16 years after salvage radiation, my PSA...

Just had a PSA done--still less than 0.10.  I had been frantic a couple of years ago when I had two ultrasensitive tests done just over a year apart. The first one showed .02, and was the first PSA that was "detectable" since salvage radiation did its job in 2007. Then in 2021 I had another ultrasensitive test. It was 0.05, or more than double.  I went to a prostate cancer oncologist, who reassured me that it was probably nothing. He said he didn't order ultrasensitive tests for people like me (post-surgery, post-radiation). So we've gone with the regular assay.

If my PSA had really been rising at the rate it seemed to on the ultrasensitive test, I would have easily passed the 0.1 mark on the standard assay by now. The fact that it did not is quite reassuring.  I've now had multiple standard PSA tests, all "less than 0.1".  No threat.

Lymphoma, treatment for lymphoma, or more likely, my heart, is the real threat to making it as long as my parents have. Both parents are alive and well, in the 80s and 90s.  My grandmother is over 105! 

Anyway, that's it for now.  

PSA Doubling Time Calculator

 Knowing your PSA doubling time is important, in terms of treatment and survival.

 Yesterday's PSA: less than 0.10.  Hurrah!

My oncologist does not like ultrasensitive PSA tests for men in my position (many years after apparently successful treatment). 

I'll take it. Even if my PSA is creeping up on the ultrasensitive test, the doubling time would appear to be pretty long--like a year or more--and so I'm not going to have any problem with prostate cancer for a long time, if ever.

Had a bunch of tests related to lymphoma as well, and they're all fine. That cancer is staying nice and sleepy, and not causing me any problems (i.e. it's not impacting my red or white blood cell counts, or my spleen, or causing any symptoms).

I'm now going back to trying to get my percent body fat down to a healthier level. I'm at 20% right now, and would prefer to get back to 18% or lower. I'd also like to lose a couple of inches on the waist. I used Noom before, but I didn't really like it, so I'm going to try MyFitnessPal, an app that counts calories, activity, nutrients, etc. Gotta get back into the hiking, biking, spin classes, and strength training.

Watching Reacher on Prime Video--it's really compelling!  I've read some of the novels. Well done on this one, Amazon. I think you missed the target on Wheel of Time, though. 

Latest Salvage Radiation News

A small study indicates PSA doubling time of 6 months or less is predictive of failure after SRT.

http://informahealthcare.com/doi/abs/10.3109/21681805.2014.982168

Encouraging New Study on Salvage Radiation

Varian linear accelerator.  

The March 2011 issue of Cancer, a journal from the American Cancer Society, carried promising news for all of us SRT (salvage radiotherapy) guys:  salvage radiation has been shown, for the first time, to confer a survival benefit across the patient population, and PSA doubling time did not matter significantly.   Some well-known doctors (D'Amico and Moul, for example) from Harvard and Dana Farber co-authored the study which looked at 519 men who had prostatectomies at Duke University between 1988 and 2008.  The median followup time was 11.3 years.  The way I understand hazard ratios, the results mean that the risk of death from all causes was roughly half that of men who did not have salvage radiation. 


http://www.ncbi.nlm.nih.gov/pubmed/21437885?s_cid=pubmed






















Photo courtesy digital cat: http://www.flickr.com/photos/14646075@N03/3798458685/. Used under Creative Commons license with thanks.

Predicting the Outcome of Salvage Radiation Therapy

I've been following the work of Dr. Andrew Stephenson, of the Cleveland Clinic, who for several years has been trying to predict the outcome of salvage radiation, like the treatments I had this spring.

He, along with experts in the field like Scardino, Kattan, Slawin, and others, have just published an important paper in the Journal of Clinical Oncology. You can read a summary of the work here.

I obtained the full text of the document (you can too--just go to your nearest public library and tell them you need interlibrary loan). The full title is " Predicting the Outcome of Salvage Radiation Therapy for Recurrent Prostate Cancer after Radical Prostatectomy" from JCO, May 2007, pp. 2035-41.

Stephenson and his colleagues looked at 1,540 patients across 17 medical centers in North America. All of these patients underwent salvage radiation (an attempt to rescue the patient when surgery fails to eradicate prostate cancer). The researchers created a nomogram to predict the outcome of salvage radiation. The nomogram is in the public domain and will be available soon in an easy to use web version at http://www.nomograms.org soon.

In general, Stephenson found as he did in earlier work, that the earlier you can get started with salvage radiation, the better. He writes "The 6-year response to SRT among patients treated at PSA levels of 0.50 n/mL or less appears to be durable because only two progression events were observed after 6 years among 32 patients at risk at 6 years (median follow-up, 90 months)" (p. 2037). Besides the pre-radiation PSA, other important variables are Gleason score, PSA doubling time (PSADT), surgical margins, hormone therapy administered along with or before radiation, and lymph node metastasis. In earlier work, Stephenson had found that of patients at high risk (because of a Gleason >= 8, or rapid PSA doubling time) many could still benefit from radiation, especially if they had positive surgical margins like I did. This new study validated this idea.


In my case, the nomogram shows I have about a 55-57% chance of being progression free at 6 years out from radiation. Those are pretty good odds, I think. The flow chart in the article, which for me goes like this:

Pre-RT PSA <= 2.0, Gleason 4-7, Positive margins, doubling time <=10 months and that comes out to 57% probability of being progression free at 6 years. This study goes back to way before the days of IMRT, though, and the average man in the study got less radiation than I did. So I think my odds are probably better than 57%, since the targeting of radiation and dose escalation are much better these days than was the case for most of the study participants. Of course, if my cancer was already systemic, then the radiation probably didn't do much good. I should get some idea soon--I had blood drawn yesterday and I get the results in one week. So check back, dear reader, on or after June 15--will this blogger get on with his life and career? Or will he start putting affairs in order? ?

Bad Omen

Not the first time I've seen this, but it's disturbing. A new report shows that a PSA that rises more than 2.0 in the year before treatment is the single most important indicator that a man has a very aggressive cancer. Mine was rising faster than that--it went up 2 points in only SIX MONTHS. That, according to the study, puts me at high risk of dying from prostate cancer.
I'm going to get a full-text copy of the report, because I have a lot of questions--such as, did any of the men have salvage radiation and how did that affect their odds of dying?