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SHEEESSHHHH - oh well ... : (

Posted by surftohealth88 @surftohealth88, Apr 15 5:54pm

I just hate when my worry proves to be "correct" *sigh.

We got new uPSA results today and it is 0.05 : (((. PSA rose from 0.026 to 0.05 in 40 days so it is not an anomaly, something is going on.

Luckily we made app. with MO and our urologist last month since I knew that getting app. is measured in months, so we have consultations next week . We also contacted RO and are waiting for app..

My husband is in much better mental place than me (as always) so he is in action mode ("I probably have BCR so lets zap it !"), and I have to make myself get into that zone too - I mean, it is a must ... : /

Based on all that I read so far we decided to do IMRT treating the whole pelvic floor and nodes and add Orgovyx and Nubeqa for at least 6 mos. We hope that we will be able to get those particular meds since my husband is on Medicare.

All in all, I just wanted to give an update ( I wish it was positive one) and will let you know what doctors say next week.

Wishing everybody nice and relaxing day 🌼💗🙂

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

Profile picture for Jeff Marchi
Jeff Marchi | @jeffmarc | 2 days ago
In reply to @melvinw "@surftohealth88 Thanks for sharing that video lecture. It’s interesting to note the Dr. Adam Kibel (Harvard)..." + (show)
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@surftohealth88 Thanks for sharing that video lecture. It’s interesting to note the Dr. Adam Kibel (Harvard) does not treat post-RP, salvage RT patients with ADT if their PSA is < 0.5 (https://youtu.be/JxO6uRM-XiM). The study discussed in the urotoday video appears to bear that out. I think the biggest concern for OS is cardiovascular disease, which is a well known risk factor associated with ADT.

Trying to find the sweet spot between undertreatment and overtreatment, especially with relapses, is not easy (well, actually, it’s damn stressful). And as you noted, new research keeps changing the playing field. Last summer two oncologists were pushing short term ADT at me real hard along with IMRT, citing the SPPORT trial. I was dubious, especially given that my PSA was 0.11 (or 0.094 with uPSA testing) and there was no scan evidence for distant mets. This latest study appears to bear out my skepticism of ADT benefits outweighing risks, in my case. Also, I have a family history of heart disease (but not prostate cancer). I have a heart murmur and aortic sclerosis and am in my mid 70s, so I factored that into my decision to steer away from ADT with RT. You really need to factor your personal circumstances into decision making, and then hope that you can find a doc that will work with you.

Yup, I expect that between AI and mRNA research and more that the recommended protocols for treatment five years from now may look radically different.

But in the meantime, we keep swimming, or least keep our heads above water. Sheeesh, indeed.

Hang in,
M

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@melvinw
ASCO also doesn’t recommend ADT with less than .5 PSA.

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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surftohealth88 | @surftohealth88 | 2 days ago
In reply to @jeffmarc "@melvinw ASCO also doesn’t recommend ADT with less than .5 PSA. From Ascopubs about what PSA..." + (show)
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@melvinw
ASCO also doesn’t recommend ADT with less than .5 PSA.

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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Thanks so much Jeff 😃, coincidentally I found the same article this very morning and it made me even more determined to push for timely tests and RT planing !

Salvage just have to happen before 0.25 !!! 😠

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daellingson | @daellingson | 1 day ago

75 years old. Original PSA of 8.6, rapidly growing with high Gleason scores. Eligard shots, and Orgovyx for 22 months after 28 radiation treatments. “Cancer free” 16 months ago with PSA at 0.02 until January 2026 when it rose to 0.06, then to 2.6 on April 2026. Now I’m back on Lupron and taking Xtandi. Cancer cells were not detectable under April PET scan. Had hoped I had it licked but maybe not. Waiting until mid-May for nest PSA yes and more direction.

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Profile picture for Jeff Marchi
Jeff Marchi | @jeffmarc | 1 day ago
In reply to @daellingson "75 years old. Original PSA of 8.6, rapidly growing with high Gleason scores. Eligard shots, and..." + (show)
Profile picture for daellingson @daellingson

75 years old. Original PSA of 8.6, rapidly growing with high Gleason scores. Eligard shots, and Orgovyx for 22 months after 28 radiation treatments. “Cancer free” 16 months ago with PSA at 0.02 until January 2026 when it rose to 0.06, then to 2.6 on April 2026. Now I’m back on Lupron and taking Xtandi. Cancer cells were not detectable under April PET scan. Had hoped I had it licked but maybe not. Waiting until mid-May for nest PSA yes and more direction.

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@daellingson
At this point, you’re sort of stuck with ADT and an ARPI.

You might ask your doctor about giving you Orgovyx, It has fewer side effects then Lupron For most people and It’s a pill you take once a day.

Have you had any problems with fatigue from Xtandi? Some people can have a lot of side effects from it, But Lupron can also cause fatigue. Not everyone has fatigue, I don’t have any fatigue from the drugs I’ve been taking. I do take Darolutamide Which has fewer side effects than the other lutamides.

How you feel can be a big deal.

If you had Success with getting your PSA undetectable with the two drugs then you really can just keep on them until Your PSA starts rising and metastasis show up In the pet scan. Eventually, the drugs do fail us all.

At that point you have chemo and Pluvicto As options.

It could be years before you even need to consider those, and new drugs are coming out all the time.

Have you had hereditary, genetic testing? At this point, it’s important to do that so you know if genetics has anything to do with your cancer coming back? For some genetic issues, there are drugs you can take.

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