Rising PSA at 5 months post-RALP

Your provided history is detailed and excellent. All I can offer when I expressed my anxiety to my urologist about my extraprostatic extension and surgical margins, is that he said that it is routine to have all blood supply removed with the prostate because any cancer cells left behind (surgical margins) need blood, like any other cells or tissue, to survive. The cells can move..."migrate" so to speak...but they may not survive without blood supply. My argument to my physician was that every cell of normal tissue left in my body needs blood supply, and that if the local blood supply for what may be cancerous cells left behind in me is still present for all of the normal, healthy tissue, then either the normal health tissue will seem likely to die, or the cancer cells still in my body, will easily find blood supply from the normal surrounding cells and tissue with their blood supply. He "danced" after that, not giving me a definitive answer, which told me that more than likely, the remaining cancer cells WILL find blood supply before they die from any lack thereof. All it will take is "one" cancer cell finding blood supply, and it can start me on my journey of BCR and phase two of this disease. Just more "watch and wait" with this frustrating disease. I STILL wonder what would have happened if I had never had my RP surgery or anything else. My dad lived to 99 years 10 months "with" prostate cancer (PSA >200 ng/ml). The last five years of his life were lower quality with diapers and perpetual UTI's and hospitalizations, but...he was alive. MY maternal grandfather lived to 96 "with" prostate cancer. He outlived it, having died of Alzheimer's. It's all retrospect now for me...I had the RP surgery and suffer the daily leaks (I regained 98% continence, but still must wear shields in my undershorts), and I haven't had an erection in a year (I am exactly one-year post-op as of mid-April). We just live - or die - with our life choices. I am hoping for at least 15-20 years, but the nature of my cancer type - pT3b with left seminal vesicle invasion (removed with the prostate) - is such that I have a 25-50% probability of recurrence "within" five years post-op. So...one year down, four to go. "Tick, tick, tick, tick, tick, tick...."

The PET-PSMA CT scan that I got a few months ago was with the 18F-PSMA-1007 tracer. I am now looking into getting another in the next few days, which will be with this same tracer.

The Oncologist is requesting the CT scan lab to do a comparison between my previous and new scans. Other than the lesion in the prostate, my previous scan came out perfectly clean.

From what I researched, the 18F-PSMA-1007 tracer seems to be the best choice for trying to identify local recurrence.

@michaelcharles
Thank you for sharing your experience. I am actually at .19, 5 months post-op, and the Oncologist is taking about 6 months of ADT. I wonder why the difference between 6 and 4 months of ADT treatment, in a case such as mine that apparently is not highly critical. Maybe I am also a candidate for only 4 months of treatment?

@begreat99
Thanks for sharing your experience. I have been told that my SRT will involve 37 treatment sessions. I wonder why you only had 8. Was this because they were only targeting the lesion that was found and not the whole prostate bed?

@rlpostrp
Thank you for your reply and sharing your experience. My Best wishes to you.

@animate
Yes. The scan did not show any additional needs. O lymph nodes. Some seminal vesicle invasion. I will likely need more radiation down the road but for now we are holding steady. I will say the radiation was uneventful. We have a radiologist here that exclusively specializes in prostrates so that gave me some comfort. I also visited Mayo for a second opinion and they concurred.

@animate

I do not know what was michael prescribed but when we discussed possible adjuvant RT with our RO he said "4 mos" of Lupron but when we asked for Orgovyx he said : " Oh , in that case 6 mos". I asked "why the difference" and he said "well Lupron lasts longer" which was to me indication that he probably meant to give my husband 2 X 3mos Lupron which is actually 6 mos but choose to say 4 mos since it sounds better lol. I mean, I might be wrong but I do not think that there are "one month" Lupron shots. (???)

According to some new studies, if cancer is low to intermediate risk, than ADT can be avoided but with high risk it should be included.

@animate
I have no explanation for the specific ADT Rx that I received. Again, I accepted the RO's design of my treatment protocol.
And honestly would have accepted an additional couple of months of ADT if he had recommended extending that course of tx.
I was only sharing my actual tx; in part to illustrate that different ROs & MOs have different lengths of ADT regimens.
In the 70's, I bought a number of pieces of old oak furniture; not quite antiques (which I couldn't afford), but I really liked the furniture pieces and even refinished a couple of them myself.
The saying then was "know your antiques, or know your antique dealer".
And I have followed that advice in my treatment: I do not know medicine, and I used my limited medical information, and education and experience, to try to identify a trustworthy RO, and then listened to his advice and decided to follow it.
Best wishes.

@surftohealth88
They do have a four month injection for Lupron. NCCN seems to favor six months As the minimum dosage.

@surftohealth88 The effect of Lupron (testosterone suppression) lasts 3-12 months after the expiration of the shot. The effect of Orgovyx lasts 1-3 months after the last pill and the risk of never recovering is lower. Therefore 6 months of Orgovyx is less than 4 months of Lupron when recovery is taken into account.