Numbers After SRT/ADT

Thanks Scott - I’d give you half the T if I could, believe me!! I’m actually hoping the high number was a rebound effect and it comes down a bit. Swear to God, I feel like I’m on some kind of amphetamine laced with hate potion….

I got a few questions for someone who has been through this.. My PSA as of April 2 is .45. Steadily climbing since RP Oct. 31. They thought that lesions on 3rd and fourth ribs were pc but as it turned out now they think it was a false positive on the PSMA PET scan since PSA is not dropping. Now they seemed to be saying to get radiation along with two ADT drugs Xtandi and the one you get with a shot. 1, Do I start ADT drugs now so PSA would be low before radio therapy because it could take some time to get the ball rolling for RT? 2, Do I need to use ADT while getting RT.? 3, Can I get or should I get another PSMA - PET scan and see if something shows up before RT? RC said that would be ok, Urologist PA did not like that idea,,wants RT and ADT. Oncologist just wants me to be on ADT indefinitely. I know, that was three questions.

The shot is ADT. You could also get Orgovyx, Which works the same, but you take a pill every day. Xtandi is pretty standard in your situation as well.

The two drugs will take your PSA to undetectable.

The radiation they want you to do is probably salvage radiation, That’s what I had when my PSA started rising after having an RP. Some doctors say wait till you See a metastasis and then zap it with SBRT, but salvage radiation does work for some people, give me 2 1/2 more years.

Rib fractures that have healed are frequently mistaken for cancer, happens to me. Possible that just damage to them can do the same thing, because I’ve heard of false positives on the ribs just today even, in a webinar.

If it has been at least three months since your last PSMA pet Scan your insurance company may allow you to have a second one, but they may want you to wait six months. You could ask for an FDG or an Axumin scan and maybe that would show something, they can see smaller metastasis than a PSMA pet scan.

I agree with @jeffmarc about getting a different scan - PSMA will probably still be negative.
Since you already had SBRT to the ribs and the PSA has not come down, then cancer cells are most probably in the prostate bed or pelvic lymph nodes - or both.
Be SURE to have those nodes irradiated; it should be standard practice since SRT fails 35% of the time if they are not. Yet, many RO’s still insist the cancer is confined to the prostate bed even though there is NO way to know this! Best,
Phil

FWIW, the sexual health doctor told me that what often happens is your T rebounds really fast after Orgovyx, then your body detects that it's climbing too fast so it drops, then rebound and ultimately stabilizes. If you're concerned you should get a full T workup that includes SGBH, Free T, FSH and Estradiol. That will give you a lot more information.

That’s an excellent idea, Scott. Pretty sure I’ll be having another test in 3 months so I’ll wait and see what that shows. Thanks for the info, bud…
Phil

10 weeks left of 6 mos. of adt (Orgovxy) along with recently finished Salvage radiation. Got a second opinion from our regional CCC hospital and Genitourinary cancer specialist. As my T is 2 and PSA undetectable, he stated that I am in danger of being over treated and to wait 6 months after ADT to get my first PSA test. Also stated if your PSA starts rising wait until it gets to 2 (not .2) and come see me and we will find it. It was recently mentioned on this site that PSMA scans cannot see cancer that is less than 2.7 mm in size. Not advice, not suggestions. Just what I was told by the best in my city. He closed by saying I don't find you interesting and I only treat stage 4 cancers. I laughed and stated I think that is a good thing and everyone in the room laughed while agreeing.

If you started off with radiation, not surgery then the rule is you do not do anything until your PSA rises 2 over the minimum that it ever reaches. If surgery is done then salvage radiation is recommended when the PSA rises to .2. With salvage radiation normal time to worry is after the PSA has risen three times in a row.

If you we're a Gleason seven then Six months of ADT makes sense. I can’t understand why he says you’re over treated. If you were only a Gleason 6 then maybe he was right. You want your PSA to be undetectable and your testosterone to be extremely low, So you can stop taking ADT and see if things go back to normal once your testosterone starts rising.

I sure would want to have PSA test every three months for the first year.

Thanks again Mark, you’ve been a great help in my situation. I guess my next question for me is, do the salvage radiation or wait for the PSMA-PET. I’ve not heard of anything to terrible with the radiation treatments other then it’s 6 weeks long other than for me it’s an hour to the clinic. My urologist is thinking at .45 the window for a possible cure is closing if I don’t do the radiation soon as possible. I’d rather do the pill form of ADT, can I request that? Radio Oncologist seemed to be okay with waiting for another PSMA PET. Decisions decisions!

I’ve asked about using a different agent for the scan, but they said PSMA is the best available. I’ll ask again. Do you wait until PSA gets higher until you get another scan or let them blast away in the hopes they kill cancer cells? Thanks for your input, I really appreciate it.