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PSA Persistence after RP and Salvage Radiation
I have not seen much information on PSA Persistence post RRP and Salvage EBRT. I think most biochemical recurrences occur over an extended period of time. I am kind of alarmed at how quickly my Prostate Cancer has progressed. Are there others out there that have been down a similar path? If so would you mind sharing some of your experience? Thanks.
03/25/21 I had my Prostate removed. PSA prior to surgery was 11.6.
05/31/21 my 1st PSA test post surgery was 0.37
09/09/21 PSA continues to climb to 0.69, salvage EBRT suggested. Because of low decipher score no ADT recommended.
09/27/21 thru 11/12/21 7 weeks, 34 rounds of radiation to the prostate bed.
12/10/21 PSA continued to climb during radiation up to 1.29
01/12/22 PET/CT scan comes back as negative. All looks good.
11/11/22 PSA doubling time is 4 months PSA up to 6.56
12/16/22 PET/CT scan shows " moderately PET Avid site near the right lung hilum that may be Prostate Cancer" No other areas of suspicious tracer uptakes.
12/30/22 Telemed visit with my oncologist "Consideration for biopsy should be made."
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I’m in the same situation. My next treatment will be Lupron treatment. But both of my doctors want me to wait as long as possible because my doubling time is slow. Just curious. Where would they take your biopsy from if your prostate has been removed already .
The biopsy will be of the the area of tracer uptake on my last PETR/CT scan, near my right lung. My oncologist has told me that all remaining treatments would be non-curative and all had very bad side effects. I am 63 and very active and (other than advanced prostate cancer) very healthy. Oncologist has said that if he put me on ADT it would only be for 6 months. I think we will be having that conversation next visit...
I was told the same thing about non - curative treatments . Just watching and waiting for now . All the best to you 🙂
When you had your RP, did pathology show any cancer in your lymph nodes, seminal vesicles, or vascular system? I am awaiting my first post RP PSA check and trying to prepare.
Hope you all had a wonderful Christmas!
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1 ReactionMy pathology did show; "Extraprostatic Extension (EPE) : Present, focal" , "Lymphovascular Invasion: Present". and "Perineural Invasion: Present". But I really can't tell you what any of that means. I am not sure there is anything you can do to prepare for your post RP PSA other than to take care of yourself as best you can. Wishing you all the best.
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1 ReactionOf interest….
10 years ago I chose HDR Brachytherapy as it had the highest success rate for a cure. Then I’m informed my cancer had spread and was non-curable. I have been on Lupron nonstop for 11 years. I’ve taken multiple different chemotherapy pills. I’ve had several doses of radiation on different parts of my body. My prostate cancer has metastasized to bone cancer and the bone cancer causes pain. My doctors tell me they won’t radiate the bone cancer unless it hurts. And it can really hurt. With a totally dead prostate, I still have PSA readings from .139 all the way up through 30.0 I am currently on Ebearla and have a reading of 2.7.
This battle has made me constantly tired, and I have some joint pain. Another side effect that is unpleasant is the loss of energy resulting in a slow down of my metabolism or? So I gain weight even though I eat very little. And exercise is not overcoming this. Just FYI stuff.
What is Ebearla?
I have metastatic in L2 T10 an dT12 Radiated once May do again On Zolodex injections and now want me on Enzalutamide PSA was 1.2 now 6.6 I'm 78
Given the PSA post surgery, your clinical data indicates there was PC outside the prostate.
Interesting that your SRT was to the prostate bed only and monotherapy. Various studies tend to say treat the prostate bed, entire PLNs with radiation and add short term ADT, six-24 months. Oh well, history as they say, can't change it, learn from it.
Generally, advanced PCa is not "curable." Question is, if we shorten our horizon to 3-5 years, can we "live" with it? Other diseases do, diabetes, AIDS...the changing landscape of treatments for PCa may very mean for most men with advanced PCa, they may be able to.
In your upcoming meeting consider discussing doublet therapy, radiation and short term ADT, six months. You may have micro-metastatic PCa which is too small to be seen by imaging, your PSADT supports that. The ADT treats that since its systemic therapy. When discussing radiation, bring a radiologist into the discussion and talk about treating the entire PLN system vice spot radiation to the one site identified in the imaging.
The PSADT you provided supports being aggressive, the general rule of thumb:
> 12 months actively monitor
6-12 months grey zone
< 6 months treat now.
As you can see from my clinical history, when surgery and SRT (to the prostate bed only, the standard of care at the time...another story) failed, my PSADT indicated as my surgeon and urologist said, "Kevin, I don't like what your PSA is doing...!" I was fortunate in that the C11 Choline scan showed only PLN but no bone organ involvement and triplet therapy has given me a durable progression free period.
Finally, take some time to read through the NCCN guidelines for patients on advanced PCa, Chapter 7 - https://www.nccn.org/patientresources/patient-resources/guidelines-for-patients/guidelines-for-patients-details?patientGuidelineId=50
Kevin
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5 ReactionsI started a similar thread. Rp 4/18. Bcr 12/20. Srt and adt 2021. Bcr 12/22. Depressing. Not getting great results fm my aggressive treatments. Thoughts?
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Hug
1 ReactionHi Kevin,
Having read the article from NCCN, do you think a DRE is required if US
PSA is negative? I found it to be unclear.
Thank you,
Dee
Glad to hear you are stable. Great news!