tweetybyrds123

Here I am, back again after more than a year. My husband had RRP in May of
2002 and has had PSAs of <.1 for the past 18 months (our small town lab doesn't
measure any more sensitively than that.) His most recent reading is .1 and the
urologist says not to worry...they wouldn't do anything until it reaches
..4...but he does want him to have PSAs every three months instead of every six
(after a year he'd stretched it to every six).

I'm concerned that the cancer has recurred and may be spreading to other parts
of his body. He just turned 56...dribbles once in awhile but not too
badly...and has had no erections even with Viagra...although he is only trying
this on his own without any help from me...he really doesn't seem interested.
We both agreed on our priorities being cancer free...number one. Incontinence
and impotence are down on the list...as long as he's healthy.

Am I worrying needlessly...or should this be followed more closely? I've
always been concerned because he chose to have the surgery in our smal town
hospital (he is a physician and knows the urologist pretty well) rather than a
large medical center...we have several within a few hours. This decision was
his...but I really feel that through this newsgroup and the reading that was
suggested here...that I was much more informed than he was. If things are
starting up again...I might have to be a little more insistent that we at least
get a second opinion. I trust this group...you have all given me wise guidance
in the past...I was just hoping not to have to visit here again.

Thanks.
Linda

jimhoney

Linda,

Well, the figures you want are on pages 309 and 310 of Dr. Walsh's book,
but it's too much to type out. Except that .1 does not qualify as "PSA
recurrence," so he's still in the clear.

So no, there is nothing more to do at the moment but work on that dribbling
with Kegel exercises, and on the erectile dysfunction in ways that some of
the other posters know more about than me.

If you don't get many comments here, remind us of his Gleason score and
whether or not he had a positive surgical margin. With that information,
people can check the literature and give you a better answer.

jimhoney


least

guidance

levin

Hi Linda...In my opinion, it is too soon to say that your husband has
recurred. There are many reasons besides recurrence that may have
produced the "apparent" PSA increase. For example, has your husband
stopped any medications recently? I have been reading (in another
newsgroup - PHML) of PSA decreases / increases associated with people
starting / stopping certain blood pressure medications. In any case,
the uro is probably saying that he wants to see 0.4 before taking
action because this would permit 2 PSA doublings (0.1 to 0.2 and 0.2
to 0.4) to be observed. This would be convincing evidence of
recurrence. If doubling does occur, the time required to double is a
significant indicator of how aggressive the PCa is.

I think your case illustrates one of the advantages of using the
ultrasensitive PSA test (your doc or hospital can send blood samples
to a different lab to have this test performed). Basically, had it
been run, you would now know whether the PSA had "moved" from 0.09 to
0.10 (perhaps normal random variation) or from .05 or less to 0.1 (an
upward trend). Rather than waiting for the PSA to rise to 0.4 before
taking action, you could have seen 2 doublings and started treatment
when the PSA hit 0.2, the point normally associated with biochemical
failure.

Again, it's not clear that recurrence is what you're dealing with.
But even if an upward PSA trend is confirmed in future readings, it's
not the end of the world. There is a lot of time between biochemical
failure, clinical failure and metastisis...and a lot of things to be
done to stop or slow disease progression. If and when an upward PSA
progression is confirmed, use the time to consider what tests you
might want run in order to differentiate between local disease
recurrence or systemic disease. Treatment selection depends upon the
answer to this question. Best wishes and good health for you and your
husband...Ron

steve kramer

Linda, the answer in my humble opinion is, "Yes, you are worrying
needlessly." Aside from the old adage about not worrying about what you can
do something about and anything that you can't do anything about, a 0.1 is
so little different from a <0.1, that it's an insignificant result.

A liftime of 0.1 is the goal of everyone hear. If it goes to .2, then .3,
act on it. But .1? Never.

--
Steve Kramer
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000
PSA .1 .1 .1 .3 .4 .8
EBRT 05-07/2002 @ 47
PSA .3 .2 .2 .2 .3
Erection 05/12/2003 @ 48
Begin Lupron 07/21/2003 @ 48
PSA .1

least

guidance

jk

Personally I'd be more concerned that he's not interested in your "help",
than those meager numbers you presented. Probably nothing.... if something,
still many choices to make it nothing again. He's still a young man,
probably with more knowledge about all this than all of us combined.


--
JK Sinrod NY
Sinrod Stained Glass
http://www.sinrodstudios.com
Coney Island Memories
http://www.sinrodstudios.com/coneymemories

danr

If I recall properly someone else had a case where the lab simply failed
to put the "<" in front of the .1. Best of luck.
DanR

rebecca ford

That was my hubby, Chris. His doc in Vancouver actually had him come down
toaday to be tested at his hospital lab, not the one we use up here in
Whistler. The doc said he didn't know the lab up here well and since it was
just his second psa since surgery with positive margins he wants to make
sure that it isn't already creeping up. The doc also said that if the
Vancouver lab does show it as 0.1 he still won't do radiation until it hits
0.2.

--
Rebecca Ford

tweetybyrds123

Ron...

Everything you say makes sense. I've wished all along that they used a lab
that ran the ultra sensitive test...his doctor hasn't felt this was
necessary...and my husband does exactly what he says...doesn't question
anything...which is starting to really frustrate me. And what you say about
the doubling from .05 to .1 vs .09 to .1 is a very important
distinction...especially when you look at two doublings...explaining why his
doctor would start treatment at .4 and another may beging at .2.

Thanks for your input and information.

tweetybyrds123

Steve...

Thanks for your reply...and good luck to you...I hope you're feeling well


..>Linda, the answer in my humble opinion is, "Yes, you are worrying

tweetybyrds123

I wish that were true...but I've learned more reading this newsgroup than he
cares to know. From here I learned what books to read, what questions to
ask...on the pre op and post op doctor visits I was asking about Gleason scores
and Partin tables and my hubby just kind of sat there. I want to respect his
decisions and choices but I wish he'd do at least a little reading...I
encouraged him to read here, get involved with our local "Man to Man" group,
read some of the books I've bought...but he just absoultely refuses (just like
he refuses my "help.")

I greatly appreciate all of the help and support this group has given me over
the past 17 months.

Linda