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PSMA PET scan: then what?
I had a prostatectomy in July 2022. The pathology report showed clean margins and no spread to 12 sampled lymph nodes. PSA tests were < 0.1 for two years, but over the last year they have risen to 0.2 and 0.21 in June and Sept of this year, respectively. I have a PSMA PET scan and MRI scheduled for the end of Nov. What comes next if the scans find something? What if the scan don't find anything?
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You are in a real gray area. 3 1/2 years after my prostatectomy, my PSA started rising and hit .2. They immediately set me up for salvage radiation. There is a reason for having to do it at that point and your waiting may not be a good idea. Here is what ASCO says about it, they discuss prostate cancer standards.
From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL: Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%). Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.
0.2–0.5 ng/mL: Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.
0.5–1.0 ng/mL: Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.
This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/
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3 ReactionsI had same situation after two years from RP , PSA rised to 0.2. Salvage radiaton with 6months orgovyx and 33xRT. No visible tumors on PSMA-scan. First PSA after that was under 0.1. Second test is in two months. I cant even think possibility that PSA has risen again...
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Hug
1 ReactionPET CT PSMA is generally done when there is rise in PSA although yield is low at when PSA is below 0.5ng/ml.
Radiation doctors will recommend early SRT to achieve possible cure.
There is also some correlation with gleason score, pre surgery PSA level, involvement of margins and doubling time (favorable if greater than a year).
My doubling time is 36 months and PSA is now at 0.23ng/ml about 5 years post surgery. Rad Onc recommends radiation but some european literature states waiting is okay since doubling time is long and PSMA PET CT was negative. Also concerned about side effects of radiation.
Best wishes...
Well, I had similar situation after 5 yrs. PET/MRI both negative. Had 25 sessions IGRT to prostate bed AND pelvic nodes (super important!).
Also had 6 months ADT at my request (RO happily agreed) even though it is not currently recommended by some practitioners at low (< .7) levels of PSA. I was taking no chances!! Best,
Phil