PSE Test for Prostate Cancer Before an MRI and for Re-Occurrence

I completed salvage radiation last May. I have been on ADT for 11 months (6 months of Eligard followed by 5 months of Orgovyx + Abiraterone. My original episode was in September of 21 when my PSA was 23. I had RP - pathology was GS 4+4 stage Pt3b. I had persistent PSA, 60 days post RP PSA was 7. Did about 2 years of intermittent Bicalutamide. Went to Houston for RO consult. They put me on the Eligard and performed the SR. Last PSA was < 0.01. My MO thinks i have a good chance for cure but wants me on ADT another 7 months for micro metastases . I wonder if a test like this could tell if there are any micro metastases or if it’s safe to stop ADT?

Six months post HoLEP prostatectomy my PSA was at 0.911
The urologist surgeon said "you're cured." Come back in six months for another PSA." I asked why would I need to have another test if I'm "cured?" He said it's standard. I asked why and he said it was to make sure there was no cancer. I commented that the "cured" statement is moot. When he told me my PSA was .911, I mentioned that it should be < 0.2
He said that I still have the capsule, that it could be any number, that perhaps I have "another cancer." But, other cancers don't produce PSA, it's a marker intrinsically made by the prostate.

What is SR?

Whether it is safe to stop. ADT depends on your Gleason score. If it is seven, you can stop after six months if it is eight or higher, you need to go 18 months or more in order to make sure it doesn’t come back. That doesn’t even guarantee it won’t come back, but it does allow some people to go into remission.

You need a PSMA pet test to see if you have metastasis that have gone beyond Micro, you would probably have to do that after you stop taking the drugs because your PSA has to be higher than < .01. . You do have to realize that prostate cancer is in your bloodstream and will stay there. The best chance of getting rid of it is stay on ADT for the recommended time.

Having a PSA of seven after an RP, and not treating it with SR is almost malpractice. Sure you can keep the PSA down by putting you on ADT drugs, but that seven means you had something active that should’ve been treated. Doing that so late may leave you with a much higher chance of recurrence than had you been treated properly.

Six weeks after my RP my PSA was < .1 and stayed that way for 3 1/2 years. Then it started to rise and when it hit .2 they did SR. That is the standard treatment that is supposed to be given, and you were not given that

I’m a little confused by your statements. HoLEP is not the same as a prostatectomy. It removes some tissue, but is not the same as a prostatectomy done under surgery. You are right, another cancer would not raise your PSA. The question is what was your PSA after six months? I would’ve wanted it tested after three months.

If you had radiation, it would not be completely unusual for you to have a PSA of .911. It should continually go down, though it might bounce around a little, but it could take a while to hit bottom. HoLEP results may be similar to radiation, I don’t know. Maybe someone else here does.

Yes - I was being treated by a very reputable urology oncologist in Mexico City, but if I had known then what I know now, i would have had SR much sooner. I did have a PET/PSMA a few months before i started the Eligard and it showed no spread beyond the prostate bed. My surgery was nerve sparing and I suspect he left tissue there that contained cancer - that is purely a guess.

I’m a little confused by your statements. HoLEP is not the same as a prostatectomy. It removes some tissue, but is not the same as a prostatectomy done under surgery. You are right, another cancer would not raise your PSA. The question is what was your PSA after six months? I would’ve wanted it tested after three months.

If you had radiation, it would not be completely unusual for you to have a PSA of .911. It should continually go down, though it might bounce around a little, but it could take a while to hit bottom. HoLEP results may be similar to radiation, I don’t know. Maybe someone else here does.

You're right. Pardon my confusion. The prostate is lased away into sections and extracted laproscopically through the urethra using a morcellator. The prostate is analyzed in pathology. The capsule of the prostate is left intact. I have had no radiation, or any treatment, or any diagnosis of cancer. My PSA after six months was 0.911

Less than/ more than - reverse them. Lol

They did enough tests to determine that the cancer had not pierced the prostate? What was your T level. T2 or T3a or something else? Coming out of a total prostatectomy your PSA should not be .91, if it rises over .2 NCCN guidelines call for salvage radiation.

Maybe that procedure is so different that they can say it’s OK to have that high a PSA. I think it might be sensible to get a second opinion from an oncologist, preferably a Genito urinary oncologist.