Choosing Radiation Oncologist - rising PSA post prostatectomy

Posted by jwoy @jwoy, Jul 16 12:39pm

One year after what we thought was a successful prostatectomy my husband's PSA level shows a rise. From undetectable to .26. He has an appt this week for repeat PSA and to see the urologist. They also prescheduled him for a Rad Onc consult. The Rad Onc specializes in head and neck so my question is.....how important is it to have someone who specializes in prostate cancer? Apparently appts are tight (Mayo AZ) due to a number of retirements. He had his surgery done at Mayo Rochester. Thank you all....so great to have this place as a resource!

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I have very similar time line as your husband I was 15 months post prostatectomy when my psa reached .13 from previous .06 3 months earlier My urologists then had me get a PSMA pet scam, no cancer found/detected which was expected. He than had me had me see urologist Rad Onc who only specializes and prostrate cancer, after consultation I was put on ADT Orgovix which knocked my psa to undetectable within 3 weeks , I expect to be on this for at least 2 more months. I than began my round of 39 treatments which I completed last week (prostrate bed and LN areas) and am now waiting for 6 week for my next psa. I was stage 4a so I took an aggressive approach which both my primary, and urologist felt was the best course of action before my Psa reached .2 I hope this helps on his quest we are all in this together.

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@namrac

I have very similar time line as your husband I was 15 months post prostatectomy when my psa reached .13 from previous .06 3 months earlier My urologists then had me get a PSMA pet scam, no cancer found/detected which was expected. He than had me had me see urologist Rad Onc who only specializes and prostrate cancer, after consultation I was put on ADT Orgovix which knocked my psa to undetectable within 3 weeks , I expect to be on this for at least 2 more months. I than began my round of 39 treatments which I completed last week (prostrate bed and LN areas) and am now waiting for 6 week for my next psa. I was stage 4a so I took an aggressive approach which both my primary, and urologist felt was the best course of action before my Psa reached .2 I hope this helps on his quest we are all in this together.

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This is really helpful, thank you. When you say you were stage 4a, what does that mean? John's Gleason was 4+3 but unsure what his stage might be.

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I was also gleason 4+3 as far as staging goes I have added this link which can explain all you will need to know about staging.
https://www.healthline.com/health/prostate-cancer-stages

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@namrac

I was also gleason 4+3 as far as staging goes I have added this link which can explain all you will need to know about staging.
https://www.healthline.com/health/prostate-cancer-stages

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What a great article. So clearly explains the issues that can be terribly confusing. Thanks for sharing!

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We heard from the Urologist about John's Pet Scan done this week. He wrote "indeterminate lesion where your seminal vesicles used to be which is indeterminate, but could be consistent with recurrence of the cancer." On the advice if the Rad Ond team he has been scheduled for MRI, soonest is mid September! He has the Rad Onc consult on Aug 14th.
I'm not sure if this means seminal vesicle invasion (I think these were removed as part of surg) so not sure how that could be. This is so disappointing as surgery seemed so successful; contained in prostate, clear margins and 31 lymph nodes from pelvis all negative for cancer. Anyone experience something like this a year or more post surgery? The waiting is agonizing as most of you know. Thank you.

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@jwoy

We saw hus local urologist last week, recieved good info and felt reassured. He scheduled John for a PET scan (today) and a Radiation Onc on 8/14 to get their opinion. As the Urologist explained a PSA at .25 is a concern because its rising but is still low and his advice is to recheck in 3 months to measure doubling time. But based on what shows on the scan the radiologist may advise some radiation or to also watch the doubling time. We will see what they suggest on the 14th. Our preference is to stay close to home for treatment. The urology team expressed confidence in the Rad Onc MD he is scheduled with. Will know more in a couple of weeks.

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Hi, please keep in touch. Husband had a prostatectomy 2008, biochemical recurrence 2022, PSA .24 x 2, PSMA scan neg, 37 Rad tx's to prostate bed, last 3 PSA 4 months apart, < 0.02. Now during every 6 months, next in September. Good Luck!

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Thank you for your kind note and words of encouragement. It's so helpful to hear from folks with shared experiences. Rad Onc consult is next.

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