Detection and treatment of microscopic cancer cells

Thanks for your advice. I am inclined to wait until the PSA gets to the 2.0 or above and then arrange a PSMA PET CT scan. I am seeing my oncologist on 12th October and will discuss ADT, doublet or triplet therapy options.

Hi Colleen, my oncologist , like myself, is very focused on the rapid increase in PSA It's gone from 0.032 on 5/11/21, to 0.30 on 20/5/22, 0.39 on 4/7/22 and 0.70 on 10/9/22. I have had 3 scans, 2 PSMA PET CT scans and 1 FDG PET CT Scan. The latter on 13/09/22 stated no definite FDG-avid metastasis identified. The previous PSMA PET scans also did not show any avid disease. My oncologist believes that I have micrometastatic prostrate cancer. I should also mention that back in February 2021 I had an esophagectomy due to cancer of the oesophagus, This was followed by 24 weeks of chemotherapy. The scans showed was no sign of malignancy relating to that cancer.
We decided that I should have another PET PSMA scan after prior checking of my PSA. This will take place last week of November and I will be seeing my oncologist on 2nd December. Treatment will depend on the results but he is leaning towards ADT possibly combined with XRT. In the meantime he is looking to see where I can get a CTC test in Brisbane, Queensland.

It would be very useful if it's possible to locate further results ( since Oct 2018) of the SPPORT trial by Dr Pollack, University of Miami.

Thanks again for all your help and support, and please thank the prostrate cancer participants for their help and support.

Robert, that sounds like a very logical plan of action and surveillance. You sound like it sits well with you.

You asked about the results of the SPPORT trial. I found this published in May 2022:
- The addition of androgen deprivation therapy and pelvic lymph node treatment to prostate bed salvage radiotherapy (NRG Oncology/RTOG 0534 SPPORT): an international, multicentre, randomised phase 3 trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01790-6/fulltext

Did you take part in the trial?

Colleen - many thanks for your very helpful response. I did not participate in the trial but my oncologist was so impressed with the initial trial results he gave me similar treatment. Again thanks for sending me the link to the latest update on the trial. I will be discussing this with my oncologist in early December after my next scan and pathology tests. I suspect that this will be the time we will be discussing further treatment as the scans may show results given the rapid rise in PSA.

What have you learned about "intraductal carcinoma " . My biopsy pathologist commented that "intraductal carcinoma could not be ruled out". I am not sure what that means biologicaly and how it affects my prognosis. Oncologist response was " just means your cancer is more aggressive ". I am Gleason 7 (4+3).
Thanks

I had treatment (EBRT) in 2004-5.
Last year i had a BCR (recurrence).
The biopsy reports which were confirmed by John Hopkins (Dr. Epstein) stated that i have intraductal carcinoma with a gleason of 7.
The conclusions that i have read are that it is more aggressive as you say!
My only treatment so far is having 6 months of ADT (firmagon).
This is different then your situation since intraductal was not (for me) diagnosed initially.
I suppose there are a number of different options. In my case, i don’t want further radiation. I am not sure what i would be thinking in your shoes. Someone said that i could remove the prostate. However, after radiation removal could cause a lot of complications. However, it might be good to do in your case…

Thanks for the reply. I have an appointment (Mayo) next week and will try to get some clarity on my prognosis.
Sorry to hear about your BCR. Best of luck going forward.

Hope you get some answers to what treatment is best for you!

I would be interested in what “Mayo” has to say…