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Rising PSA's after treatment - an answer
Prostate Cancer | Last Active: Jan 11 8:59am | Replies (31)Comment receiving replies
The standard and generally accepted definition of BCR for single decimal PSA tests is .2, with a 2nd PSA tests 90- days later of .3 or higher.
For USPSA, two decimal points, no such consensus exists. Add to that, the newer imaging generally cannot locate recurrence at the two decimal place whether it be .02 or .03.
You may want to check the NCCN guidelines for BCR and SRT, they are considered the SOC and insurance companies generally, sometimes with prodding, abide by them.
More and more. doublet and triplet therapy is mainstream clinical practice today, not monotherapy such as SRT to the prostate bed. Should you reach a point where treatment is needed by on clinical data - PSA tests, PSADT and PSAV, GS, imaging, any symptoms you are experiencing, I would discuss with my medical team as a minimum doublet therapy, some form of ADT combined with radiation. If for some reason that does not knock down the PSA, you can then add a triplet, ARI, Docetaxel...
For now, relax, enjoy life, actively monitor , develop and discuss decision criteria with your medical team.
Kevin
So, what to do?
My medical team and I had decision criteria:
No reacting to single lab results.
Any decision to image would require three or more consecutive increases in PSA, spaced 2-4 months apart with PSA between .5-1.0. Why you ask, greater than 60% chance of locating the recurrence.
In march of this year, that decision criteria was met, we imaged with Plarify, it showed a single PLN which we treated with SBRT. For the micro-metastatic disease, we added 12 months of Orgovyx, not Lupron. Why, well...
Lower CV SE profile.
Faster castration Higher sustained castration while on it.
Faster return of T when stopping.
PSA tests can vary even if you use the same labs, they don;t change the assay method, follow TMDE calibration requirements...same pre-test routine...That's why my decision criteria was 2-4 months apart. If a lab showed an "increase," we tested again in two months, if it "decreased" or stayed the same, we tested in four months.
Interesting, even while on Orgovyx and T< 9 which is the lowest my lab can measure, I can still achieve erections, though with physical stimulation, not just visual. This of corse dismays my wife, but, that's a different doctor...
Replies to "The standard and generally accepted definition of BCR for single decimal PSA tests is .2, with..."
Oh early on in all my research I read about Orgovyx. It seemed like a no brainer except wasn't sure if insurance was going for it shortly after approved due to the cost? But because of all the benefits you mentioned, including pill instead of shot, it seems like you could make a compelling case to get approval.
I've heard horror stories on the low-T side effects - hot flashes, no strength/energy, muscle wasting, erectile dysfunction. On the other hand I heard other people made it a point to be in best shape possible before, do strength training and keep exercising, which sounded like it mitigated the side effects to an extent. Plus as you point out since the onset/offset is so rapid you therefore can rebound back to 'normal' from it more quickly.
That's an interesting decision point Oncologists have to grapple with. Let PSA go up to detect where the cancer is versus early pelvic radiation to try to prevent metastases in the first place.
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Found the study citing 0.08. I'm still thinking this has to be a misprint? Maybe not:
Pubmed 36765111
"Of those with a delayed detectable PSA, 46% underwent salvage treatment within 10 years after RP at a median PSA of 0.08 ng/mL"
That's got to be 0.8 not 0.08? But I guess they key here is it's 46%. So it that the average of the 46% with the lowest median PSA?
What's funny is the conclusion is not advocating SRT!?
"Men who develop a detectable PSA > 6 months post-operatively may have excellent long-term outcomes, even in the absence of salvage therapy."
But an "excellent long-term outcome" for most is basically not dying of PCa. If you have Gleason 7 at age 53, it's a different long term risk than having it at age 73.