Saturday, October 20, 2012

Every Roller Coaster Ride Has its Ups and Downs: Relishing a Crest

An internet Pca buddy of mine recently metamorphed into a valued friend. Aware of my PSA concerns he invited me to participate, indirectly, in his one year post treatment consultation at UFPTI. He offered me an opportunity to submit questions for his physician's consideration. He assured me his physician, Dr. Joy Tidings, is extraordinarily bright, an expert and the most reliable source at the institution. In addition to these admirable qualities her unusual name turned out to be amazingly prophetic.
The questions I submitted (Q's), her responses (R's) and my optimistic interpretations (MOI's) appear below:
Q.1. Are all prostate cells killed by proton therapy or do healthy cells survive thus continuing to produce the protein measured by the PSA test?
A.1. Not all healthy cells are destroyed during treatment, but some are. Whether a cell survives is dependent on what cycle the cell was in during the time of treatment. Some healthy cells are damaged but regain their health and begin to produce the protein antigen. This explains why there can be a rise in the PSA score after treatment. It is no indication of biochemical failure or recurrence.
MOI. 1. Based on this perspective one could argue a moderate rise in one's PSA is a positive indication.
Q.2. Does the institute base its concern on the rate of increase from test to test, or from an increase in the baseline score over a selected amount of time?
A. 2. There is concern only when the PSA score gains two or more points on two consecutive tests. What the institute is looking for is a trend or pattern. The PSA scores may vary, up or down, over the course of four years. Any increase of the PSA that is less than two points over two consecutive tests is No Cause For Concern (emphasis mine).
MOI. 2. In view of this crystal clear standard, I have little to worry about.
Q, 3. What constitutes an extended upward movement of the PSA score that would be an indication of biological failure?
A, 3. The institute is looking for trends over a four year period. The PSA score is going to flucuate. To date, there has been only one biochemical failure of a patient at UFPTI. For reasons unknown the radiation did not kill the cancerous cells. The patient was subsequently treated by surgical removal of the gland.
MOI. 3. Based on this perspective (a) my worry and concern may have been a tad premature and (b) at this juncture I have difficulty visualizing myself as UFPTI's second biochemical failure.
I may not be out of the woods completely, but my new found compass improves my chances for a safe exit substantially.
My next routine PSA test, scheduled for April, looms on the horizon. Stay tuned.


MedaFit said...

couple of comments and my own experience ......

1) you ask about rises over two consecutive tests - neither you nor the doctor indicate how far apart are the tests. velocity can be just as important as absolute level.

2) very recent research indicates that proton beam radiation may result in higher co-morbidities

while i had a combination of IGRT & seeds back in early 2008, my own experience may comfort others. i also had 27 months of lupron so the PSA was artificially suppressed; it took 6 m. to get a reading after i came off HT. PSA then rose continuously for 12 m. to 0.95 before declining steadily the following year to the 0.1 reading i received this week.

Dave_K said...
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