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Recurrent prostate cancer: It's come back
Prostate Cancer | Last Active: Jan 31, 2023 | Replies (22)Comment receiving replies
Had prostate removed 8 yrs ago. Yearly psa tests been good. Although last year went from .19 to .20..this year it doubled to .45..have another psa test in 3 months...afraid now it's back. Doc told me to eat healthy no meat lotsa veggies and fruit and check in 3 months...
Replies to "Had prostate removed 8 yrs ago. Yearly psa tests been good. Although last year went from..."
Ugh, what we all dread, BCR. I remember well when 15 months after my surgery with undetectable PSA tests my surgeon hesitated after looking at his screen and turned to me...
So, things to keep in mind:
PSA tests can vary so to the extent possible, follow the same pre-test routines, same lab, same time of the day, hydrate, avoid vigorous exercise 24-28 hours prior...
If it increases again, calculate doubling and velocity times, useful clinical data in making any treatment decision.
Have your medical team order imaging, one of the newer PSMA imaging.
Then, informed by that data, discuss with your medical team whether to treat, with what, and for how long.
If the PSA test increases again, the PSADT could inform any decision to treat or not. The general rule of thumb:
< 6 months - treat
6-12 months - is there any other clinical data to support a decision.
>12 months - may consider to continue actively monitoring.
If the imaging shows recurrence, location will be important, PLNs, or is there bone or organ involvement? If PLNs then consider treating the entire PLNs and include short term ADT, six-18 months. If you do that, your medical team should start the ADT, then the radiation treatment. The ADT is added to deal with micro-metastatic PCa and there are synergistic affects with the radiation.
It's a juggling act, do we treat too soon or too late. The answer may depend on your personal preferences on aggressiveness and input from your medical team. Some medical teams may recommend not treating at this point, preferring to actively monitor until PSA gets to 2.0 or higher. Others may say, treat now while the PCa is "small."
PSA 5 biopsy positive
Radical prostatectomy Gleason 9
All surgical biopsy point to contained
8 week post op PSA<0.10
16 week PSA 0.18
Referral to radiation oncologist
PSA 0.331
Eligard and 39 radiation tx
@539, I'd like to add my welcome along with @natem @kujhawk1978 @vjlvpjalways who have added helpful information and experiences.
I moved your question about recurring prostate cancer to this existing discussion:
- Recurrent prostate cancer: It's come back: https://connect.mayoclinic.org/discussion/reoccuring-prostate-cancer/
I did this to connect you with more members and their helpful responses to @globalhouse.
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Similar experience for me. RP in 2013 then sudden recurrence October 21', been <.1, suddenly .20. I wish I hadn't waited 6-7 weeks to retest. It's my understanding that a .20 is considered the threshold. Six weeks later retest had increased to .30. Then scheduled appointment with radiology oncologist quickly. Had ultra sensitive PET scan and inconclusive spot in upper lymph node. Had several weeks of radiation with this newer machine (expanded treatment area to include the inconclusive spot in upper lymph), looked like from the future but I forget the name at the moment. Did that along with and ADT (6 months Orgyvx). Just retested a week ago, which is 6 months after stopping ADT and thankfully psa undetectable with ultra sensitive psa test. I retest in 6 months. I suppose that's the drill and hope it doesn't come back. And if it does, the longer the better. I'm 62yo. Wish you the best...