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Rapid Reccurance and Short Doubling Time after RARP
I had my non-nerve sparing prostatectomy at Mayo in Phoenix in late June. Pathology showed Gleason 9, stage pT3a IDC with Cribriform present, but I did have negative margins and none of the 21 lymph nodes removed showed matastisis. At 3 months my PSA was 0.26. Six weeks later I'm at 0.41 which is a PSADT of 2.3 months. From everything I research and what my urologist has told me, reoccurance at three months post-op and having such a short PSADT is quite unusual. Worse yet, it predicts a high likelihood of early distant matastisis, early castration resistance, and my favorite, "poor clinical outcomes."
My question to our "special" group is, has anyone else experienced similar fast reoccurance and short PSADT? If so, what has been your journey from that point?
Thanks, Steve
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Doc, based on your response I did some followup. What you described as treatment for your mHSPC was the use of hormone therapy (Lupron), an androgen receptor pathway inhibitor (darolutamide), and chemotherapy (docetaxel). This treatment was approved as of 2023 and is refered to "triplet" therapy and would now be considered the SOC.
What is a bit of a conumdrum are the guys with Grade 5 disease with short time to BCR, short PSADT's, and other predictors of matastasis, yet the PSMA PET scan shows no MET's. The fact that no MET's are identified could be false negatives from the scan (PSMA negative PC) or it could be the MET's are too small to detect, yet all stakeholders know there is micromatastisis, if not outright matastisis going on. The SOC here is going to be salvage radiation with possibly an androgen receptor pathway inhibitor, and NO chemotherapy.
This is where it seems appropriate to assume this individual is not just having BCR, but in fact has mHSPC. In this case I suspect the patient is going to have to work hard to add the third leg of chemotherapy to the protocol as it is not the SOC.
I had my first recurrence about 4.5 years after the initial treatments. My PSA was 30 and gleason scores were 8 and 9's.
Treatments, in order, I received them.
ADT for 12 months, followed by 28 seasons of radiation therapy and last but not least was brachytherapy.
At 4.5 years my PSA went from .2 to 2.9 in 6 months, psadt of 1.6 months.
A PSMA/PET scan showed metastatic PC of the right common iliac lymph node.
Treatment was 42 sessions of Radiotherapy. Initial psa after treatment was .1. 6 months later psa was 1. My next psa test, 4 months later, was 3.5.
I have an appointment with my urologist tomorrow to see what's next.
Steve,
What was your PSA before surgery? And what was your Decipher score? These would be helpful for others with similar pathology.
Thanks,
John
John, my PSA prior to surgery was 8.2. I have not had the Decipher test. I have another PSA test, PSMA PET scan, CT scan (to check on an infected lymphocele from my prostatectomy that hospitalized me for a week, 3 weeks ago), and I meet with my Mayo team and should have a new treatment plan!
Bandsaw, how did you get so much radiation? 28 sessions….and then 42 more? I did not know you could do this.
I thought you could only do targeted SBRT after salvage radiation. Thanks.