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← Return to Numbers After SRT/ADT
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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.
Replies to "I got a few questions for someone who has been through this.. My PSA as of..."
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
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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.