prostate removed 15 years ago, PSA rising 2 years ago, radiation

I had the same thing happened to me, but my timing wasn’t identical to yours. I had a prostatectomy and 3 1/2 years later My PSA started rising. I had about eight weeks of radiation two months after having a six month Lupron shot.

2 1/2 years later it came back and I had to go back on ADT full-time. While you can get a PSMA pet scan It may not show Anything. In that case, there is nothing to zap so you either wait around until your PSA rises more and you wait for a metastasis to show up (While Micro metastasis that can’t be seen accelerate) or you can go on ADT Along with an ARPI To prevent you from becoming castrate resistant.

After I was on ADT 2 1/2 years, it came back, I became castrate resistant and went on abiraterone. I was on that for 2 1/2 years and now I’m on Orgovyx and Nubeqa. After 16 years of prostate cancer, I Have been undetectable for the last 29 months.. I do have BRCA2, which makes my cancer more aggressive. I’ve now been on ADT for eight years.

What I’m getting at is with the proper drugs you can live a long time.

Carefully consider your options, The drugs work well for almost everyone, but the side effects can be problematic.

Have you just had a PET PSMA? Detection with PSA >1 and < 2 is about 85% so now would be a good time to get a scan if you have not gotten one since PSA has been high (it is 95% at >2). You might find a metastasis that can be zapped with SBRT. Detection is about 30% at 0.2 and 40% at 0.5 PSA so no detection at these levels does not preclude detection now. If the PET finds too many hot spots or none the first choice will be to go back on the drugs.

So sorry to hear this. You would think that 15 years puts you out of danger of relapse; But the cancer comes back (?!) and you figure that ADT and SRT would finish it off for sure, right?
Just another WTF moment in the lives of those living and sharing this thing…
I agree with others that a PET scan might be very useful at this point; hopefully, it’s a cluster of cells that were outside the SRT field of battle and they can be zapped with SBRT.
Phil

Well, what you describe seems to have been SRT to the prostate bed combined with short term systemic therapy, very short...

A "good" decision but two months systemic therapy seems "short" when generally I see six months.

Question is, what now?

As others have suggested, if not already, a PSMA PET

Depending on what that shows, he will have choices.

There may be the possibility of MDT which can push back the need for systemic therapy, generally used if 1-3 metastases.

You may add systemic therapy to the MDT, ADT or ADT+ ARI. Which agents... discuss with his medical team How long, 6-36 months though given the clinical history likely 6-24...

There are other treatment possibilities to discuss with his medical team, ARI monotherapy as in the EMBARK trial, Estrogen vice ADT as in the PATCH trial.

Chemotherapy is generally more effective in high, not low volume cases.

He may not be at the continuous treatment point.

Depending on treatment choice a positive indicator of de-intensification may be achieving undetectable in the first six months.

He may be managing his advanced PCa the rest of his lifetime. That's the good news, really.

Kevin

@magdabragg, if you and your husband would like to request a second opinion from Mayo Clinic, you can start here: https://mayocl.in/1mtmR63
How are you doing?