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Rising PSA years after radical prostatectomy
Prostate Cancer | Last Active: Mar 5 7:14am | Replies (206)Comment receiving replies
I am 75 and in good health. I had a robotic-assisted radical prostatectomy in 09/2020. I had right and left apex and left inferior positive inferior margins however no adjuvant radiation treatment. Gleason score was 3+4; pT2, pNO. The PSA results were: 12/28/2020 < 0.1, 04/06/21< 0.1, 10/08/2021< 0.1, 04/05/22 .05, 10/.07/22 .05, 03/30/2023 .06, 10/02/2023 .08. The PSA is slowly rising. My Dr. is getting Decipher test done so as to help guide what treatment might be needed in the future. My next PSA test will be 1/02/24.
Is there anything I should be doing between now and then? If the PSA continues to increase, when should I consider salvage radiation? If we get to that point, what kind of external beam radiation therapy (EBRT) should I choose? I understand that the various forms of EBRT are: 3D conformal radiotherapy, intensity-modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT) and stereotactic body radiation therapy (SBRT). I put these questions to this forum because over the last two years I have been reading the posts here and I have learned so much from them. Any advice would be welcome.
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This is an update of a previous post that I submitted on Nov 12, 2023. Since then I have had two more PSA tests: 0.11 on 1/02/24 and 0.10 2/07/24; my Decipher test score came in at 0.36 (suggesting low genomic risk).
I have consulted with a medical oncologist, two radiation oncologists and my urologist. All four feel that the PSA results suggest that there is, or will be, a biochemical recurrence depending on the definition of biochemical recurrence one uses. The medical oncologist said that based on the Decipher result, no hormone treatment is necessary with salvage therapy at this time.
This coming week I will undergo a PET/CT tumor PSMA(w/Dose) to see if the cancer can be detected. At this low level of PSA it seems unlikely to me that they will find anything. If that turns out to be the case and because I had (three) positive margins after the prostatectomy, I think the radiation would be mainly confined to the prostate bed.
My concerns are two:
1) Should I go ahead and undergo salvage radiation this spring, or wait a bit, perhaps, until the fall to do it? The Decipher score suggests that my cancer is not aggressive and the PSA doubling time does not appear to be that fast (see my Nov. 12 post for more PSA results). On the other hand, the sooner I get this treated the higher the probability of curing the cancer.
2) Should I do photon therapy (EBRT)or proton therapy? Both approaches appear to be of equal effectiveness but the proton therapy supposedly has less side effects. Proton therapy is expensive and I would have to check that it would be covered by my insurance. In addition, the nearest proton therapy location is about 60 miles (about 70 minutes) away while the nearest photon therapy is about 6 miles (12 minutes) away.
I mainly worry about the side effects from salvage therapy. I have no urinary incontinence nor bowel issues from the prostatectomy and I certainly want to avoid them. I do understand however that salvage therapy can cause such issues. I could not find any data on the percentage of people who have these issues after salvage therapy.
Any thoughts or advice from the many who have faced these issues would be greatly appreciated,