Recent PSMA PET does not detect cancer, what’s next?

Yeah, it’s a slower process than we’d like; the radiation doesn’t out and out kill the cells, but damages the DNA so they can’t replicate.
Then, because it’s bone, it takes a while for that eaten out portion to remineralize and fill in so that on either Xray or PET, the original highlighted area appears smaller.

Thanks for that information. My radiologist PA said that a higher PSA .21 to .31 post RT to the ribs is expected? I did not hear that from my radiologist. Will certainly ask her during our next telemedicine visit in two days. I’m going to contact my oncologist after this, he made it pretty clear that the “Standard of care” is to put me on ADT indefinitely, I’m not sure if I wanna go that route yet.

Might also have to do salvage radiation, you say no big deal so far? I am a little worried about the side effects.

I had some rectum and bladder urgency issues. My provider requires my rectum to be clear of stool, Bladder full with 28 oz of water and no gas.
-I take a half teaspoon of Psyllium Husks at 7:00 am with 25 oz of water and have a couple of BM's before radiation at 12:15. They can see everything and will throw you off of the table if not right.
-I take 3 gas pills by 9:00 am.
-I drink 12 oz of water between 9:00-9:30. My bladder is empty by 11:15 or so.
-Between 11:20 and 11:35 I drink between 28-35 oz of water finishing 45 minutes prior to appointment. ( I would rather release water than risk getting thrown off the table for not having a full bladder)
** Cautions: I had gradual bladder urgency (bladder spazzing) starting my second week that gradually got worse until I could no longer hold my water at the end of 4 weeks and peed on the table twice in one day. I ask my doctor's nurse to hook me up with some Oxybutynin which I started taking this past Saturday and not a single issue yesterday and today. ASK FOR YOUR NEEDS TO BE MET, IS MY LESSON. Make your nurse your best friend and tell and ask her everything. Don't expect a Rad Tech to meet your medical needs. Their only job is to operate the machine. Reach out to your nurse or doctor for help.
Use the Psyllium to get regular. I did better with plain Psyllium husks than Metamucil. I suggest figuring it out prior to your first treatment.
All the times I listed were based on my 12:15 appointment.
A good plan will get you through with normal Rad irritation which isn't a big deal. After radiation I literally head to our local state park and mountain bike for an hour or so.
It's tedious but with planning you will be fine. Try to connect with the other guys in the waiting room and build comradery with them. Takes your mind away from the suck. Good luck and hope I didn't overshare.

Hey jkoop, what was your primary treatment?? You mention maybe salvage radiation….did you already have prostate removal?
Thanks
Phil

PSA “bounce” after radiation - totally normal.

I had RP October 31 2023. The only treatment so far is SBRT to my third a fourth rib, three sessions.

Your cancer reoccurred and you had bone metastasis. It’s not like this is not going to continue, you have active prostate cancer. If you don’t get on ADT you are headed for more metastasis which can greatly reduce your overall survival.

You have no idea how ADT will affect you, if you get Orgovyx and find it unbearable you can stop and return to normal fairly quickly.

It’s your longevity you are risking. Good luck.

Just want to be clear, these spots that showed up on PSMA-PET are suspected not confirmed prostate cancer on my ribs. They could not do a biopsy, said it was to risky. Oncologist thought it was an 80-90 percent chance that it was PC. Yes, rising PSA is concerning and I'm not ruling out having to use ADT or salvage radiation to pelvic or prostate bed areas. The thought of shooting radiation blindly at no targets bothers me a bit.

Well, I totally understand your aversion to the saturation bombing concept of salvage radiation; lots of innocent bystanders but a lot of bad guys too…
When I had my PET PSMA something showed up at the edge of the femur; my radiologist said it was a natural biologic process - inflammation or bone cyst. When I asked him how did he know it was NOT prostate cancer metastasis, he said that for bones to show metastasis, other soft tissue areas much closer to the prostate bed would have to show up on the scan as well - even brighter in fact; I did not have any of that and evidently, neither did you. Also, my post surgical PSA never got higher than .18, which he also said ruled out bone metastasis….what was your pre surgical PSA and Gleason score? That might give you an indication of how aggressive your cancer was (absent a Decipher score).
But what gives me pause is your PSA bounce after SBRT. If those lesions were not PCa, why the bounce? And if not PCa, what are they??
If everything else is normal, you have active prostate cancer somewhere in your body (as jeffmarc pointed out) - and even salvage radiation, which usually targets the prostate bed and pelvic lymph nodes, may not even get it if it has already migrated somewhere else.
Not trying to raise alarm, but PCa can travel pretty far from its original home; I saw a case where it traveled to the clavicle and that person was basically put on ADT for life. However, he was still alive 14 yrs later.