What to do? In limbo after radiation + Lupron, now rising PSA

The following is just my opinion having been through 2 and a half years treatment at several institutions with urologists, Radiation Oncologists (RO) and Medical Oncologists (MO) as well as an exhaustive reading of the literature (I used to interpret these tests prior to retiring from Radiology this year). Not giving you medical advice just my general opinions.

At this point in your journey I would consider getting a consultation from a Medical Oncologist that specializes in Urological/Prostate cancer at a Center of Excellence.

PSMA PET scan is becoming the Standard of Care (SOC) for Imaging of prostate cancer. All PET scans include a CT that helps the Radiologist pinpoint the exact location of any residual or metastatic disease.

Treatments for localized prostate cancer (confined to the pelvis) and limited metastatic disease (oligo metastatic) have undergone significant change the last several years. New therapies for more advanced disease also.

Many RO and MO will aggressively treat limited disease with MDT (Metastasis directed therapy -mainly focal radiation to PET positive nodes or bone to actually kill the tumor in limited sites), anti androgen receptor drugs that block testosterone from binding to the cancer cells (testosterone feeds them like fertilizer) and chemotherapy.

At this time, there is no definitive SOC as the landscape of treatment options is changing so rapidly (thankfully!). That is why it was important for me to have an experienced, up-to-date MO who concentrates on prostate cancer directing my care. But my case was complicated. Not everyone's is and not everyone needs a specialist at a major medical center.

Talking openly with your Urologists about your concerns and asking him/her if they believe you need to consult a MO or see your RO again would seem to be the next step.

Good luck!

The following is just my opinion having been through 2 and a half years treatment at several institutions with urologists, Radiation Oncologists (RO) and Medical Oncologists (MO) as well as an exhaustive reading of the literature (I used to interpret these tests prior to retiring from Radiology this year). Not giving you medical advice just my general opinions.

At this point in your journey I would consider getting a consultation from a Medical Oncologist that specializes in Urological/Prostate cancer at a Center of Excellence.

PSMA PET scan is becoming the Standard of Care (SOC) for Imaging of prostate cancer. All PET scans include a CT that helps the Radiologist pinpoint the exact location of any residual or metastatic disease.

Treatments for localized prostate cancer (confined to the pelvis) and limited metastatic disease (oligo metastatic) have undergone significant change the last several years. New therapies for more advanced disease also.

Many RO and MO will aggressively treat limited disease with MDT (Metastasis directed therapy -mainly focal radiation to PET positive nodes or bone to actually kill the tumor in limited sites), anti androgen receptor drugs that block testosterone from binding to the cancer cells (testosterone feeds them like fertilizer) and chemotherapy.

At this time, there is no definitive SOC as the landscape of treatment options is changing so rapidly (thankfully!). That is why it was important for me to have an experienced, up-to-date MO who concentrates on prostate cancer directing my care. But my case was complicated. Not everyone's is and not everyone needs a specialist at a major medical center.

Talking openly with your Urologists about your concerns and asking him/her if they believe you need to consult a MO or see your RO again would seem to be the next step.

Good luck!