Biochemical Recurrence: Questions about PSMA PET scan & radiation

In my opinion if PSA gets to .4 ask for SRT with 6 months ADT.

Hmm..

The generally accepted definition of BCR is a PSA of .2 followed by a subsequent increase and a PSA of .3 or higher.

There is less consensus with USPSA about what constitutes BCR and the value of determining PSADT and PSAV.

Still, the clinical data you have, your pathology report and labs may indicate BCR.

Again, we generally know the earlier one begins salvage radiation treatment when there is BCR, the greater your "chances" are of either an elusive "cure" or a durable remission.

With that GS, you may have advanced PCa with micro metastatic disease outside the prostate bed.

As you say, the challenges are many:

The lower your PSA, the less likely the scan is to locate site(s) of your PCa.

Should the scan locate your recurrence, there may be micro metastatic disease that does not show up, too small.

If the scan shows nothing, how long do you have to wait for the next one?
Your medical team is suggesting mono therapy based on population based medicine that frankly, is outdated. As you can see from the attached clinical history chart, I had SRT to the prostate bed in March 2016. I brought up extending the treatment field to the pelvic lymph nodes and adding six months of ADT based on emerging data from clinical studies. They rejected my thoughts, miserable failure...

So, think about this. You may have advanced PCa with spread outside the prostate bed. If so, systemic therapy may be your best treatment choice. If that is the case, waiting for a few more labs where your PSA is >.5 may provide a target for your radiologist to use in building his or her treatment plan that is part of doublet or triplet systemic therapy. If you believe that systemic therapy is your best treatment decision then waiting a bit longer for actionable imaging data may not mean a change in the treatment decision but add more precision to it.

Kevin

Had pet/PSMA scan,showed one lymph node infected nothing more detected. When the rest of the team return from vacation they will meet to evaluate and make treatment recommendation. They said possibilities are, surgery although young doctor doubtful due to location of lymph node, but cannot be discounted , radiotherapy,ADT or combination of strategies,a bit nervous that I have to wait 3 weeks due to holidays, worried that could spread to other areas in this time, although doc assured me that we found it early and is extremely small at the moment,but that doesn't really stop my concerns.

Hello, I have gone through the exact same scenario. After my RP surgery, on January 7, 2022, eight lymph nodes were tested. One was positive with a Gleason score of 7. Ugh. After discussion with my radiologist, he suggested 39 treatments, I decided to wait. My oncologist suggested ADT treatments for 24 months. Since each of these treatments come with their own set of negative side effects, I decided to monitor my PSA level and follow a healthy diet coupled with exercise. I had a Zoom follow-up appointment two weeks ago with my oncologist. We reviewed my two PSA test results, which said my PSA levels were undetectable (<0.1). 😊 We decided to stay the course and continue to monitor my PSA level every three months for the next 18 months and less often thereafter. I know every situation is different; I hope this helps you.

Great discussion and in my case based in the UK, can concurr, that if you can initially get your Pca under control, then adopting a healthy diet, which for me is whole food plant based, combined with daily exercise, running, walking, light weights etc, will amplify the positive effects of conventional hospital treatments. I was originally diagnosed almost a year ago with local advanced Pca, prostate plus 2 lymph nodes in pelvis and Gleason 10, had an oncologist, who recommended that I get after it aggressively with a multi- pronged attack, so started with Lupron jabs, then chemo, then added in Enzalutimide hormone treatment, then recently completed 20 rounds of SBRT. Get my post radio treatment scans PET/CT in 3 weeks to see what's what. Initial PET scan in Jan this year didnt show any metastasis outside of Pelvis, but consultant said although good news, could simply be the case that too small to be detected. An MRI post chemo in April, showed no solid tumours evident in either the prostate or lymph nodes, but consultant still gave me radio to ensure nothing on a micro level remained and on that basis, he still wants me to continue with Lupron and Enzalutimide for another 15 months, even if my next PET/CT shows nothing. Currently my psa is <0.06, ie below limit of detection. I'm age 61 by the way.

Hi, any side effects from SBRT?

Hi , after having pet PSMA scan 2 weeks ago as PSA 0.22 doctor saying foundsomething in lymph node, just had another blood test and PSA gone back down to 0. 13 ion less than 4 weeks, extremely happy in the fall in PSA but also quite confused after doctor said something spotted lymph node.

Just had new blood test one week after pet/PSMA scan (3000€) PSA gone back down to 0.13 from 0.22 in less than a month., Very happy but also supprised and confused that it coul fall so much in 4 weeks. Maybe should have waited a little longer, I can't afford to pay 3000€ each time PSA goes up. If it rises sharply again will wait a bit longer for a new scan.

I’ve had Gallium 68 PSMA PET scan and never heard of it causing cancer. My scan found four cancerous pelvic lymph nodes. Five SBRT treatments later and starting Nubeqa PSA went from 1.0 to <0.008. So far so good.

Hi, thanks for your previous reply, very informative.
Results of pet/Psma showed activity in 1 lymph node but not 100% conclusive. PSA dropped from 0.22 to 0.13 three weeks after pet/Psma scan,now back up to 0.24.
Radio oncologist in the same private clinic recommends regular surveillance with PSA testing if PSA continues to rise to 0.3 -0.4 then make new pet Psma scan to update imaging and treat with proton therapy to all lymph nodes in the necessary area and prostate bed and says that the proton therapy has minimal side effects compared to conventional radio therapy.
However he doesn't advocate using ADT yet , saying the proton therapy can still be curative at this point, but this treatment will cost me in the region of €50.000euros.
On the other side the public social health system (free treatment) radio oncologist recommends I start straight away with
25 -30 radiotherapy treatments (not advanced proton type) together with hormone therapy and described various side effects from mild to severe that I could experience but also most would disappear after treatment stopped. I am nervous about making the wrong decision and also about the life changing negative side effects that hormone therapy and conventional radio therapy can have.
Do you have any insights to offer me , thank you.