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Advice for further treatment

Posted by neronel @neronel, Aug 4 1:20pm

I’m sorry if I’m submitting this again. Internet interruption.

So, I’ll try again.

I would like your advice on further treatment.

History
Robotic assisted radical prostatectomy December 2017
Undetectable until July of 2021. PSA 0.04.
The PSA kept increasing. In May of 2024 PSA was 0.17.
My RO ordered a PSMA PET scan.
June of 2024 the PET imaged an Obturator lymph node SUV 2.9.
In July of 2024, SBRT, 3 sessions.
PSA measurement in November of 2024. PSA 0.23
January 2025 PSA 0.25
PSMA PET +MRI negative scans.
May 2025 PSA 0.25
August 2025 PSA 0,34.

Calculated DT 18.1 from last 4 PSA measurements.
Pathological Gleason 4+3
Decipher 0.84 (High)

Not sure what to do next. I’m told the following, I listened to Dr. E. Kwon and my RO.

I can wait till the PSA doubles to 0.5 and get more scans. Higher probability of detection. Around 50%. PSMA + MRI. Then if positive, try the SBRT approach. Essentially Wack-a-Mole. Last time my PSA still kept rising. According to Dr. Kwon, wait until the PSA doubles to 0.5.

Or, go through an arduous treatment (36) +/- ADT of the prostate fossa and the pelvic lymph nodes. The probability is 66% of the cancer being here, even though the PSMA PET scan cannot find the cancer.

Or, forget about the cancer and get on with the rest of my life. I’m 15 years old (cat years).

So, what do you guys think?

Thanks,

Lou

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neronel | @neronel | Aug 4 1:33pm

Forgot to mention. pT3a from pathology. EPE.

Lou

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heavyphil | @heavyphil | Aug 5 12:05pm

A recent discussion posted about when to use ADT, suggested using the PSA doubling time as an indication for definitive treatment. Even evidence of lesions on PSMA are not given much weight…

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neronel | @neronel | Aug 6 4:33pm

Thanks for the info.

I have been plotting the PSA since first detectable. Dr. Walsh mentioned that if the doubling time is greater than 15 months, the pathological Gleason score is < 8 and you are over 70, there is nothing more to do. And anything that is done will reduce the quality of life. The PCSS survival 10 years after BCR is 98%with a 95% CI (96-100). That’s a lot better than my overall survival of only 51.5% (50.4%with PC). But 10 years from now my PSA will be 4.51, if I don’t die from something else, or if the DT doesn’t decrease. Dr. Walsh did not mention DT changes, especially decreases.

And, that’s my problem. I read a paper that shows a 65% chance of increasing DT and a 35% chance of decreasing DT for GGG 3. I could live with the existing DT but it could decrease. Then it’s curtains.

So, I’m still trying to figure out what to do, if I should do anything. I guess I will never be able to draw a conclusion other than I don’t know. Maybe someone does and they could offer some constructive advice. Treatment? Maybe wait awhile to see if the PET can image anything and do the Whack-A-Mole?

Anyway, here is a link to my PSA plot. And, I’m going to discuss all of this with my RO next Friday.
https://drive.google.com/file/d/1Ul1FzP9WQ1ohA_ppSW_d-GK9eCkD2zYQ/view?usp=drivesdk
Thanks,
Lou

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1 reply
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heavyphil | @heavyphil | Aug 7 7:14am
In reply to @neronel "Thanks for the info. I have been plotting the PSA since first detectable. Dr. Walsh mentioned..." + (show)
Profile picture for neronel @neronel

Thanks for the info.

I have been plotting the PSA since first detectable. Dr. Walsh mentioned that if the doubling time is greater than 15 months, the pathological Gleason score is < 8 and you are over 70, there is nothing more to do. And anything that is done will reduce the quality of life. The PCSS survival 10 years after BCR is 98%with a 95% CI (96-100). That’s a lot better than my overall survival of only 51.5% (50.4%with PC). But 10 years from now my PSA will be 4.51, if I don’t die from something else, or if the DT doesn’t decrease. Dr. Walsh did not mention DT changes, especially decreases.

And, that’s my problem. I read a paper that shows a 65% chance of increasing DT and a 35% chance of decreasing DT for GGG 3. I could live with the existing DT but it could decrease. Then it’s curtains.

So, I’m still trying to figure out what to do, if I should do anything. I guess I will never be able to draw a conclusion other than I don’t know. Maybe someone does and they could offer some constructive advice. Treatment? Maybe wait awhile to see if the PET can image anything and do the Whack-A-Mole?

Anyway, here is a link to my PSA plot. And, I’m going to discuss all of this with my RO next Friday.
https://drive.google.com/file/d/1Ul1FzP9WQ1ohA_ppSW_d-GK9eCkD2zYQ/view?usp=drivesdk
Thanks,
Lou

Jump to this post

Yup, the life and death decisions just don’t end with this crap!! When is enough enough before it becomes too much?
20/20 hindsight doesn’t help us at all unfortunately. And with so many conflicting recommendations - all by well known experts - which one do you choose?
I think a lot depends on your age, general health and family history before you can commit to doing treatment or not.

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neronel | @neronel | Aug 7 11:23am

I guess it all depends on the Doubling Time, which isn’t very useful if it changes over time. It’s worse than weather forecasting. What good is it if it can’t be used as a predictive tool. And, it could take time to identify a true value.
I plotted the DT as a function of time in months, DT(t). Seems like it might be settling. Next measurement might help.
https://drive.google.com/file/d/15ebt1Mh0o9xIkM9mkPC1xZRnyTyK4G6W/view?usp=drivesdk

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neronel | @neronel | Aug 8 9:47am

I guess I’ve gone from denial to bargaining. I’m hoping to bypass anger and depression and make my way quickly to acceptance.

Lou

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neronel | @neronel | Aug 8 4:38pm

Here’s what I read in several papers that addressed DT. It should be evaluated in the event of BCR. It may take 6-24 months to reach a useful number. And, over time, it may increase, which is good, decrease, which is bad or remain fairly constant.
Most authors say that PSAs should be measured at three month intervals and certainly not sooner than one month. My next measurement will be in November.
Lou

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