PSA is .4 ng/ mL 3 years after prostectomy

Hi James,

Thanks for the reply and suggestions. We are in northern Colorado, close to UC Health's Cancer Center in Fort Collins. I have been researching RO's in our region. The one that comes up most often is a UC Health RO in fort Collins. I have an appointment with my urologist on Dec 20 so your input and suggestion are much appreciated. Have a great day.

Jerry

Ask for a PSMA pet test to see if it is spread out of the prostate bed, Maybe to a bone. Get a decipher test to see if it will spread quickly.

The fact that you have cribriform glands is problematic. Cribriform Glands are associated with worse outcomes than other pattern 4 subtypes.

Get genetic hereditary testing to see if there’s a genetic issue. Can get it here for free

Prostatecancerpromise.org

You may want to get on ADT as soon as you can after you get your pet test, Ask your doctor. If you are doing surgery soon you can probably hold off ADT. Even though you are a Gleason seven you want to do something as soon as possible so you can live for decades.

Well, if you have read through these comments, you can see common threads:

Decipher test
Genetic testing
PSMA PET
Consult with a radiation oncologist and a medical oncologist, preferably with experience and expertise in treating PCa.

Generally reaction to a single PSA test is not recommended, usually 2-3 spaced a few months apart may then confirm a trend.

Imaging when PSA is between .5-1.0 may statistically give you a 67% chance of locating recurrence. Keep in mind micro-metastatic PCa, too small to be seen.

Informed by your clinical data from your pathology report, PSA tests and imaging, you can then discuss treatment with your medical team:

Which treatment?
For how long?
If for a defined period, what are the clinical criteria for ending treatment?
If ending treatment, then actively monitor and have decision criteria based on clinical history as well as any new clinical data.

Rinse, repeat...

Inform yourself about treatment options, starting point may be the NCCN guidelines. There are also good resources from the PCF, PCRI, AUA..

There is a plethora of choices...doublet or triplet therapy, SRT to the prostate bed only or with ADT for a defined period. 6-24 months. including whole pelvic lymph node radiation, chemotherapy, adding an ARI, which ADT, Lupron, Orgovyx, if the former, which shot, monthly, 90 day, six month, if the latter is there financial toxicity associated with your insurance. Certainly Orgovyx has advantages over Lupron, which ARI...

If your medical team recommends mono-therapy, run...if they recommend SBRT only to the site(s) identified in the scan, keep in mind that is a possibility for palliative care but if your outcome objective is a longer PFS, then doublet or triplet therapy may be a better choice.

I've attached my clinical history.

The "good" news, advances brought about by medical researchers in imaging and treatment have brought a plethora of choices, that may mean there is no "correct" decision, only the best decision based on your clinical data and consultations with your medical team.

Kevin

I’m about two years out from a radical prostatectomy with the robot. Immediately after the surgery, I got sepsis and was in the hospital for about six weeks, the sepsis was creating so much swelling in my belly that it burst my appendix. I had to go on oil anabiotic’s and wait for my organs to come down to normal size so they could tell which one was which. The first couple CAT scans they couldn’t tell the difference between most of my organs cause the swelling. They were all covering each other, etc. But I’m still alive and still kicking and I do have a PSA again. It’s at .2 and we’re trying to figure out exactly what to do. I have found this site to be fantastic.

Sorry to hear of your ordeal, but the good news is that you don’t ever have to go thru that again.
The not so great is that you may need ADT and salvage radiation….MAY! Perhaps a PSE test might be in order to see if the rise in PSA is from normal prostate cells ( some are left behind in some nerve sparing surgeries) or malignant ones.
Once you get past that hurdle you would then do additional testing such as PSMA PET and even Decipher score from your post-op pathology samples. Best of Luck!

I'm going back 18 years, but my husband was 49 with a psa of 70, Gleason of 9/10. He had a radical prostatectomy at NYU Langone. It had gone beyond the seminal vesicles. We knew they didn't get it all, but his dr had hope. 6 months after surgery his psa went to .05. His dr told him he needed salvage radiation immediately. He was reluctant. But he did it. Once the psa starts rising, his dr felt it was critical to do radiation immediately. Short story.....he lived another 16 years after radiation. It did go to his bone, but for the first 10 years he continued to work and carry and lived a somewhat normal life. He had various treatments off and on including additional radiation to help with bone pain. So, I know a lot has changed since then, but the basic is there. RRP and radiation can extend your life for years. Talk to you dr immediately or find a new one. I lost my husband this year. It was a grim diagnosis initially. One of the best cancer hospitals in NYC refused him because they felt psa and Gleason were too high and he was too young (hormonally driven). If we listened to them, he would have mostly likely been gone in a few years. Talk to a couple of prostate cancer specific oncologist. There's lots of hope!