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!

Hi James,
I had another PSA on Dec 20 that came back at .54. My Urologist then ordered a PSMA PET Scan. It uncovered a lesion 8mm X 11mm on my sternum. Just had appointment with my Radiation Oncologist today. Maybe I had my head in the sand, but it really threw me when he told me that the is Stage 4 bone cancer. This is not curable, but treatable. He tells me that the goal is to not die from bone cancer, but with it. I want not expecting that. Big kick in the gut. I'm coming to terms with it. He tells me that this could go on not 20 years, but likely 15. (I'm 67). He is sending me to a medical oncologist for ADT to get goin on that and will do radiation 60 days after starting on ADT. I'm working hard to come to terms with my own mortality. I'm worried about managing the side effects of ADT. Are people living well on ADT? Feel like I am rambling. I would welcome any suggestions on resources to cope. Thanks

I was on ADT for eight years. Just Stopped a few months ago because my testosterone should never come back since I was on it for so long. I never really had fatigue problems, or depression, the results vary.

Effects of ADT (Lupron, Orgovyx etc) include hot flashes, memory fog, muscle deterioration, fatigue, a beer belly (weakening of stomach muscles) and other issues. You want to keep active (walking/running) in order to limit the fatigue and do weight training to offset the muscle deterioration that is going to happen.
There are a few solutions to the hot flashes, I had terrible hot flashes constantly, if you become uncomfortable come back and ask for help. Some people have depression, It is not as common a problem as other things.

I had one bone Metastasis on my spine and had it zapped with radiation last year. It was on there at least four years and the drugs kept it from growing or spreading.

I’ve had PC for 15 years, It has reoccurred four times. Started at 62 now 77. You are more likely to die of something else rather than prostate cancer I had a prostatectomy 15 years ago and 3 1/2 years later it came back so I had salvage radiation like you’re gonna have. I have BRCA2 Which prevents my body from fixing DNA errors and which brought me the cancer, and I am still alive with it undetectable for over a year.

They’re constantly come out with new treatments for prostate cancer, you will probably have a lot more time than you think. The drugs and treatments they have now could Keep you going until they come up with a cure.

Jerdeb - Gezzz thats a kick in the pants . Sorry to hear of this ...BUT ... on the bright side I think you caught this lesion early. I forget if you have had Radiation before ? You had a prostatectomy when ? Everything been OK since then ? 0.54 is low for a session but it does happen. I think you got it early . Any other features in the PSMA Pet scan ? It is fairly large on the sternum, however it doesn't seem to be putting out a lot of PSA at this point . With regard to the PSMAPET scan was there any other lesions detectable? You have to remember that for every five years it goes by it's a new landscape with respect to prostate cancer research and therapy maybe every three years. Things are moving very quickly. The RO will help you through this. As a parallel therapy, ask your doctor about taking.FenBen 222mg three times a week. Like Mon, Wed, Fri . Continue taking that indefinitely. Yes it is a derivative and similar to ivermectin. Read a lot of repurpose drug use for FenBen . I am not a doctor, but it's very well. Tolerated with most people, with very few side effects. Take it with food at your dinner time, but get your doctors permission before hand. Read up on it about its ability to stop cells from dividing that are cancerous. It's been around for three decades at least, and you can buy it for a very, very cheap. Hence there will be never any in-depth repurposed drug analysis on this as there is no money in it for pharmaceuticals. Let me know what your doctor says. He will probably say something like "...I don't think it will help but go ahead, haven't heard much about FenBen. That's good enough to start it 🙂 . Amazon sells a few brands . take WITH food though , as without food, the absorption is very low. If you took it every day at about four times a dose, it can be hard on the liver, certainly not the doses that I suggested, and the regime. Anyway, let me know what your doctor says. So, cancer therapies are changing so quickly that within 3 to 6 years, there will be another therapy for you to hop onto. I have never been on ADT but I've had the radiation therapy. How many sessions are you going to be getting? 33 to 38 is usually standard. I had 22 without ADT. It certainly works. Are they going to radiate the sternum and the pelvic region? Or just the sternum? I am sure you will live long past the 20 years given the development of cancer medical care. Like with me and you, something else will get us. In the meantime it won't be this darn cancer thing. Keep the faith and keep in touch with me. I am here for you. God bless and don't worry too much( I know easy to say ! ) . It's unproductive, in the end . I will pray for you too ! James on Vancouver Island .