Ultrasensitive PSA Test Post RP

Hi @lindasteinkamp, I hope you saw the helpful posts from @web265 and . @jerryegge.

It sounds like your husband's cancer team is being thorough to continue with hormone therapy despite the PSMA-PET scan no showing cancer, but the PSA indicating otherwise. I think you'll be interested in this related discussion:
- Has anyone had the PSMA-PET scan? Was cancer found? https://connect.mayoclinic.org/discussion/psma-pet-technology/

@bandit11 @kujhawk1978 @natem @scullrower @bburg and @olanordman have experience with the newer PSMA-PET scan and can share more about what to expect.

How are you doing, Linda?

I had the PSMA- pet scan after having a biopsy that indicated prostate cancer. The reason for mine was to try to confirm that there was no spread outside the prostate which it did to the extent this test can( not totally accurate but much better than anything else) I was debating whether to have ADT which was recommended by the oncologist and radiologist for 4+3 unfavorable intermediate. As a result, I decided not to undergo ADT because of age 75 and ADT side effects. Good luck to you! Ron

I am also 75 had Gleason 9 and had RP and had a year of ADT ( lupron and Erleada ) I just came off of that treatment. The ADT side effects were mostly tired and sleep disorder and a minor rash in the 11 th month. The side effects were not all that bad for me. If ADT would work for you and are offered to you I think that it would be something that you should seriously consider. Good luck in the new year.

I went for PESMA-PET scan in April or May 2021 when my psa had risen to 0.18 and kept on rising. They did not find anything. Then in August 2021 it hit 0.20. This time my urologist said they suspected the postate bed and there was no need for a PSMA-PET scan. So I started with Biculatamide 150mg on 9th Sept 2021 followed 25 doses of radiation on the postate bed. I continued with the biculatamide 150mg daily since I started on 9th September and will finish the therapy on 31st March 2023 - that will be 18months of it.

I have gone for lab test at same lab in Dec 2021, Feb. 2022, April 2022, May 2022, August 2022, October 2022. All resulsts showed undetecatble level. I was asked in October, during my last visit to check twice a year but I have opted for 3x a year. I will check in Feb.

I have had stress incontinence, at times erectile dysfunction, burning sensation in in the toes, body weakness, constipation, pain in the pelvic which comes and goes, side pain. Of recent the side pain is no more.

Training at the gym has helped since I train at least 3 times a week. Hope this helps

You probably had the scan too soon. It usually won’t show the microscopic Cancer until PSA gets more around the single digit area. The treatment you are having will probably work if your microscopic cancer is in the area where they are radiating. It won’t work if the cancer is elsewhere. The drugs will keep your cancer dormant regardless of where it is at. You won’t know the success of your treatment until you stop it.

This was my concern as to whether it has spread outside the postate bed. The answer I got was that they reviewed the scans and concluded it was the postate bed. When I had the surgery to totaly remove the postate, out of 13 lymph nodes, only one lymth node on the left pelvic had metasis of less than a mm. The Gleason score was 7a ( intermediate).

What is the bench mark of PSA level after surgery, combined radiation and hormone therapy for further treatment? I am yet to ask my doctor on the 19th of this month.

Should be zero a few months after surgery without drugs if the surgery was successful.

Sorry. It was not only the postate bed but the pelvic region was also involved since there was one lynth node with about a millimeter metasis

That's up to you and your treatment team to come up with that benchmark.

After my RP, (they took the R Pelvic LN as well) the pathology report stated that there was micro metastasis in the blood vessels and nerves. (paraphrasing that) The surgeon's hope that those were between the prostate and LN that was taken. The LN was perfectly clean. Margins were clean.

PSA did this...
01/26/22 0.039
04/26/22 0.091

At that point my surgeon recommended I go for radiation. I was in a agreement with this although a lot of folks might think this a bit aggressive. It would have likely been fine to have one more PSA test to ensure my PSA wasn't "settling" around that .09 number somewhere or it wasn't artificially high for some unknown reason.

There are folks, a lot smarter than me, who will suggest waiting till you get to around 1.0 then do imaging so that you can see if there is any cancer. I had that imaging done at the .091 mark, nothing was located. That imaging was likely a waste as I've learned from some of the experienced folk here that there would only be a 30% chance of finding anything at that PSA range.

I'm learning a lot can effect your PSA, particularly in those ultra low scales. Dehydration being one issue, heavy exercise before a blood test (which I did regularly, I'd schedule the tests for after the gym. Stinkin' OCD, didn't want to miss my workout!). Also, doubling time isn't quite as important (according to my radiation oncologist)

Now after treatment and still on hormone therapy last test (before workout!) was <.006 so with the radiation in the rearv iew for now, I'm happy I did it. (knocks wood)

That last test was about 5 mos after the final radiation treatment.

Honest question @round5 , is an absolute zero possible? I've never hear of it. Or are you referring to a non ultra sensitive PSA?