UltraSensitive PSA < 0.03

There really is no way to know if your cancer will come back with the information you have provided. Your PSA is so low that your options look good. To know whether it comes back you would have to supply information like what your Gleason score is, your PSA at diagnosis, your decipher score, What the biopsy showed as far as issues beyond just cancer in the prostate. What your genetic test shows, whether you have genetic anomalies. What’s the PSMA Pet test revealed.

That would give a lot more information needed to provide you with a guess as to whether or not it will come back.

Surgery
Robotic-assisted Radical Prostatectomy - Gleason: 8 (3 + 5), and negative surgical margin involvement status. The disease was pathologically staged as T3a N1.
Post-op stricture

Prostate bed+pelvis (Started on 13/9/2023)
Most recent fraction:
300 cGy given on 11/10/2023
Total given:
6,000 cGy / 6,000 cGy (20 of 20 fractions)
Elapsed Days: 28
Doctor's Notes:
A diagnosis of prostate cancer. His disease was initially clinically staged as T1c N0 M0. He underwent a Robotic-assisted Radical Prostatectomy on Feb 15, 2022. Surgical pathology revealed adenocarcinoma, Gleason: 8 (3 + 5), and negative surgical margin involvement status, +IDC, + cribriform pattern, and extraprostatic extension. The disease was pathologically staged as T3a N1. His most recent PSA has risen by 0.79 as of July 2023, and the PSMA PET scan from May 15, 2023, suggests a recurrence at the vesicoureteric junction. He started on Zoladex on August 14, 2023, and underwent 20 fractions of radiotherapy to the pelvis on October 11, 2023, on the MIDAS protocol.

PSA < 0.03 29/04/2024
PSA 0.12 14/08/2023
PSA 0.58 12/06/2023
PSA 13.28 14/02/2022

Testosterone 0.4 (L) 29/04/2024
Testosterone 20.0 14/08/2023
Testosterone 14.6 12/06/2023
Testosterone 10.7 14/02/2022

Thanks

A Gleason 8 means that your cancer is aggressive. The T3a means that it is broken through the prostate. The N1 means that lymph nodes were affected, related to T3a.

In this situation, your cancer is more likely to come back after a few years. There are many treatments you can have if it comes back. Those would allow you to live many more years. It is not time to panic, there are so many drugs and treatments available for you in the future, and every year they come out with new life extending drugs.

If your PSA rises three times and gets to .2 they usually want to start on something like Lupron, which can give you two or three years without any issues. After that, there are many more things you can do that extend life.

I have had prostate cancer for almost 15 years, it has reoccurred four times but the drugs I’m on now keep me undetectable. It will come back, but then there are more drugs I can take.

Get PSA test no less than every three months. That way you can keep track of what’s going on.

Thank you for the valuable information.

@zj69 Every time you have your PSA checked and the day or week it takes to get the result back, there will be some level of anxiety including the times that it unintentionally goes up because of sex or bicycle riding. It’s at that time that I find a way to distract myself with some positive activity. It helps.

When you get that less than sign in your PSA reading, that means you are at the bottom of the range of the test. In other words, that's as good a result as you are going to get with that test! May this time of peace last long :-). As others have said, you are past the point when you might expect PC to leave you alone forever. Instead you're fighting for a longer life with better quality while living with the presence, detected or undetected, of prostate cancer. [That's my take based on what you shared, not a medical opinion.]

The short answer, possibly...

With advances in imaging and treatment brought on my medical research, there is discussion about "curing" advanced prostate cancer with the combination therapies. There is also discussion about these evolving treatments enabling "management" of advanced prostate cancer as a "chronic" diseased,

For the 30K or so who die here in the US (I have a friend who will shortly be in that category), neither of those statements are true.

In clinical decision-making, physicians aim to identify the best treatment option concerning the timing of metastatic disease

De Novo vs. metachronous mHSPC)
Tumor volume - low vs. high volume according to CHAARTED criteria).
Four different types of mHSPC patients possibly distinguished:
• De Novo Low Volume (DNLV).
• De Novo High Volume (DNHV).
• Metachronous Low Volume (SecLV).
• Metachronous High Volume (SecHV) mHSPC.
https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/154263-impact-of-time-to-metastatic-disease-onset-and-extent-of-disease-volume-across-metastatic-hormone-sensitive-and-castration-resistant-prostate-cancer-beyond-the-abstract.html?utm_source=newsletter_13452&utm_medium=email&utm_campaign=advancing-the-standard-of-care-in-mhspc…
...demonstrate that patients with DNHV mHSPC harbored the worst outcomes, while patients with SecLV mHSPC harbored the best prognosis.

So, likely your PCa does return, question is when...?

What you can do is continue to actively monitor - labs and consults say every three months, stay informed though reading about advances in medical research - NCCN Guidelines - https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients, the Prostate Cancer Foundation - https://www.pcf.org/ has excellent guidelines, articles and videos, may even consider watching Dr. Kwon's videos, there are others, decision criteria about when to resume treatment and informed by your readings and discussions with your medical team, make a treatment decision - when, with what, for how long, and criteria to come off treatment.

Clinical data includes prior treatment, data such as the pathology report, imaging, PSADT and PSAV, Grade Group-, Gleason Score. The GS you provide puts you in the high-risk group, so, likely you will need to make decisions in the future about treatment, when, who knows. My triplet therapy in Jan 17 and finished in May 18 brought 4-1/2 years off treatment. The doublet therapy from April 2023 to April 2024 is now at six months, waiting lab results from yesterday to see if I'm all clear.

I am at 10+ years with high risk PCa, three of those have been on treatment, the other 7+ off. With a high risk PCa, I have chosen to treat aggressively and early, I believe for me, that approach has paid off. Remember, this is a heterogenous, not homogeneous disease, my PCa is not yours. I also try and keep in mind that guidelines such as the NCCN while based on science, are still population based, historical...They are a useful starting point in discussions with my medical team, Still, my treatment decisions have been more based off data from clinical trials pertinent to my clinical data.

Perhaps rather than cure, think in terms of progression free survival, radiographic free survival,,,,

Kevin

I appreciate everyone's comments. Thank you.