Prostate removed in 2008: What are treatments options for rising PSA?

Posted by pushcart07 @pushcart07, Feb 22 1:33pm

Hello all, I had my Prostate removed 2008. Gleason 4+3 Age 60. Follow up PSA readings always low. I assumed they never got it all. Figured there would be problems in the future. Well, after 17 yrs
PSA has slowly risen to .78 in about a year. DRs recommendation is radiation, hormone therapy or closely monitor. Drs want to radiate the area where Prostate was. How do you know that's where it is after Pet scan is clear? I am in A-Fib, Have chronic kidney disease not on dialysis though. Heart doctor feels if I have ablation I could need pacemaker due to obesity and cpap. Any thoughts appreciated. What is ADT, PSMA. Thanks

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jeff Marchi | @jeffmarc | Feb 22 2:35pm

I had my prostate removed in 2010 at 62. Gleason 4+3. 3 1/2 years later, my PSA started rising and when it hit .2 they gave me a 6 Month Lupron shot and two months later I had a salvage radiation. 2 1/2 years later, my PSA started rising again and I went on Lupron full-time. I have BRCA2, which makes my cancer more aggressive. Have you had genetic testing? The fact that you’ve got prostate cancer so young could be due to two genetics. You should talk to your doctor about getting hereditary genetic testing. Has anybody in your family had breast, Prostate or pancreatic cancer. Those can point to an hereditary problem. I’ve had three more reoccurrences since salvage radiation.

Your PSA is quite a bit above where they recommend doing salvage radiation. Not too late, but it’s time to start moving. It is not unusual for the PSMA PET scan to show nothing, The most frequent location for metastasis to start growing is in the prostate bed and near the lymph nodes in that area. That’s why they do salvage radiation there. I run into quite a few few people who’ve had the similar experience to what you’ve had. Long periods between surgery and reoccurrence.

I’ve had four afib events while on Zytiga, been on ADT (hormone therapy) for eight years and had no issues with afib with that alone. A warning about staying away from Zytiga, There are other drugs that work as well or better.

Here are the salvage radiation recommendations from the American Society of clinical oncology. They said some of the standards for one treatment should be done. As you can see, they recommend you not only have salvage radiation, but also hormone therapy. This reoccurrence could just be the start of future issues if you don’t do this.

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/

pushcart07 | @pushcart07 | Feb 22 3:42pm

Thanks. Seems I may have waited to long. I was diagnosed at 59. The VA presumed my cancer was due to Agent Orange from Vietnam. Regardless it’s back. Have notified all my doctors for input. Radiation oncologist will be next.

michaelcharles | @michaelcharles | Feb 24 10:41am

If PSMA pet scan is negative, the belief is that there is residual PCa in the prostate and/or pelvic lymph nodes and radiation would be the tx (and that is what I received).

ADT, or androgen deprivation therapy, may or may not be recommended by the RO together with the radiation.

There are 2 free Patient Guides available from the Prostate Cancer Foundation pcf.org: download or hard copy ordered from the website that address new and recurrent PCa and treatmentscthat might be informative.

Best wishes.