Advanced Prostate Cancer

I'm 66 yo, had RP at 53 yo (7/2023). Disease gone until 10/21 (age 61, 8 years later) Bio chem reoccurrence .20 psa.6 mos after jab. had radiation to abdomin after although inconclusive if they actually found spot. Had radition with psma(?) machine, and to Orgyvx for 6 months. PSA undetectable for 18 months at which PSA Disease hit a couple ribs an a vertabrea, but doc withdrew radiation because MRI PET scan depicted like 10 different spots in rib albeit microscopic. Went back on Orgyx plus Enzalutamide 5 months later when psa hit .8. PSA remained undetectable for 2.5 years until March 2026 PSA hit .05. Rested 4 months later and PSA hit .08 in July of this year. Had teriible cough from winter cold/flu that took a couple months to shake. I noticed some chest pain which I thought was due to violent coughing until realizing PSA increased to .08 last month. Now I suspect spots on rib above heart causing some bone pain. I took saliva/DNA test along with a couple blood test when nurse came to home and collected a couple viles, to see tumor markers and other, which I don't know. Supposed to meet /oncologist again in mid to late September. I wonder what's next, anyone have experience or knowledge with this? Thank you.
Nate

@natem
The problem is that PSMA pet scan may not find anything because the PSA is so low. With very microscopic metastasis, it is really hard to see them. If they have grown larger than they may be able to be seen. Insurance companies don’t like to pay for a PET scan with that low a PSA.

There’s not many ways to find such small metastasis. If the doctor thinks that truly is the problem, then they usually want to do chemo or Pluvicto. Guess I need to talk to the doctor and find out what they think.

Have you had hereditary genetic testing? Getting prostate cancer so young and having it keep coming back could be due to you having a genetic problem. I got it at 62, Had surgery, 3 1/2 years later it came back, had radiation, 2 1/2 years later it came back. I’ve been on multiple drugs since then. Four years ago I found out I have BRCA2 a genetic problem that makes it very aggressive. That’s why it has come back four times. The test is free with insurance.

@jeffmarc
Thanks Jeff,
I just had that genetic testing done about 3 weeks ago. I suspect I do since my mother died of breast cancer when she was 54yo in 1994. I'm sure my Oncologist will have that info by my upcoming September appointment. I work full time in sales and love my job and I'm afraid the Chemo will take me down from work.
Thanks very much!