Chemical Recurrence Treatment Options

Doesn’t sound too bad. I’m not too far from your situation. Every case is unique but both MRI and PSMA scans are useful. Critical to have a medical team you can trust and are willing to spend the time with you to fully explain and answer questions (even dumb ones in my case). They need to be able to answer: are the areas discovered large enough to create the PSA rise. Sometimes the PSA needs to be higher to have full confidence in the scan. In my case, two small areas were discovered but they are doing a MRI in that area along with a C11 PSMA PET/CT to get a better view and make sure cancer cells that don’t show themselves under the normal gallium or F11 scans aren’t hiding. I’m grateful for the careful and comprehensive care at Mayo. (I drive almost 1,000 miles each way and I’m glad to do it.)

My non medical advice is to relax and take your time to discover as much as you can.

(I’m a 4+3 with no bone lesions discovered, so your situation may be totally different.)

SBRT spot radiotherapy is likely to reset the clock back.

azmarkv mentioned the C11 (choline) PET CT at MAYO. That is only available at the HQ in Rochester, Minnesota. Incidentally the FDA has just approved a newer PET Scan agent (F18) a variant on PILARIFY (sp ?) It has greater agreement by radiologists, and greater positive predictive value (PPV)...while equally sensitive. Apparently it has a greater shelf life so smaller centers may be able to afford it.

I was diagnosed in late 2017 at age 51. First I had surgery, then within a year I started two years of ADT and had prostate bed radiation. Once off the ADT and my testosterone rose, I did 18 months more of ADT and had radiation to a lymph node area around the abdomen region. Lastly, after a spot showed up on my hip, I got back on Lupron and added Nubeqa in April 2025, then did six chemotherapy infusions from June 2025 through October 2025. I still have an undetectable PSA. Dr. Kwon @Mayo mentioned Lu -177 as the next treatment if needed. I was hoping to perhaps alter the hormone treatment medication‘s first, but I’ll have to do more research if necessary.

At this point, they would want to do SBRT Radiation on the spot found in the PSMA PET scan. If they really can’t confirm that it has an SUV that implies it’s a metastasis then you really need to wait and see what happens with your PSA.

They would go by PSA doubling rate at this point, Unless they put you on drugs, which are the standard of care actually.

They could put you on ADT and an ARPI. The easiest choice for those two would be Orgovyx and Nubeqa. They have the least side effects though orgovyx Is ADT so it will have some noticeable side effects. Those two drugs can shrink what’s already there and can stop anything from growing and spreading, Something that could last for years.

@florida11
I’m a little surprised they did chemo with only one spot In the hip. Normally, they would zap that with SBRT radiation and it would usually take care of your PSA for a while. That is even something Mayo Talk talks about at the PCRI conferences, Zapping instead of further treatment.

Chemo is usually saved for when people have multiple metastasis. Do you know why Chemo was Picked instead of just zapping the one hip spot? Was it in a spot they could not safely do radiation? Did they suspect you had more tumors they could not see?

The next time your Lupron shot wears out ask about having Orgovyx Instead. It has fewer side effects for most people and when you stop your testosterone comes back quicker, It has less of a chance of giving you Arteriosclerosis. It is a pill you take once a day.

@jeffmarc

Mayo was originally just going to zap the hip bone. Then my local oncologist looked back at multiple scans and saw some potential red flags. They weren’t definitive, but she thought with my age and fitness level, I might get the best long-term outcome by hitting it hard now. I was Gleason 4+3 = 7, but with a tertiary score of 5. My PC was also intraductal. I went over her opinion with Dr. Kwon and he agreed with her.

I am definitely going to bring up the change in hormone drugs with her next month and with Mayo when I’m there in July based on one of your earlier posts. Many thanks Jeff.

@thmssllvn The two areas mentioned were discovered using using a F18 scan.

According to my searches the other two Mayo Clinics also now offer C11 scans.

Hi,
Have to agree with the above survivors, some form of external beam radiation. Proton or Cyberknife to two good ones. Orgovyx is one of the newer less side effects ADT drugs.
Dave 3+4

@zmarkv

Following the Condoleezza Rice paraphrase: 'Distrust and Verify' I inquired my inerrant (LOL) Dr. Google. The result used the singular MAYO clinic when asked specifically if Choline PET CT scans were available at one of the other sites. Had it been available at other sites the response could have been more transparent.

Incidentally, I had misremembered it's use. I had thought it was good for PSMA negative PCa rather than undetectable PSMA. Supposedly 10% do not light up. Possibly it was initial use after MRI detectable PSMA negative (10%)? I believe the newly FDA approved F18 version of Pilarify is useful for 0.2 through 0.75. Jump in and clarify my errant takeaways?