Connect
← Return to Rising PSA's after treatment - an answer
Discussion
Rising PSA's after treatment - an answer
Prostate Cancer | Last Active: Jan 11 8:59am | Replies (31)Comment receiving replies
My mind says to initiate salvage treatment as soon as possible.
I feel relatively fortunate (?) that with a PSA of .19 after RP, I had immediate radiation treatment to the whole pelvic region (WPRT) and the pelvic lymph nodes, together with 4 months of ADT.
The time for treatment, to paraphrase Kevin, is when you individually and under your circumstances believe that you have evidence of BCR or a definitive trend toward BCR.
Without regard to the actual PSA.
If a PSMA PET scan is negative; all the better.
If not, that's probably a fork in the road, or a European roundabout.
And, do not fear the course of salvage treatment.
Yes, the ADT sucks. I had a relatively mild case of side effects, and they still sucked.
And yes, the radiation can be a problem. I had a particularly severe case of radiation proctitis (probably related to the necessity of a balloon insertion), but it all cleared up about 4 weeks after radiation ended.
So God and good fortune willing, you will never require additional post RP treatment. I know 2 men who had RP over 10 years ago and have not had a recurrence.
Just my thoughts; wishing all well and thanks for your comments and input.
Replies to "My mind says to initiate salvage treatment as soon as possible. I feel relatively fortunate (?)..."
Connect
Well I talked to Dr. Kishan (the radiation oncology expert) at UCLA today. He was pretty confident a 0.02 was an early sign of BCR. One recent study I read said only 25% of cases did not see a PSA progression after reaching 0.02, so that's why 0.03 is the new 0.2 in a sense as basically no cases escaped BCR once you reached 0.03. So I was surprised he was pretty confident 0.02 is the start of BCR. I can't remember the figure, think it was like 99% confidence. He said many people mainly delay to 0.1 or later just to delay having to experience the potential side effects, or they have a very long doubling time, or they are very old. A lot of people are very scared of radiation treatment. He of course agreed it would not be wise to wait to 0.3 when something may show on a PSMA scan since my tumor, from the pathology report, was fully contained and cancer was not found in any of my 14 lymph nodes and had not escaped the capsule. Obviously if I'm starting BCR there are cancer cells circulating outside where my prostate was but in tiny amounts. I have read that there can be small amounts of tissue left behind that are non-cancerous that produce PSA but he didn't pose that as a potential cause of the 0.02 PSA so maybe that is very rare
His opinion has been that there isn't any data to show a significant reduction in chance of cure waiting to do SRT up to 0.1. My logical argument to him was, but sooner can only be better if you're sure of BCR and his response was then we should schedule SRT now! I said "hold on" lol, I think my personal choice based on both your opinion and the studies I've read is I'll wait until two successive increasing results => 0.03, or, I get a result => 0.05. If I went from a 0.02 to 0.05 in 3 months I wouldn't wait for another confirming result. Like many have said here, it's a personal choice based on your analysis of the available data and input from your oncologist/radiologist.