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What would you do if PSA stayed at 0.15 after prostatectomy?
Prostate Cancer | Last Active: Nov 2 8:53pm | Replies (74)Comment receiving replies
@josephtj I asked the same about a subsequent PET scan if my PSA increases to >0.1 ng/ml. Right now, my first two post-op PSA's were < 0.1 ng/ml ("zero"). But being a pT3b category patient, my doctor wants me to talk with a RO about getting radiation therapy. I "know" the RO will say he wants me to do it, but I have read a fair number of articles that say there is no benefits and there could be some negative outcomes (urinary and rectal incontinence) to having radiation therapy at any time. I am just now at about 98% urinary continence..."finally" at six months post-op.
When I mentioned a second, post-op PET scan to my urologist if/when my PSA rises to 0.2 ng/ml or greater, he said that there are not usually enough detectable prostate cells for the PET Scan to be sensitive enough to show radiation hot spots. The test is very "specific" using the gallium-68 tracer, but it is not sensitive enough to detect the handful of prostate tissue producing the PSA. And...(back to incontinence)...
I NEVER want to go through all the post-op kind of incontinence again, and I never want to have bowel/fecal incontinence...just bury me if that happens. I went through five years with my 95 year old dad just being in diapers all of the time because he had limited mobility and could not make it to the bathroom in time. I was frequently the person who had to clean him up. I never wish that on anyone that I know to clean me up - family or otherwise, job or not. The humiliation my dad experienced was unbearable as well. So...
Good luck with a second PET scan, but don't be surprised if your physician advises against it due to suboptimal "sensitivity" in its ability to find the handful of prostate tissue producing the PSA.
Replies to "@josephtj I asked the same about a subsequent PET scan if my PSA increases to >0.1..."
@rlpostrp
You can also opt for early salvage radiation. In that case you need to do ultra- sensitive PSA tests, which I would advise anyways due to higher BCR possibility. My husband considered adjuvant but was advised by surgeon and MO not to do it due to possible heighten toxicity so early after surgery. MO advised possibly having 0.05 as actionable number (starting intensive testing and planning RT). RO said that it might make sense to do adjuvant but at that point we did not have the first PSA test done. After ultrasensitive test came at less than 0.014 at 7 weeks post op, adjuvant became really questionable, especially since there are new studies in Japan that show that the first ultrasensitive test has actually prognostic value. Our surgeon confirmed that. The lesser the number, the longer time to possible BRC and better prediction overall.
To make the story short - we made decision to do ultra sensitive PSA tests every month for the first 6 mos and than ultrasensitive every 2 mos. etc. Ultra sensitive test will show possible unfavorable trends "ultra early" and give us a head start. For us PSA of 0.1 will be actually "time to do something" if PSA starts to change early and with doubling time (god forbid).
At the same time, we are just 2 mos post op and only time will tell if the plan is good, but for us it makes sense for now.
Also, our pathology was little bit more "contained" than yours, maybe it made some difference (knock the wood)
Hope I was of any help and I am wishing you a complete success with whatever you decide.
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@rlpostrp
Even at .2 a PET scan is unlikely to find anything. The PET scan can’t see metastasis smaller than 2.5 mm and according to the UCSF radiation oncologist, even 5 mm metastasis frequently can’t be seen. And that’s when the PSA is much higher.
You may be getting overwrought about having radiation in the future. You could get proton radiation, which would really reduce any chance of the problems you describe. I know when I had salvage radiation I had absolutely no side effects. Five years later, I started having some incontinence, but that’s after having both surgery and radiation which means either one of them could’ve caused the problem. It’s more likely to actually have the problem with surgery according to doctors I’ve spoken to and AI searches.
I can’t imagine any radiation oncologist wanting to do salvage radiation if your PSA just hits .1 but they might want to do adjunct radiation.
I really highly respected GU oncologist wrote this about doing Adjunct radiation, Which is what you really are referring to. You are pT3b, But do you fit even one of the other criteria?.
Dr. Efstathiou concluded as follows:
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur
Here is a link to the article supplied by @surftohealth88 originally
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html
You could follow what a couple of PCRI doctors have said. Wait until your PSA rises and they find something, and have it zapped rather than have your prostate bed radiated.