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Low, But Rising PSA--Wait for Imaging or Act Now?
Prostate Cancer | Last Active: May 11 3:56pm | Replies (72)Comment receiving replies
Thanks again for the input. I have decided that I want to get "treatment" as soon as possible and have asked for a PSMA-PET scan as soon as possible.
I am wondering why Dr. Nagur was so reticent to give his opinion and why, when pushed, he recommended a standard/basic treatment course (Orgovyx for 6 months and an unspecified course of radiation), when I don't have a "standard case" (I have IDC, Cribriform, EPE, GL 7(4+3)). In terms of urgency, he just said get the radiation done during the 6 month window of ADT.
My appointment with Dr. Greco at JH (where I will be treated) is 5/14. Should I push for hormone therapy right away? Or is the sRT the higher priority ? It will take a few weeks to get the results of the Decipher test on the prostate tissue, the ALTERA, and hopefully a PMSA-PET scan. Thanks as always
Replies to "Thanks again for the input. I have decided that I want to get "treatment" as soon..."
@bikeman1
My husband has all those aggressive features plus gleason 9 and he has the same proposed treatment.
Six mos of Orgovyx and 66 gys of radiation to the whole pelvic floor and nodes.
This is a new approach that is based on the newest research done which showed that no significant extension in OS was achieved with longer ADT for initial localized sRT.
For low and intermediate cancer it is now suggested that no ADT should be used. There is definitely new approach to the ADT usage at present moment. (Google POSEIDON study, dr. Amar Kishan , for some reason I can not paste the link here ) .
Addition of ARSI might help but those are still used only in trial setting so ARSI is not available unless PSMA shows possible lymph node invasion. I think that ADT +ARSI + sRT study results will be available this summer.
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@bikeman1 There’s a lot of new revised thinking on the role of ADT. It is quite possible that 6 months is the absolute minimum (while getting SRT) and then you are monitored every 3 months for PSA rise.
After all, it IS the radiation that kills the PCa, so if all you need is the weakening effect of ADT during treatment, why sign up for long term ADT?
ADT is not going to kill cancer cells on its own, regardless of where they are, just keep them suppressed. Better to use it during radiation to the bed and pelvic nodes to, at least, help eliminate all the cancer cells there.
Any PSA rise after that indicates that cancer is also someplace else, so in that case you would wait for a PET scan to show it. Best,
Phil