Prostate cancer recurrence: RT advised concerned about quality of life

Posted by waynebarry @waynebarry, Apr 4 9:30am

After 10 years my prostate cancer has come back. PSA went from 0 to 0.4(from 0.2 to 0.4 in last 6 months). PET/CT TEST was negative. To be safe my urologist advises doing radiation in the area where the prostate was removed. He does caution about quality of life issues. I am an active 75 and am concerned about prolonged incontinence. please comment

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kujhawk1978 | @kujhawk1978 | Apr 7 7:05pm

In reply to @waynebarry "thank you, ill run it by the doctors" + (show)

May be of interest in your discussions...https://www.urotoday.com/conference-highlights/eau-2024/eau-2024-prostate-cancer/151006-eau-2024-avoiding-overtreatment-using-psa-doubling-time-kinetics-long-term-management-of-bcr-following-rarp.html?utm_source=newsletter_12775&utm_medium=email&utm_campaign=insights-on-prostate-cancer-risk-definition-and-screening-personalized-approaches-in-high-risk-and-metastatic-disease-eau-2024

kujhawk1978 | @kujhawk1978 | Apr 8 3:34am

In reply to @waynebarry "thank you, ill run it by the doctors" + (show)

and another article which may be relevant in your discussions and decision making - https://www.prostatecancer.news/2021/10/exceptions-to-early-salvage-radiation.html?m=1

Colleen Young, Connect Director | @colleenyoung | Apr 8 11:50am

In reply to @wtr "Does Mayo offer the Choline Pet/ct at all locations?" + (show)

@wtr, I believe it is currently offered at the Rochester, MN location
- Choline C-11 PET scan Mayo's approach https://www.mayoclinic.org/tests-procedures/choline-c-11-pet-scan/care-at-mayo-clinic/pcc-20384630

You may wish to call to confirm.
For details about requesting an appointment for choline C-11 PET scan in conjunction with evaluation for recurrent prostate cancer, please call 507-293-0933 from 8 a.m. to 5 p.m. Central time, Monday through Friday.

heavyphil | @heavyphil | Apr 8 3:32pm

In reply to @brianjarvis "That being the Pylarify PSMA PET scan, and that result being negative, how are they confident..." + (show)

Perhaps I am mistaken but isn"t the PSMA the most sensitive of all the scans? I had an Axumin a few years back and it was negative; but I was told the next step would bePSMA since it could detect smaller amounts of cancer cells. Don't get me wrong, most of these are still not a guarantee which is why they recommend pelvic lymph node radiation along with prostate bed.

brianjarvis | @brianjarvis | Apr 8 7:23pm

In reply to @heavyphil "Perhaps I am mistaken but isn"t the PSMA the most sensitive of all the scans? I..." + (show)

Yes, the PSMA PET scan is the most sensitive of the previously developed scans under normal circumstances: F18-FDG —> F18-NaF —> Choline C11 —> Axumen —> PSMA (Illuccix; Pylarify; Posluma).

However, PSMA is not perfect. For example:
> Even at PSAs of 0.4 ng/mL, PET scans will miss prostate cancers about 50% of the time. (See attached chart.)

> Up to 15% of prostate cancers may be PSMA-negative (or PSMA-naive), and not express any (or much) PSMA, such that a PSMA PET scan won’t even see them - even though you know something is a problem due to the elevated PSA.

In those very unique cases, an earlier form of PET scan might work better than a PSMA PET scan. (I’ve heard that sometimes Mayo uses C11 Choline PET/CT in these unusual cases.)

So, depending on where the recurrence is eventually found, might require a different treatment.

bettwils16 | @bettwils16 | Apr 8 7:34pm

Hi, also 75 yrs old. RP 2014. BRC 2023, PSA .24 x 2, 2 months apart. CT/Scan/MRI/PSMA PET all neg. 38 radiation treatments to the prostate bed. 1st psa one month after 0.02 and has been that result every 3 months now for over a year. Now will do every 6 months. I had no urinary incontinence, only slight fatigue that went away after a month or so after I finished. Good Luck if you go this route!

lag | @lag | Apr 10 4:38pm

In reply to @brianjarvis "Yes, the PSMA PET scan is the most sensitive of the previously developed scans under normal..." + (show)

A choline C-11 PET can find active cancer that is not expressing PSMA and that would therefore not be seen by the PSMA PET, even though the PSMA PET is generally more sensitive. My husband is having PSMA PET scans during Pluvicto treatment at Mayo Rochester, but a choline C-11 PET scan will be used a few weeks after he has had the six Pluvicto infusions to see if any avid cancer still shows up.

nicholas7 | @nicholas7 | Sep 3 1:46pm

In reply to @nicholas7 "I would seek a consult from an oncologist first to what your treatment options are. I..." + (show)

I had a pet psma with tracer wich showed 2 lymph nodes as hot spots then had an mri to confirm. before radiation started 45 mg / 6month lupron shot,that was April ,psa now undectable!

heavyphil | @heavyphil | Sep 4 12:43pm

At age 75 it’s almost a coin toss - and 10 yrs is a LONG time for cancer to recur. But you are active so your life expectancy goes up which makes the decision harder.
Maybe one more PSA in 3 months to confirm? If it goes up from here then it is something to be concerned about because it is moving quickly. At that point treatment is much more palatable than the consequences of not having it. Besides, it’s pure speculation and legal ass-covering that prompts your RO to inform you of the possible risks.