Three PSA tests in two months. 6, 7, 5.4. MRI indicates 1cm lesion.

@allex50, welcome. What treatment plan was recommended for you? How are you doing?

@colleenyoung Hi, thanks. So far I have been on Relugalix for some 7 weeks and PSA down from 5.8 to 0.45. That's it! I have a stricture which makes radiation complicated I understand but I have requested to talk to an Oncologist to discuss this. other than that I have been told I should get another PSA in 3/4 months. So end Sept (when I talk to them again) I intend to ask what we will be going forward with. I sincerely hope they have not pegged me up as being on ADT for good without some curative plan! That worries me a lot.

Not sure why this plan especially since you are at a top hospital like mayo. What good will a PSA test be in a few months when you are on ADT! Of course PSA is going to be low because of ADT so that's not much help! The next step is a Fusion guided biopsy. I would insist on a Transperineal biopsy, not rectal type, and no you don't need to be put out for this. Local anesthesia is fine.
Best of luck

@allex50
There must be something missing. It does not seem they have a plan that they have shared with you as putting you on Relugalix should have been a part of a specific plan. A PSA is of little value while being on it as it should be down while on it. I know they are recommending a biopsy but no mention is made by you of your PSA history, MRI’s?, free PSA, PSE, or ExoDx to help determine the need for the biopsy. The talk of your urinary stricture which is a concern for Radiation I understand, but don’t understand why we are even at that conversation prior to a biopsy and known Gleason scores, unless that has been done now and would be helpful to know results to understand Mayo’s recommendation of watching PSA.

@copyman The original poster was at Mayo and asked about biopsy. allex50 never mentioned where he is being treated but had a biopsy result of Gleason 9 or 8. In the US the next step would have been a PSMA PET before ADT.

Apologies, maybe I'm mixed up about this then. I've had a biopsy and all scans are negative (no perineural or extraprostatic and the biopsy was 8 of 14 cores positive overall score 4+5 but I think they all cluster around the lesion near the prostate wall – I saw the screens and the bright dots when the scan was being done). I am in UK on NHS. That is why they put me on ADT to (I am told) to starve the lesion (and any bits elsewhere) of testosterone.

@allex50
Often times ADT is started prior to Radiation treatment beginning. I am assuming that is the case unless possibly they could not do surgery right away and since it was close to the prostate wall , they don’t want it to break out prior to you being able to get the surgery. Either way their is a horrible lack of communication if they have not shared what is the next step.