What would you do if PSA stayed at 0.15 after prostatectomy?
Hi everyone,
I am 58 years old. I had a radical prostatectomy seven months ago and my PSA never dropped to undetectable levels. It has stayed at 0.15 for the past three months.
One doctor recommends a conservative approach with low dose radiation to the prostate bed only. Another recommends a more aggressive plan with radiation to the prostate bed, glands, and lymph nodes along with hormone therapy (relugolix for 6 to 18 months).
I am torn between avoiding side effects now versus hitting it hard to lower long term risk. Has anyone here faced this decision? How did you choose, and do you feel it was the right call?
Thanks for any insight. I would really appreciate hearing your experiences.
Interested in more discussions like this? Go to the Prostate Cancer Support Group.
From my perspective, regardless of the path you take, accept it and embrace it as part of the gift life is. We can never be sure a decision we make is ”right” or “wrong”, only that other people and ourselves will pass judgment on it. Regardless of which decision you make, know it is a good one. Best to you on your journey…
First off. This is only my opinion. I've been, somewhat, in your shoes when my PSA was staying in the low numbers area. When it stayed the same or close to the same for an extended period all was good for a wait and see. That wait and see turned in doubling and then it was time to determine a course of action.
Hope this helps.
Gleason 4+3, pT3a. No lymph node involvement, no distant spread, but locally advanced because of extension outside the prostate. Margins were negative after surgery.
I have an appointment in the next couple of weeks to talk about Trimix. Right now I’m on 5 mg of Cialis daily just to keep blood flow going down there, but I’m wondering if I should ask about a higher dose before sex to see if that helps with erections.
Rochester Regional is suggesting a conservative route with low-dose radiation and no ADT. Sloan Kettering (NYC) is more aggressive. I’m also waiting to see if I qualify for Proton Therapy from Sloan Kettering, though I’m not sure it makes much difference with prostate cancer.
My surgeon ordered a Decipher test, I just need to get that report from him.
Thanks for your advice, it really has helped ease a lot of my anxiety.
Wow, it looks like you were tracking your PSA right after surgery. My surgeon had me wait until four months post-op before testing. Since then, I’ve been checking every 30 days:
May: 0.11
June: 0.15
July: 0.15
August: 0.14
From everything I’m learning, it seems like taking an aggressive approach early on may give me a better chance of avoiding recurrence down the road. Really glad to hear your PSA dropped!
Hi Phil,
I’m starting to think the same way. Being aggressive feels like the only way to fight cancer. I’m hoping to be approved at Sloan Kettering. I’m curious, how was your experience with them? So far I’ve been thoroughly impressed with their follow-up and customer service. I already received the (ADT) relugolix 120 mg prescription in the mail, but I’m not starting it until the doctor reviews my PET scan and MRI. They just wanted me to be ready to begin after our next consultation. They’ve been fantastic so far, so I’m assuming the radiation treatments will be handled with the same level of care. Tim
Yes, MRI and PET Scan coming up in 3 weeks. Thank you!
Yes, that’s exactly where I’m at. It feels like only a matter of time before the PSA starts climbing. I don’t want to wait until it doubles, which would put me at 0.30. I’m definitely planning to move forward with treatment now rather than later.
Hey Tim, I think you’re on the right track with Sloan - they’ve got decades of experience with this.
I had my treatment in Commack and had no complaints; the techs were awesome, caring and knowledgeable. I was totally impressed with their daily enthusiasm and supportive attitude. Maybe I just got lucky?
Not sure about proton therapy for salvage radiation. I know it’s used but still can’t see the point of it, when the whole idea is to literally carpet bomb the gland and nodes. But I am not a physicist so don’t go by me.
But they built it and now they have to pay for it so there’s always that.
Do a little homework (NIH, PCF, etc) to see how the two modalities compare.
I will, however, urge you to take the Orgovyx. A 6 month course ‘won’t kill ya’ as my referring urologist said and he was right. Most SE’s were mild and temporary; but its effects on your T (PCa food!) is dramatic.
The synergy of the radiation +ADT is powerful indeed. Neither alone is quite good enough but together they pack a terrific punch. Ask yourself this: How many more times do I want to wrestle with this thing? Twice was more than enough for me!!🤞🤞
Phil
You could ask about having Viagra, 100 mg works quite well But if you’re still having problems With erections then Trimix may be your only choice. I know that for me, Viagra didn’t work at all. Cialis is supposed to work to keep your blood flowing the right way And last a lot longer than Viagra.
Low-dose radiation is not a big deal, Probably at least 20 sessions and that can eliminate the cancer. Not having ADT after having a T3a There’s something you should discuss with Sloan-Kettering. It sounds like that is a little under treatment, But I am not a doctor. You only need six months of ADT, With a Gleason seven. This is something a doctor would have more Information about with your biopsy report and the details about minimal Spread outside the prostate (T3a).
Proton therapy will probably be the standard and another five years. It used to require a whole building now it just requires one or two rooms. That will bring the cost down greatly. It would always be better to have proton therapy because it has less chance of damaging other organs, something that is not very likely but more possible with photon..
Thanks, Jeff. I’m sure I speak for many on this forum when I say your advice has helped me stay focused and reminded me that there is a light at the end of the tunnel, although at times it feels like a very long tunnel. I’m so glad I found this forum, because even though our families care deeply, it is hard to explain the inner turmoil we go through. It really helps to know we are not alone in this. I’m sure you will hear more from me once treatment starts. Thanks again!