Zero point five: a number to remember

Earlier is better when it comes to salvage radiation therapy (SRT) another study reports. This had been clearly identified by Stephenson et al., in the past. This time the study comes from Italy and is reported in European Urology: nearly 3/4 of men who had SRT at PSA levels of 0.5 or lower were alive and  free of biochemical progression nearly 5 years later.  (Being free of biochemical progression basically means undetectable PSA).

So if your PSA has risen after prostatectomy, and you're considering radiation as a second attempt at a cure, time is of the essence. If your doctor says it's okay to wait until you hit 1.0, or, God forbid, 2.0; run, don't walk, to get a second opinion from a radiation oncologist who is more up-to-date on the literature. 

A lot of the time with prostate cancer, time isn't that critical. But with salvage radiation, the clock is ticking.

books!

Édouard Manet, Stéphane Mallarmé, 1876, Musée d'Orsay. WikiMedia Commons

Kindle ebooks

Prostate Cancer:
Dr. Patrick Walsh's Guide to Surviving Prostate Cancer
Prostate Cancer for Dummies

Salvage Radiation:
Recalled to Life

My History of Prostate Cancer.

A long time ago, in a pelvis far, far away:




Age 38
8 Dec 2000
bothered by frequent urination, went to primary care phys.
PSA 4.5
PCP said prostate was boggy
referred to Urologist
Biopsy Ordered

Jan 2001
Biopsy:  negative for cancer, findings consistent with prostatitis

Age 39
16 Jul 2001
PSA 4.1

20 March 2002
PSA 6.1
START Cipro 500mg daily for 3 wks, Motrin 800 mg daily

Age 40
30 May 2002
PSA 5.7
Free PSA 11.9%
CONTINUE Motrin
Urologist believes probably prostatitis

30 Sep 2002
PSA 7.3
Free PSA 11.3%
START Avodart
STOP Motrin
ORDER Biopsy

November 2002
Biopsy:  negative for cancer, but PIN III found

31 Jan 2003
PSA 2.2
Stop Avodart

Age 41
03 Sep 2003
PSA 4.9
Restart Avodart

23 Jan 2004
PSA 2.2
Continue Avodart

Age 42
24 July 2004
PSA 2.5
Continue Avodart

26 Jan 2005
PSA 3.3
Continue Avodart

29 Apr 2005
PSA 2.9
Continue Avodart

Age 43
11 Jan 2006
PSA 4.8 (on Avodart)
Abnormal DRE
Biopsy ordered

7 Feb 2006
Biopsy finds cancer
PIN also found
No perineural invasion
Gleason 3+4
20% on right
5% on left

Age 44
14 April 2006
SURGERY
Robotic prostatectomy
Positive margin at apex and left lobe
No perineural invasion identified
Extension into capsule, but not through
Gleason 3+4
70% of gland involved
stage t2c NX MX


16 May 2006
PSA less than 0.1

15 Aug 2006
PSA 0.2

14 Dec 2006
PSA 0.6

REFERRED FOR RADIATION

Day before radiation commenced, PSA = 0.7

Radiation Jan-Mar 2007.  PSA quickly fell to less than 0.1 and remains there as of early 2013, now age 51.
No side effects from radiation at this point.

Latest Salvage Radiation News

A small, in-house study from the Graduate School of Medicine in Kyoto, Japan found multiple, independent risk factors for recurrence after salvage radiation (SRT). These were:

• Gleason at or above 8
• PSA nadir (low point) after SRT at or above 0.04 ng/ml
• Negative surgical margins

They found that 77.8% of patients in their study with zero risk factors were free of PSA progression five years later.  50% of patients with one risk factor were progression-free, and only 6.7% of patients with two or three risk factors were progression-free at the 5 year mark. 

In my own case, I was okay on the Gleason and surgical margins, but I don't know my PSA nadir to that level of specificity. 

This was an interesting little study, but I trust Andrew Stephenson's much larger one a lot more.

Kyoto blossoms. Photo: jmurawski  Creative Commons license.

Attention must be paid

In my office I have a few pet trilobites, in the same way people used to keep pet rocks.
Trilobites were highly successful, as species go, and their timeline will dwarf that of our own in the geologic record. They scuttled about the ocean floors for over 270 million years.  Imagine the alien paleontologist of the future: "Humans--flashy but self-destructive. But these trilobites--wow!"
250 million years after the trilobites died out, I  was promoted into my current position. Before that, the incumbent was here for over a decade. In a few years, that manager will largely be forgotten, aside from an occasional visitor to the company's archive. Almost no one remembers the two (or was it three?) people who came before her. "Look upon my works, ye mighty, and despair!", the forgotten Ozymandias admonishes across the sands of time. What my predecessor thought of as their potential legacy--a training program--was eliminated in a brief email discussion that probably took all of two minutes' thought. Not even a pen stroke, just a tap of the Enter button.  "Look upon my--oops, okay, I'll just put my stuff in a box and go."
Last week, a friend of my father's, not even 70, dropped dead in a parking lot as she went to pick up her grandchild. Here one second, gone the next. As a genealogist, I know that the majority of people do not know the last names of their great-grandparents. Three generations, and poof!
Time, even on  the scale of one minor planet in the Milky Way, is vast, and our lives are short. Ars longa, vita brevis. Art is long, life is short, Hippocrates tells us. But even art is short, and quickly forgotten, compared to geological time. That's what my frozen little friends on the shelf remind me. "Look upon our works, ye mighty," trilobites proclaim, "and despair."
I may be a poor player strutting and fretting my hour on the stage, but the hour is mine before I am heard no more. Cancer refocuses priorities for a lot of patients. I feel that refocusing.
As Geddy Lee put it, we must get on with "the real relation, the underlying theme."

I'll have whatever he's having..

Post-hoc review of my genetic risks

My genetic risk factors.  Over all my risk was/is 2.86x the average man of my ethnicity.

And my PSA result is...

...less than 0.1, as it has been for years.  Yippee!

Blood draw today

Had blood drawn for PSA (and cholesterol) today, which coincidentally is the 6th anniversary of the start of my salvage radiation.  Probably get the results by the end of the month.  Not nearly as nervous as I have been in the past.