Re: Can PSA kinetics distinguish PSA failures from PSA bounces?

[Guest guest]

I thought the study below might be

of interest to anyone who had undergone EBRT (External Beam Radiation

Treatment) and might be concerned about a rising PSA

As the study says <snip>

With adequate follow-up, 44% of PSA failures by the Phoenix definition in our cohort were found

to be benign PSA bounces. <snip> - that’s almost half and the

bounce occurred over a pretty wide range – between 6 and 36 months.

All the best

Terry Herbert

I have no medical

qualifications but I was diagnosed in ‘96: and have learned a bit since

then.

My sites are at www.yananow.net and www.prostatecancerwatchfulwaiting.co.za

Dr

“Snuffy” Myers : " As a physician, I am painfully aware that most of

the decisions we make with regard to prostate cancer are made with inadequate

data "

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of B

Sent: Thursday, 18 February 2010 2:21

AM

To:

malemedicalproblems ; malemedicalproblemsgooglegroups; ProstateCancerSupport

Subject:

Can PSA kinetics distinguish PSA failures from PSA bounces?

With adequate prostate cancer follow-up,

44% of PSA failures by the Phoenix

definition in our cohort were found to be benign PSA bounces. This Canadian

study reinforces the need for adequate follow-up when reporting PB PSA

outcomes, to ensure accurate estimates of treatment efficacy and to avoid

unnecessary secondary interventions....

Click on the below link for the full story:

<http://www.urotoday.com/61/browse_categories/prostate_cancer/evaluating_the_phoenix_definition_of_biochemical_failure_after_125i_prostate_brachytherapy_can_psa_kinetics_distinguish_psa_failures_from_psa_bounces__abstract02172010.html>

Non-doctors are welcome to browse UroToday.com

but you'll be requested to register, which you can safely do, since this

professional medical site never sends spam!

[Guest guest]

I thought that this was a very interesting study. I'm not sure that we can all take heart from it, though it gives me hope, possibly being in the middle of a second PSA bounce.

1. Is it reasonable to extrapolate from brachytherapy treatment numbers to those undergoing other forms of treatment? Those of us with higher Gleason scores in the UK at any rate are not usually offered brachytherapy. I was told in my own case that it was unsuitable although I could never follow why that was so, when EBRT plus ADT was OK. So if that approach prevails generally then the sample in this study may have been of folk with Gleason 6, 7 and 8, only, say.

2. Does the study not suggest that the Phoenix definitions are flawed? An error rate of 44% would be wholly unacceptable for any standard in other fields. Surely this suggests that a much higher PSA number than nadir plus 2 should be in use and that a longer period should be used in judging bio-chemical failure than the present three consecutive readings (which could be as little as three months, but more usually nine months, I suppose)?

I'd be particularly interested in 's take on this one, as well as that of our other experts.

To: ProstateCancerSupport Sent: Wednesday, 17 February, 2010 23:38:02Subject: RE: Can PSA kinetics distinguish PSA failures from PSA bounces?

I thought the study below might be of interest to anyone who had undergone EBRT (External Beam Radiation Treatment) and might be concerned about a rising PSA

As the study says <snip> With adequate follow-up, 44% of PSA failures by the Phoenix definition in our cohort were found to be benign PSA bounces. <snip> - that’s almost half and the bounce occurred over a pretty wide range – between 6 and 36 months.

All the best

Terry Herbert

I have no medical qualifications but I was diagnosed in ‘96: and have learned a bit since then.

My sites are at www.yananow. net and www.prostatecancerw atchfulwaiting. co.za

Dr “Snuffy†Myers : "As a physician, I am painfully aware that most of the decisions we make with regard to prostate cancer are made with inadequate data"

From: ProstateCancerSuppo rtyahoogroups (DOT) com [mailto: ProstateCancerSuppo rtyahoogroups (DOT) com ] On Behalf Of BSent: Thursday, 18 February 2010 2:21 AMTo: malemedicalproblems @yahoogroups. com; malemedicalproblems @googlegroups. com; ProstateCancerSuppo rtyahoogroups (DOT) comSubject: [ProstateCancerSupp ort] Can PSA kinetics distinguish PSA failures from PSA bounces?

With adequate prostate cancer follow-up, 44% of PSA failures by the Phoenix definition in our cohort were found to be benign PSA bounces. This Canadian study reinforces the need for adequate follow-up when reporting PB PSA outcomes, to ensure accurate estimates of treatment efficacy and to avoid unnecessary secondary interventions. ...Click on the below link for the full story:<http://www.urotoday .com/61/browse_ categories/ prostate_ cancer/evaluatin g_the_phoenix_ definition_ of_biochemical_ failure_after_ 125i_prostate_

brachytherapy_ can_psa_kinetics _distinguish_ psa_failures_ from_psa_ bounces__ abstract02172010 .html>Non-doctors are welcome to browse UroToday.com but you'll be requested to register, which you can safely do, since this professional medical site never sends spam!

[Guest guest]

DAVID COLLINS wrote:

> I thought that this was a very interesting study. I'm not sure

> that we can all take heart from it, though it gives me hope,

> possibly being in the middle of a second PSA bounce.

> 1. Is it reasonable to extrapolate from brachytherapy

> treatment numbers to those undergoing other forms of treatment?

> Those of us with higher Gleason scores in the UK at any rate

> are not usually offered brachytherapy.

My then radiation oncologist told me that PSA bounce is not

associated with EBRT, only brachytherapy. I don't know if he's

right though he was a pretty smart and well informed guy. I have

seen other people say that a bounce CAN occur after EBRT. If

your PSA went up, then down again, we have one possible data

point indicating that it can happen.

> ... I was told in my own case that it was unsuitable although I

> could never follow why that was so, when EBRT plus ADT was OK.

> So if that approach prevails generally then the sample in this

> study may have been of folk with Gleason 6, 7 and 8, only, say.

As I understand it, at least one reason why an oncologist may

consider EBRT to be suitable but brachytherapy unsuitable is that

he thinks there is a significant chance of extra-capsular

penetration of the tumor. Again, as I understand it, EBRT can

radiate the area around the prostate as well as the prostate

itself, whereas brachytherapy is confined to the prostate.

I would think that the bigger the area to be radiated, the less

practical it is to insert seeds. Also, there would be more

danger of seeds wandering off into places where they shouldn't

be.

Sometimes the two are used together. I had a combination of EBRT

plus HDR brachytherapy. But I don't think brachytherapy alone is

used when extra-capsular penetration is suspected.

Factors suggesting extra-capsular penetration can include a

higher Gleason grade, higher PSA, MRI imaging, and perhaps

others.

Another radiation oncologist I consulted told me that he also

thought brachytherapy alone was unsuitable and offered me a

choice of brachy + EBRT or EBRT alone. I asked him which had a

better chance of success and he said he had not seen any data

suggesting that one came out better than the other.

He also urged me to have new-adjuvant ADT, as your onc did.

> 2. Does the study not suggest that the Phoenix definitions are

> flawed? An error rate of 44% would be wholly unacceptable for

> any standard in other fields. Surely this suggests that a much

> higher PSA number than nadir plus 2 should be in use and that a

> longer period should be used in judging bio-chemical failure

> than the present three consecutive readings (which could be as

> little as three months, but more usually nine months, I

> suppose)?

Agreed.

The first rad onc I referred to above told me that early ADT is

better than late ADT, but in spite of that, he advised me not to

rush into ADT after a PSA rise due to the fact that bounces have

occurred multiple times to some men, and have occured more than

three years after treatment for at least a few patients.

Another definition I've seen of treatment failure is three

successive rises in PSA, measured at least three months apart.

My rad onc thought even that one would occasionally result in a

misdiagnosis of recurrence.

Alan

[Guest guest]

On 2/18/10, Alan Meyer replied to Dave , in pertinent part:

>

> My then radiation oncologist told me that PSA bounce is not

> associated with EBRT, only brachytherapy. I don't know if he's

> right though he was a pretty smart and well informed guy. I have

> seen other people say that a bounce CAN occur after EBRT. If

> your PSA went up, then down again, we have one possible data

> point indicating that it can happen.

(su-nip)

Here’s a quote from the encyclopedic site of the Prostate Cancer

Research Institute, at

http://www.prostate-cancer.org/education/localdis/scholz_newlydiagnosed2.html

“Another potential side-effect of brachytherapy, **indeed all

forms of radiation**, is called the PSA “bump” phenomenon. The

PSA “bump” is a delayed PSA rise occurring after the radiation

finishes. Although the exact cause of PSA “bump” is not known

with certainty, it is believed to result from irritation of the

residual prostate gland by radiation. The “bump” follows a benign

clinical course and usually resolves itself within a year. The

main danger of the PSA “bump” comes when physicians mistakenly

conclude that the rising PSA represents recurrent cancer and

decide to start ADT when no cancer is present.” (emphasis mine)

Regards,

Steve J