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Recurrent prostate cancer: It's come back
In 2012 I had a positive Biopsy for prostate cancer. Initial Gleason score of 3+3. Chronology is as follows (w/Chart):
*Dec 2012 - Brachytherapy PSA score decreased to 1.0
*Completed 90-day PSA testing for 2 years.
*PSA lowered to 0.5. Physicians pushed my PSA testing to 6 months, then annually after year three (2015).
*In 2017 my PSA increased to 1.0.
*From 2017 through 2021 my PSA increased to 4.2.
*Feb 2020 Bone Scan, results negative.
*July 2020 PET, and Biopsy. Biopsy negative. PET imaging was inconclusive. Later discovered the Seminal Vessels were not biopsied in 2020.
*Oct 2021 additional PET and biopsy. Biopsy revealed cancer in one of the seminal vessels. PET scan was again inconclusive. Based on biopsy results, a salvage prostatectomy was scheduled.
*Dec 2021 PET Scan conducted with PSMA Trial AT CCA Seattle to locate any advancing cancer spread. PET scan was again inconclusive.
*Feb 2022 Salvage Prostatectomy
*Post-surgery pathology reports revealed no cancer in the seminal vessels or prostate. Meaning the Oct 2021 biopsy findings were a false positive.
*Post-surgery PSAs are 6.2, 4.9 & 6.1 respectively.
*Presently under 90 day PSA surveillance with a prognosis of hormonal therapy treatment upon PSA reaching level 10.
Anyone with similar experiences please share. Your information is no doubt invaluable.
Respectfully...
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Yes looking into it Can I do both Enzalutamide and 177
looking into it https://www.youtube.com/watch?v=JoJomACA5UM
Yes, I see in San Diego its for when other items don't work so well, am looking at why not now. https://health.ucsd.edu/news/releases/Pages/2022-10-05-patient-first-in-region-to-receive-new-treatment-for-advanced-prostate-cancer.aspx
Here is something to google. They7 have discovered that high doses of testorone killed castration resistant prostate cancer. At this point it is just science and I do not think anyone is using it as a therapy.
https://www.hopkinsmedicine.org/news/media/releases/surprise_high_dose_testosterone_therapy_helps_some_men_with_advanced_prostate_cancer
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1 ReactionHi, my husband will be staring IMRT x 40 sessions next month. How did your husband do with the radiation, side effects? Did he use SpaceOAR Hydrogel? Thank you.
He did amazing well. Tired but no real side effects the radiologist was great. If I remember he had to drink 16oz water everyday before he went. Not sure what space OAR Hydrogel is but I just read about it, it only came out in 2005 which is interesting as no one ever mentioned that to him. It’s been a long time ago 2011 when he had his radiation which is strange because we always said we wondered why they had not come up with a procedure to block that area. It makes me mad that drs don’t tell you everything. Good luck with your husband.
We have both had radiation and if I had a choice I would much sooner have that than chemo.
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...
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...
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."
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3 ReactionsPSA 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