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Rising PSA years after radical prostatectomy
Prostate Cancer | Last Active: Mar 5 7:14am | Replies (206)Comment receiving replies
I just joined, not sure I'm writing this in the appropriate place. I had a Robotic Prostatectomy 8 yrs ago. PSA started going up slowly last three years, .19, .20, 1.6. My surgeon told me because I'm stable, he is transferring my care to his APRN, that I won't be seeing him anymore. He will review my PSA and any issues with the APRN prior to my visit. I feel uncomfortable with this arrangement and I think I'm at a point where I need to find a Medical Oncologist to continue with. Fortunately, for me, the hospital in my town is one affiliated with the Mayo Clinic. Does this seem like a good plan? Thank you!
Replies to "I just joined, not sure I'm writing this in the appropriate place. I had a Robotic..."
Eight years is a good run, but...
Just my thoughts as a layman who has traveled this path too.
It may be time to add a medical oncologist to your team.
It may also be time to throw the BS penalty flag on your urologist and find a new one. With your PSA, it seems inexcusable that he has not suggested imaging to locate where the recurrence is.
https://www.fda.gov/drugs/news-events-human-drugs/fda-approves-second-psma-targeted-pet-imaging-drug-men-prostate-cancer
These scans, or the Aximun and C11 Choline scan can provide critical clinical data to inform any treatment decision such as where is the recurrence, prostate bed only, lymph nodes, how many, where, is there any bone or organ involved...any clinical data from imaging would be critical in a treatment decision.
Another piece of the clinical data may be your doubling and velocity times - https://www.mskcc.org/nomograms/prostate/psa_doubling_time
A general guideline is:
>12 months - monitor
6-12 months- consider treatment
< 6 months - treat.
There are other clinical factors involved, your age, life expectancy, health snd and morbidity factors along with your personal regarding quality versus quantity of life.
So, your Urologist handing you off as you described would constitute grounds for my firing him for failing to actively diagnose you using current NCCN guidelines - https://www.nccn.org/patients/guidelines/content/PDF/prostate-advanced-patient.pdf
Bring a medical oncologist on board.
Kevin
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U should consider MRI with contrast .
A visit to Radiation Oncologist is fine.
Any positive surgical margins?
What is doubling time?
All questions to ask. Hormone and salvage radiation a possibility.