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PSA detectable 18 mos after prostatectomy
My husband had a prostatectomy in June 2022. Postsurgery PSA tests were all undetectable < .10 until January 8, 2024. The PSA result was .14
Does this mean his cancer has returned? Can PSA fluctuate?
We spoke to a friend who had a prostatectomy 9 yrs ago and had two detectable PSA >.10 tests then returned to undetectable. Is this typical?
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HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
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Here's my clinical history.
After surgery in 2014, I had BCR. At the time, the standard of care was SRT to the prostate bed. Yet, there was data and evidence emerging from CTs and Mayo that including short term ADT and extending the radiation to the pelvic lymph nodes was a better option since they were finding more often, BCR actually included disease outside the prostate bed.
I discussed this with my radiologist and urologist, they dismissed the idea, no long term data they said, not in the NCCN guidelines, wasn't mainstream clinical practice. I acquiesced and you can guess the rest of the story, I was right, too bad I was.
So, starting point would be to familiarize yourself with the NCCN Guideines - https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459
You can also do literature searches on doublet and triple therapy - https://dailynews.ascopubs.org/do/would-you-use-doublet-therapy-and-not-triplet-therapy-patient-newly-diagnosed-mhspc
Next, the forum will need your clinical data, pathology report for example to provide you feedback. The answer in part lies in your risk category.
All that being said, you'll have choices, what you choose will in part be what your medical team recommends and in part what's important to you - going for a cure, quality, quantity of life, financial toxicity associated with treatment...
You could do nothing, there is some data that says it may be up to eight years before you have metastases, remember, risk category!.
You could do treatment to the prostate bed only, radiation, there are plenty of choices there too, IMRT, SBRT...
You could be aggressive, do SRT, extend it to the PLNs, add short term ADT, say six months.
If not already, you may want to add an oncologist to your team to get further medical input (I am not a medical expert!)
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2 ReactionsMine was .23. 4 months adt and sbrt to whole pelvic area including lymph nodes.
No real reason to wait. .2 to .4 sweet spot for success.
There is no doubt that the data support the earlier one does SRT, the greater the possibilities of a "cure." That cure depends on many things since generally, advanced PCa is not consider "curable," It may be if one is fortunate enough, managed as a chronic disease. Certainly the dizzying array of treatments and advances in imaging that have come into play during the last decade have changed how we treat and manage prostate cancer.
My thought was, he has choices, discuss those with his medical team, familiarize himself with the literature, NCCN guidelines, doublet, triplet therapy., then decide in conjunction with his medical team.
As an aside, my PSA was .3 when we started SRT in March 2014, 90 days after completing it, my radiologist hesitated before turning from her screen, then saying "Kevin, you're PSA has risen to .7, it didn't work,,,Granted, we didn't include the PLNs, nor did we add short term ADT, wasn't mainstream clinical practice then.
The questions with imagining in discussion with my medical team are usually:
Will the results change the treatment plan?
Is there a risk in waiting to image?
Those are questions pertinent to shared decision making between the patient and his medical team.
I'd be curious as to your definition of "success.?" How long are you after your treatment, months, years...a decade...?
The reason I ask is because many on this forum and others, define success as duration of progression free survival, time off treatment, not dying from it... For some that's 3-5 years, there are others, albeit limited, who 5-10 years later have had their prostate cancer rear it's ugly head. Then again, I have two close friends who had surgery from the same urologist who did mine, they are past the ten year point with no return of their prostate cancer. They were not high or very high risk (Grade Group 4-5), as I was and still am, rather intermediate.
Kevin
Kevin, I have been following your story and agree with you points. My Gleason score was 3+4 with one node positive. Duration to bcr was 3 years. Had mri ( negative) and PSMA pet showing suspicious spot where seminal vesicle was removed. I had negative margins. RO at mayo recommended srt and 4 months adt. His success rate with patients similar to me was 85% meaning that, after this treatment, cancer is gone for life, never to return. I guess we will see. Seamed like an easy decision to me.
Good Luck to everyone. Each of us are all different
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1 ReactionAlso PSA at time of detection was 4.3
Here's to being part of his 85%!
Thanx
Kevin
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1 Reaction🙏🙏🙏
has any one used xtandi drug for cancer
PSA went from 12 to 6 in 3 months after eligard injection.Is this normal decrease or should it have been more?
Some more "homework..."
https://www.urotoday.com/conference-highlights/asco-gu-2024/asco-gu-2024-prostate-cancer/149342-asco-gu-2024-systemic-treatment-of-high-risk-biochemical-recurrence.html?utm_source=newsletter_12512&utm_medium=email&utm_campaign=emerging-evidence-in-localized-and-recurrent-prostate-cancer-genomic-insights-novel-therapeutics-and-enhanced-detection-strategies-asco-gu-2024