Rising PSA after seed Implants

You didn’t just have seeds you had radiation. What kind of radiation? Brachytherapy?

You don’t have Salvage radiation after Radiation. You have salvage radiation if you’ve gotten a prostatectomy.

You need a PSMA pet test to see if there are metastasis that can be zapped. That would be the first thing since your PSA is high. The other thing that’s important is how fast your PSA has been rising the doubling rate. That is what the doctor goes by to figure out what sort of treatment applies.

At this point, you should be on ADT, Unless they are able to zap metastasis that are causing this PSA rise. It could be the PET scan doesn’t find anything, because you’ve got Micro metastasis and they can’t be seen because they are too small. If that happens, then ADT is what they give you plus an ARPI Like Zytiga or one of the lutamides. You need to speak to an oncologist to find out what you should do. A radiation oncologist might be able to handle this to begin with, but you’ve got reoccurrence.

I’m assuming you had LDR ‘permanent’ seeds placed? What was your PSA before and after treatment? What was your nadir?
How much higher is your current PSA from its measurement at its lowest point, roughly 18 months after treatment?
Phil

@heavyphil Lowest PSA .08 PSA now 2.68 Had a pet scan yesterday and it showed no cancer.

@celtic So that’s good news…but are they planning any kind of salvage therapy?
I know you probably cannot irradiate the prostate further, but can they target the pelvic lymph nodes only?
Most radiation failures occur in the nodes, even if the PET scan looks clear.
Phil

@heavyphil I don’t know Dr hasn’t seen PET scan results yet I got the results same day of PET scan.I think he will wait a few months and take another PSA and PET scan.

@celtic Yeah, he might be waiting for the PSA to go higher, in the hopes of seeing something he can zap…
But it’s a double edged sword: wait and SEE it…or wait and have it spread, still unseen.
It’s really tough to sit by and wait when your mind won’t allow it.
Phil

@celtic At 2.68 should be able to see with the PET. Was the 0.08 with ADT? What is your PSA doubling time (when did you last have a PSA about 1.34)? That is a good indicator of Cancer if that was rapid.

@jim18 The PSA of .08 was with Brachytherapy only.Took a while after the implants to get to .08.PSA before the implants was 5.2.Dr. that ordered the PSMA Pet scan hasn't contacted me yet I was able to get the results the same day.I think he will wait a few months and reorder a PSA if it hasn't gone down order a PSMA Pet test again.

Do you have BPH increasing the size of prostate? If no cancer seen and rising PSA I would look at the sizes on all the imaging over the years, if the size increased that means the PSA increases could be from that and in that case PSA rise = BPH. If no change in sizes on imaging (which can be not very accurate sometimes), then PSA is more likely cancer related or other things raise PSA too, from bike riding, to sex, to supplements especially ones with biotin in them. Just an idea to investigate if not done already, not sure, but hope you get to the right answers and anything needed is taken care of.

@bjroc
Just a side note - Biotin makes PSA result falsely "lower", not higher.