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Rising PSA immediately following RP
Anyone here experience rising PSA on first test after RP? I am 57 years old. I was diagnosed in April with PSA of 35. PMSA Pet and MRI were clear. Biopsy Gleason 8. RP in June. Clear margins, cancer contained to prostrate. Raised to Gleason 9. PSA last month was .17 at 8 weeks. Followup PSA last week is 1.5. I was hopeful surgery was successful or would at minimum give me a number of years without treatment. I have PMSA scheduled next week and a consult next month. I feel defeated. Am I going to be actively battling this the rest of my life? I am just starting to feel like myself after surgery and now will likely have to start another treatment. Anyone else go through something similar? Did the subsequent treatment work and give you some quality of life time without being in active treatment? I imagine I’m looking at hormone therapy and radiation.
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What about a PSMA Pet Scan? Would that help?
Dont mind me. I am just another layman trying to make some sense out of the whole business.
PMSA is scheduled this week. Not sure if I want to read results myself or wait for consult… scared to see them if it is bad but could provide relief if it’s isolated…
Hi Bob. My PSA post RP was undetectable in 2018 but it began to slowly rise and I paid for a private PSMA-PET scan in January 2022 which did detect a small cancerous cell where my seminal vesicle had been. This led to SRT (33 doses) along with 2 shots of Zoladex. My radiation team did not feel that further shots were required. I have now had 4 PSA tests since the SRT and they have all been undetectable. I asked my radiation oncologist what the likelihood of me remaining cancer free would be and he suggested that normally he would suggest 50%; but in my case he is hopeful that it might be 75%. I am currently 81, and although I am dealing with some bowel irregularities post radiation, I can live with them. I remain fairly active; skiing, golf, squash and participating in my "Butts" exercise program. Eat healthy, exercise and enjoy life to the fullest as you never know when you might be run over while crossing an intersection.
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2 ReactionsJust have to take a deep breath. We all go through the same. It might help to know these days the medical profession has something to deal with the situation.
Dont mind me. I am just another layman trying to make some sense of the whole thing.
Bob65:
The PSMA PET scan is an attempt to identify any "hot spots", in the pelvic floor, lymph nodes or elsewhere.
Test sensitivity with PSA below .2 is 20 - 30 % accurate.
Layman experience: Pelvic floor or lymph nodes may or may not light up, but I had whole pelvic radiation treatment (WPRT), because that is the most likely location for runaway cancer cells, together with tx of questionable pelvic lymph nodes.
If there is a distant metastases, then it would be targeted also with radiation.
You sound appropriately concerned, and I was also.
Deep breath. Immediate additional tx is distressing.
I sometimes try to comfort myself by thinking, ok, we will chase down and clean up the residual or escaped PCa before they have chance to cause mischief.
Not a pleasant 6 mos experience with IMRT radiation and hormone therapy, but not disabling either.
Best, Michael
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4 ReactionsI just received my pathology report from my RP last Tuesday. The good news: my lymph nodes are cancer free.
The concerning news: my Gleason score was re-graded to 4+5 after the initial biopsy came back 3+4. My doctor called me to tell me that there was some cancer in the prostate capsule. He said he got it all and would be doing regular PSA monitoring. There is a 20-25% chance of cancer. If my PSA goes up at all then radiation treatments will be necessary.
I will be meeting with him tomorrow to discuss this and learn more about this and have my catheter removed.
Has anybody been in a similar situation? Any suggestions? Thank you
I recommend reading the post on the topic of rising PSA after RP. Very relevant information to your questions that can be helpful to read before your meeting with your doctor.
See what your nadir is after your first PSA test.
Watch see what it does overtime if it starts to gradually increase I would suggest getting radiation treatments to the prostatic bed. Good luck!
We met today and that’s pretty much the plan. He may consider hormonal therapy as well. My first PSA test will be early January. Hoping for the best!
Yes usually minimum 6 months 2 - 3month duration Lupron.