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.

Latest Salvage Radiation News

 Some recent discoveries in salvage radiation

Early salvage RT after prostatectomy improves outcomes: https://www.cancertherapyadvisor.com/home/news/conference-coverage/american-society-of-clinical-oncology-genitourinary-asco-gu/asco-gu-2022/early-salvage-radiation-after-surgery-improves-mfs-in-recurrent-prostate-cancer/  (Research continues to confirm that earlier is better if you need SRT.)

When to Add ADT to Early or Late Salvage Radiation: https://www.urotoday.com/video-lectures/prostate-cancer-genomic-classifier/video/2269-when-to-add-adt-to-early-or-late-salvage-radiation-dan-spratt.html (I didn't have ADT, otherwise known as hormone therapy, but in higher-risk cases it makes sense)

Salvage Radiotherapy versus Observation for Biochemical Recurrence: https://pubmed.ncbi.nlm.nih.gov/35159007/. (Salvage radiation was associated with better long-term survival, both in terms of being free of metastatic disease and overall 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. 

the name of this blog

So what's the big deal with PCa before the age of 50? Well, it's not common. Visit the waiting room of your nearest urologist, or go to a support group meeting. You'll see what I mean. I was diagnosed at 43.
A recent study showed the median age at diagnosis was 68. ZERO percent were diagnosed under the age of 35. Only one half of one percent of the diagnoses in that time were in my age group--35 to 44. Over 91% of the time, diagnosis happened at 55 or older.
See what I mean?
Now that doesn't mean prostate cancer isn't lurking. Autopsy studies of men who died from other causes have found prostate cancer is lurking in a surprising number of relatively young men. But obviously, since prostate cancer only accounts for about 3% of male deaths, and the median age at death from PCa is 80 most of those men probably had a form of the disease that was latent. Most men die with prostate cancer, not from it. My PSA was rising quickly, however. (and still is, at least up until I start radiation). I would most likely NOT be one of those guys who dies in their 80's with the disease--I'd be one of those guys who dies in his 50's FROM it, if not for treatment.

The Story So Far..

I'm young, as far as this disease goes. Diagnosed shortly before my 44th birthday (whoopee!). Robotic surgery (more on that later) shortly after my birthday. At first, all seemed fine...PSA dropped to less than 0.1. But a few months later it was 0.2, and then 0.6 just before Christmas. Merry Christmas, your cancer is still there...

I grew increasingly anxious. But the problem was, I didn't have all the facts. Here's what I thought my situation was:

Gleason 3+4
PSA 9.6
Seminal vesicle invasion--unknown
Negative margins


Now, with those indicators, and a rise in PSA within 1 year--it looked like my recurrence was distant. No longer curable. Time for hormones--at 44, I was looking at a drastic change in my personal life.


But I had two crucial facts wrong. My oncologists (radiation and medical) confirmed that I had POSITIVE margins--cancer extended to the edge of the tissue that was removed and it would be a safe bet that it went further than that. So that provided a logical, and much more optimistic explanation for the rise in PSA--there was cancerous tissue left behind. If that's the case, a cure might still be possible, by radiating the prostate bed.

And, the seminal vesicles were known to be free of cancer. Again, good news, and another slight nudge to the "local" end of the local vs. distant disease question.

Of course, there are no guarantees. I could have localized AND distant disease. But my outlook is much different.

I'll start IMRT this week. It's the latest thing in radiation oncology. The radiation can be focused very precisely, and the amount of radiation can be varied and exquisitely controlled by the oncologist.

I got tattooed last week. One right above my crotch, and one on the side of each hip. Lasers will be centered on those tattoos each time to insure the radiation goes where it should.

Next will be a dry run, where X-rays will be taken with me in position as if I'm going to receive treatment. The X-Rays will be compared to a CT scan done last week, to insure everything lines up.

And then the treatments will begin--15 minutes each morning, 5 days a week.

I'll let you know how it goes.