Rising psa 15 years after radiation: Is cancer back?

I understand that you are only the messenger, but what they’re saying is really SO different from what we’ve all been told. Basically, they’re saying that SBRT to a lesion is more effective than salvage radiation because you can see it - it’s targeted.
But if there is a mass (greater than 2.7mm since PSMA can detect it) that you CAN see, it has to mean that there are micrometasteses that you CAN’T.
Isn’t that the current thinking? Or not? Are they including ADT in the treatments? Salvage radiation, at the very least, will take care of residual cells in the prostate bed and pelvic nodes - a site which if left untargeted will be a cause for treatment failure.
I know these are two highly respected men and I’ve watched a few of their YouTube videos. Personally I’ve found Scholz very blase’ and somewhat wishy-washy in his approach - almost like, why treat at all? It’s weird…probably more my problem than his!
Phil

Yes I did radiation 39 times in 2017 March Make sure last 5 are RAPID arch to get the margins

Then get on Cosedex and later Zolodex injections to stop testosterone the fertilizer of PC

In 202 it metastases to my bones Then its Stage 4 and not curable Only controllable

I have been on Xtandi, Radium 223 , 2 sets of Chemo and now Abiraterone with Prednisone as well as Xgeva injection every 3 moths

Google all these

Next year LU 177 Pluvicto

Pray It does not come back @northoftheborder @heavyphil ill

It is surprising to see somebody switching from a Lutamide to Zytiga.

Did Xtandi stop working For you or did you switch to Zytiga before that happened.

Some study showed that switching from a lutamide to Zytiga after the lutamide failed is only effective in 5% of the cases. Is your PSA staying near undetectable with Zytiga?

I understand that you are only the messenger, but what they’re saying is really SO different from what we’ve all been told. Basically, they’re saying that SBRT to a lesion is more effective than salvage radiation because you can see it - it’s targeted.
But if there is a mass (greater than 2.7mm since PSMA can detect it) that you CAN see, it has to mean that there are micrometasteses that you CAN’T.
Isn’t that the current thinking? Or not? Are they including ADT in the treatments? Salvage radiation, at the very least, will take care of residual cells in the prostate bed and pelvic nodes - a site which if left untargeted will be a cause for treatment failure.
I know these are two highly respected men and I’ve watched a few of their YouTube videos. Personally I’ve found Scholz very blase’ and somewhat wishy-washy in his approach - almost like, why treat at all? It’s weird…probably more my problem than his!
Phil

"But if there is a mass (greater than 2.7mm since PSMA can detect it) that you CAN see, it has to mean that there are micrometasteses that you CAN’T."

Yes, there may be — that's why they don't talk much about a "cure" for stage 4 prostate cancer, oligo- or polymetastatic.

I think the idea is that we use ADT + ARSI (say, a -lutamide) to keep those individual cancer cells and "micrometastases" dormant, or at least, to slow their progression down to a crawl, then we zap any big ones that do manage to grow.

One line of thinking is that big tumours might provide critical support to help smaller ones to grow, so zapping the big ones may even help ADT and ARSI to keep the little stuff dormant.

It's definitely a bit like playing whack-a-mole right now, keeping stage 4 under control, but at least we some decent mallets now to whack with.

@sharlee
No it does not mean your cancer is back. This does not come from my opinion but my Mayo urologist, and R/OS at Mayo and UFHPTI.

Just like before you had prostate cancer diagnosis many things can make your PSA rise. BPH, irritations, infections, etc.

Regarding cancer. Most radiation treatments are not designed to kill prosate cancer. What is done is it damages the prostate cancer cells and they cannot reproduce. Unlike regular prostate cells when damage they can reproduce. This was explained to me by R/Os at Mayo and UFHPTI. There are some radiation treatments done to actually kill the cells but most radiation treatments are done to damage the cell reproduction ability of prostate cancer.

What has your PSA levels been? Have they been rising every time you get a PSA? How long did it take to get to 2. How ofter where you getting PSA test done?

Looks like you are seeing a urologist and thus asked him your questions. He/she is your best source of answers to your questions as he is familiar with your prior cancer diagnoses and treatment you received. His/her suggestion for a PSMA is good as can detect cancer cells.

A 2 is still below the norm level of PSA (below 4). Are you having any BPH symptoms?

My R/Os at UFHPTI said their goal was to have my PSA below 1. So far I am below that almost 2 years later. However BPH and many other things can cause PSA to rise and many others. Think optimistic.

When you had your radiation done did they radiate all your prostate? Why do I asked? My R/Os stated to me they radiation all the prostate and margins not just the areas identified by biopsies. Why? Because almost impossible to do a biopsy of all prostate tissues. Thus you urologist doing biospsied could miss areas that have prostate cancer cells. It is normal to do margin for this reason also.

Even if you have a RP surgery does not mean there were not prostate cancer cells in other areas. It is that PSA number that rises steadily that needs addressing. You are seeing a urologist and looks like he/she is looking to see if any signs of the cancer are there. Just cross fingers and hope that it is BPH, infection, irritation and you can easily treat it.
Good luck on your PSMA.

@jc76 Interesting and encouraging as I am facing the same situation right now, PSA of 2 after 14 months, I need to get in touch with my oncologist.

@jc76 Interesting and encouraging as I am facing the same situation right now, PSA of 2 after 14 months, I need to get in touch with my oncologist.

@ray311f503 After 14 mos. of which treatment? After RP it took me 2 years to get to .2. How often are you being tested? Testing measures a couple of things. Obviously you PSA number but perhaps more importantly the velocity of the increase.