morbidities (if any), the professional advice you may receive and what pragmatic choices are available. I hope this helps your considerations. - John@newPCa.org (aka) az4peaksView Thread
Hi Tim, - From what you Post above, it appears that Active Surveillance (AS) is certainly an appropriate consideration as one of choices for going forward. However, there are other options as well and you should be aware of their pro's and con's, so that you can make an INFORMED decision.
Are you comfortable with your present Urologist and confident in his/her knowledge and technical skills and, also, confident in the Pathologist/Laboratory that examined and provided the Pathology Report on the Biopsy tissue samples?
Are you comfortable in monitoring this Gleason 3 3=6 Cancer which, since changes adopted in 2006 in REPORTING clinical Gleason Scores, is now the lowest G-Score commonly seen on Biopsy results. It appears that it is also limited in size and found only in one Core of the total samples taken, which would normally amount to 12. (2 each in 6 patterned locations), although you do not specify. Some men have psychological difficulty in monitoring knowing a Cancer is present in their body.
It appears that your clinical STAGE is either T1c or T2a, depending on whether any abnormality was found on your Digital Rectal Exam (DRE), although again, you do not specify. I'm GUESSING that it was probably T1c, which indicates that the Biopsy was performed solely because of an elevated PSA, although again you do not supply that information.
IF AS is your continuing preference, then have formal plan of action and stick to it. Like the planned follow-up Biopsy at 18 months after the first one and regular PSA results not more than 6 months apart. The question always is, "do the Biopsy tissue SAMPLES accurately reflect the PSA present in the entire Prostate". This is something that has statistically improved since the changes in reporting made in 2006, but can not be guaranteed.
I will directly E-mail you a chart that I made of the common considerations for acceptance into the Johns Hopkins AS Program, based upon T1c Biopsy Results for your information. (helping to define clinically significant vs. clinically insignificant disease).
Only you can make the appropriate choice for YOU, but guidance from a trusted Physician and being informed of options helps the comfort level with your decisions. Hopefully, some of the above has helped clarify a few of the considerations. Good luck! - John@newPCa.org (aka) az4peaksView Thread
Hi Mike, - Let me respond to the questions that you have posed and to which the answers, in my opinion, have been confusing, to say the least.
For years, the Clinical Standard for "undetectable PSA" in routine monitoring situations following surgery has been LESS THAN 0.1 ng/ml, which is usually depicted as < 0.1 on Laboratory Reports. Although there are RARE individual situations where this may not be the standard used by an individual Physician, it remains the most widely accepted definition of "undetectable PSA', BY FAR.
So, in nearly every case of ROUTINE monitoring following surgery this still remains the criteria for the use of the term, "undetectable" in reference to post-treatment PSA. The figures you cite in your Posts are all below this Standard if the decimal points are accurately reflected.
Obviously, accuracy of the decimal point placement is critically important in judging PSA significance in the post-treatment monitoring, as is the understanding of the metric system in use. The 0.1 ng/ml threshold, referred to above, represents 1/10th of a BILLIONTH of a Gram of PSA found in 1 milliliter of blood. The finding of 0.01 ng/l is 1/100th and 0.001 is 1/1000th of a BILLIONTH of a gram, so these are "minute" (my-noot) amounts of PSA that are present.
Again, anything below 0.1 ng/ml (<0.1) is therefore considered clinically undetectable in routine monitoring of low and/or moderate risk, post-treatment results.
The < icon always identifies the term "LESS THAN" and reflects the fact that any PSA present, IF ANY, is BELOW the known reliability of the assays (the test's) known sensitivity and so is reported thusly.
As long as PSA results remain below the 0.1 ng/ml level, you usually need not initiate any aggressive secondary treatment, in low or moderate risk patients. I hope this helps your understanding. - John@newPCa.org (aka) az4peaks
Hi Tim, - Having a world renowned expert like Jonathan Epstein at Johns Hopkins (JH) review the Biopsy slides is an excellent choice. I would suggest that you call Johns Hopkins and tell them your Dad's situation and ask for information about international shipping of the slides and appropriate preparation instructions.
Go here for information about the JH Department of Urologic Pathology with several "contact" phone numbers and addresses.
Hi rib, - It certainly is reassuring that your Biopsy was negative for Prostate Cancer (PCa). Unfortunately, traditional patterned but "random" Prostate Biopsies cannot totally rule out PCa as they find only about 80% of existing PCa cases on an initial attempt.
"Standard" needle biopsies of the Prostate, today, take about 12 tissue samples in a random, but patterned, manor with any additional samples representing either "suspicious" areas seen on the UltraSound images used to guide the Biopsy device location or compensation for an unusually large volumed Prostate gland.
Since the SAMPLES are exactly what they are called, "samples" they do not NECESSARILY represent a totally accurate reflection of the either the amount or the aggressiveness of the Cancer tumor(s) present in the TOTAL prostate. They do, however, (4 out of 5 times) reliably establish the PRESENCE of PCa, if it exists. A subsequent second Biopsy rounds these "positive" (PCa identified) findings to about 90% of existing cases eventually found. The remaining 10% take 3 or more Biopsies to be eventually identified.
Some reasonable assumptions can be made after two or more serial Biopsies are found to be negative (no PCa identified) and to a lesser extent even after an initial negative biopsy. These are (1) that any PCa that might have been missed, is not likely to constitute a widely spread PCa volume within the Prostate itself. (2) Due to #1, it is substantially less likely to presently constitute an advanced PCa, thus increasing the chances of successful treatment and "cure".
However these are assumptions and NOT GUARANTEES, so follow-up monitoring and other possible diagnostic endeavors may be employed to further enhance such findings. Therefore, it should be recognized that "positive" Biopsy results alone are much more "certain" as to the presence of PCa, than "negative" findings are indicative as to its non-existence.
There are other causes for elevated PSA readings, if that was the sole cause for your Biopsy, particularly Prostatitis (Infammation) and/or BPH (Benign Prostate Hyperplasia (or Hypertrophy) so PCa may not be the cause of your elevated PSA. Follow-up may be able to better identify the most likely cause. That will be the most beneficial time to determine your next step in action.
If the decision is to take conservative monitoring action, you should have a formal plan to regularly evaluate diagnostic results and act accordingly to what they tell you is appropriate at the time. I would strongly suggest that you acquire copies of your diagnostic results, for your records, including PSA results and your Biopsy Pathology Report, for future comparison of results and clarification of possible causes.
History: Originally, there was considerable controversy as to whether exposure to Agent Orange resulted in an increased risk of numerous Cancers, including of course, Prostate Cancer (PCa).
Vietnam veterans were now composing a substantial portion of the age-related segments of the general population that were subject to naturally acquiring PCa. Along with very "mixed", and often conflicting Study results, there was no clear-cut answer to the question. Additionally, if it was thought to be a cause, how would it be determined which individual service men were actually physically exposed to Agent Orange during their active duty?
Finally, the controversy was pragmatically resolved by a VA declaration, that it would be ASSUMED that all service men,many years later acquiring PCa, whose records could establish that they had physically served in the Vietnam war theater, would be PRESUMED to have had Agent Orange exposure that caused their PCa.
Realistically, this was a "politically correct" decision, more than one clearly supported by scientific evidence, but due to the factors stated above, it appeared to the decision-makers that this was the most practical and expedient solution to a growing controversial issue, as the men effected continued to age.
As a result, a geographical "war zone" area (and time-frame) was established, that constituted the service area in which one had to have served for AUTOMATIC approval as "cause and effect" of their later PCa diagnosis.
Because of the volume of the such applications, it can take a while for such applications to be finally approved, but it is the qualification of time and location of service that is being checked and not any actual exposure to presumed cancer causing agents that is involved. Approval normally starts at 100% disability and is re-evaluated later, following treatment for any residual morbidity and is usually permanently adjusted downward, unless diagnosed with very advanced disease.
Once approved, reimbursement is paid retroactive to the date of application, so a potential beneficiary needs to be patient, since delays are common. Hope this history helps understand the procedure. - John@newPCa.org (aka) az4peaksView Thread