I am 10 yrs post surgery. I was a 4-3, T3a. Zero PSA until yr 8, then .1. Last three PSA's were .4, .5 and .5. Two clean PSMA scans. My urologist is not recommending radiation until we know where it is, a recommendation I agree with, though he thinks most likely spot is the bed. There does seem to be support to radiate even with with a negative PSMA. https://pmc.ncbi.nlm.nih.gov/articles/PMC10774185/
I believe the sooner after surgery your BCF occurs the more aggressive your approach should be. My doc is basing his recommendation on the fact that it took 9 yrs for my BCF.
Good luck
I am 10 yrs post surgery. I was a 4-3, T3a. Zero PSA until yr 8, then .1. Last three PSA's were .4, .5 and .5. Two clean PSMA scans. My urologist is not recommending radiation until we know where it is, a recommendation I agree with, though he thinks most likely spot is the bed. There does seem to be support to radiate even with with a negative PSMA. https://pmc.ncbi.nlm.nih.gov/articles/PMC10774185/
I believe the sooner after surgery your BCF occurs the more aggressive your approach should be. My doc is basing his recommendation on the fact that it took 9 yrs for my BCF.
Good luck
@squash05 I’m curious to know a little more about your PSA history. You say that you were zero for 8 years. What threshold of test were you using? Did you have the less than sign preceding a number? Was it something like < 0.02 or < 0.006? Or, was it a tiny number like 0.02 with no less than sign?
Thanks for any details you can provide on your PSA history after surgery.
Zero probably a bit of an over statement. It was not detected fr surgery in 2015 thru 2022, threshold was < .03. Jan 23, 0.1 (read as "normal", PCP said nothing); Nov 24 0.44; Mar 25 0.5 and June 25 0.5 (Mar and June same lab). Retest every 3 months.
My PSA went from threshold (0.05) to 0.13 in 10 months; I was expecting to talk to my RO about a PSMA, ADT & perhaps radiation to the prostate bed. This week my PSA dropped to 0.08 and now we're going to wait another 3 months for the next PSA test. (BTW: G8 in 10% prostate, pT3a pN0, prostatectomy Nov 2018).
It will be interesting to hear how your RO proceeds, given that it was just 2yrs to BCR.
My PSA went from threshold (0.05) to 0.13 in 10 months; I was expecting to talk to my RO about a PSMA, ADT & perhaps radiation to the prostate bed. This week my PSA dropped to 0.08 and now we're going to wait another 3 months for the next PSA test. (BTW: G8 in 10% prostate, pT3a pN0, prostatectomy Nov 2018).
It will be interesting to hear how your RO proceeds, given that it was just 2yrs to BCR.
Not sure who you were asking for information. You should use the reply option if you want an answer from a specific person.
3 1/2 years after my prostatectomy, I had a reoccurrence. Salvage radiation was done and it reoccurred 2 1/2 years later. G 4+3 but also BRCA2 . 15 years since RP.
Unfortunately, there is no standard for this situation. Had one guy come to a meeting who was 30 years following his prostatectomy before he had reoccurrence. Another person had 20 years between RP and reoccurrence..
A higher percentage of people have no reoccurrence.
Squash, I concur. If I get to that point I’m going to hold off on radiating anything until they can see it. Probably in the minority but that’s my early thought process.
I am curious as to what your Gleason score was and what your surgical pathology was: did you have any of the following - Extraprostatic Extension ("EPE"), "surgical margins", cribriform glands, seminal vesicle invasion, etc.?
I read a lot of posts like yours and wonder how many cases were lower level Gleason 3+3=6 and had none of the above, vs 3+4 = 7 or 4+3 = 7 (or 8 or 9) with one or more of the above?
My Gleason score after biopsy was barely a 3+4=7 with just 6-10% of cells being "4". My doctor was confident that "we caught it early, and you'll be alive in fifteen years or longer." That all changed with my surgical pathology report: I am classified a pT3b because I had slight invasion of my left seminal vesicle, plus all of the above. Even though I was barely a 3+4=7, my urologist now says that my cancer seems to have been a more aggressive form, and...even though the prostate is gone, along with both vas deferens and both seminal vesicles, cancers that are pT3b "always seem to come back within five years", especially when the urologist was incompetent to a degree by leaving cancerous prostate tissue behind (a.k.a. "surgical margins"). It is hard to believe that only 10-20% of all RP cases have "surgical margins", yet I read so many posts here that guys' cancer came back after 2-3 years. Were they all like mine with EPE, surgical margins, cribriform glands, and seminal vesicle invasion, or were they all "contained" cancers without all of that, yet still came back? Maybe I read a lot of this here because, we are the men whose cancers were the pT3b type or worse with seminal vesicle invasion, etc. Maybe men with Gleason 3+3=6 and none of the other pathology, just don't read and contribute here???
I am curious as to what your Gleason score was and what your surgical pathology was: did you have any of the following - Extraprostatic Extension ("EPE"), "surgical margins", cribriform glands, seminal vesicle invasion, etc.?
I read a lot of posts like yours and wonder how many cases were lower level Gleason 3+3=6 and had none of the above, vs 3+4 = 7 or 4+3 = 7 (or 8 or 9) with one or more of the above?
My Gleason score after biopsy was barely a 3+4=7 with just 6-10% of cells being "4". My doctor was confident that "we caught it early, and you'll be alive in fifteen years or longer." That all changed with my surgical pathology report: I am classified a pT3b because I had slight invasion of my left seminal vesicle, plus all of the above. Even though I was barely a 3+4=7, my urologist now says that my cancer seems to have been a more aggressive form, and...even though the prostate is gone, along with both vas deferens and both seminal vesicles, cancers that are pT3b "always seem to come back within five years", especially when the urologist was incompetent to a degree by leaving cancerous prostate tissue behind (a.k.a. "surgical margins"). It is hard to believe that only 10-20% of all RP cases have "surgical margins", yet I read so many posts here that guys' cancer came back after 2-3 years. Were they all like mine with EPE, surgical margins, cribriform glands, and seminal vesicle invasion, or were they all "contained" cancers without all of that, yet still came back? Maybe I read a lot of this here because, we are the men whose cancers were the pT3b type or worse with seminal vesicle invasion, etc. Maybe men with Gleason 3+3=6 and none of the other pathology, just don't read and contribute here???
Yes, your last comment is absolutely true: why post here if your surgery was successful and you have not had BCR? A few men who were on the forum before surgery - and are still progression free - have stayed on to offer advice and
encouragement, which is wonderful.
But this is an absolutely bewildering disease which follows no rules; the more you try to understand the ‘whys’ and ‘hows’ the more confusing it becomes.
While most diseases have exceptions to the rule, PCa seems to be nothing but exceptions. Even so, Treatment invariably follows very limited parameters; do this…or that…maybe both and throw in a little ADT for good measure.
But expanded genetic and somatic testing (and hopefully better AI) will allow practitioners to offer customized treatment to their patients in the future and maybe recurrences will become the exceptions instead.
I am curious as to what your Gleason score was and what your surgical pathology was: did you have any of the following - Extraprostatic Extension ("EPE"), "surgical margins", cribriform glands, seminal vesicle invasion, etc.?
I read a lot of posts like yours and wonder how many cases were lower level Gleason 3+3=6 and had none of the above, vs 3+4 = 7 or 4+3 = 7 (or 8 or 9) with one or more of the above?
My Gleason score after biopsy was barely a 3+4=7 with just 6-10% of cells being "4". My doctor was confident that "we caught it early, and you'll be alive in fifteen years or longer." That all changed with my surgical pathology report: I am classified a pT3b because I had slight invasion of my left seminal vesicle, plus all of the above. Even though I was barely a 3+4=7, my urologist now says that my cancer seems to have been a more aggressive form, and...even though the prostate is gone, along with both vas deferens and both seminal vesicles, cancers that are pT3b "always seem to come back within five years", especially when the urologist was incompetent to a degree by leaving cancerous prostate tissue behind (a.k.a. "surgical margins"). It is hard to believe that only 10-20% of all RP cases have "surgical margins", yet I read so many posts here that guys' cancer came back after 2-3 years. Were they all like mine with EPE, surgical margins, cribriform glands, and seminal vesicle invasion, or were they all "contained" cancers without all of that, yet still came back? Maybe I read a lot of this here because, we are the men whose cancers were the pT3b type or worse with seminal vesicle invasion, etc. Maybe men with Gleason 3+3=6 and none of the other pathology, just don't read and contribute here???
G8, pT3a here & EPE ... BCR @ 6 years after surgery. I had several second opinions before my surgery at excellent cancer centers. Everyone (including an RO) believed from the MRI that the cancer was contained & surgery would remove it all. I was expecting T2 but upgraded to T3.
My cancer was in only 10% of the prostate. I find it odd that the profession consider G7 with "4" in only 10% of the prostate as less risky that G8 with all the "4" in 10% of the prostate & nothing in the other 90%. Today, if I was told I had any "4" I'd be just as worried regardless if it were 3+4, 4+3, and 4+4. Just my opinion.
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It seems every case is different. You seem to be in good hands
That is the normal treatment.
@squash05 I’m curious to know a little more about your PSA history. You say that you were zero for 8 years. What threshold of test were you using? Did you have the less than sign preceding a number? Was it something like < 0.02 or < 0.006? Or, was it a tiny number like 0.02 with no less than sign?
Thanks for any details you can provide on your PSA history after surgery.
Zero probably a bit of an over statement. It was not detected fr surgery in 2015 thru 2022, threshold was < .03. Jan 23, 0.1 (read as "normal", PCP said nothing); Nov 24 0.44; Mar 25 0.5 and June 25 0.5 (Mar and June same lab). Retest every 3 months.
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1 ReactionMy PSA went from threshold (0.05) to 0.13 in 10 months; I was expecting to talk to my RO about a PSMA, ADT & perhaps radiation to the prostate bed. This week my PSA dropped to 0.08 and now we're going to wait another 3 months for the next PSA test. (BTW: G8 in 10% prostate, pT3a pN0, prostatectomy Nov 2018).
It will be interesting to hear how your RO proceeds, given that it was just 2yrs to BCR.
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Hug
1 ReactionNot sure who you were asking for information. You should use the reply option if you want an answer from a specific person.
3 1/2 years after my prostatectomy, I had a reoccurrence. Salvage radiation was done and it reoccurred 2 1/2 years later. G 4+3 but also BRCA2 . 15 years since RP.
Unfortunately, there is no standard for this situation. Had one guy come to a meeting who was 30 years following his prostatectomy before he had reoccurrence. Another person had 20 years between RP and reoccurrence..
A higher percentage of people have no reoccurrence.
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Hug
3 ReactionsSquash, I concur. If I get to that point I’m going to hold off on radiating anything until they can see it. Probably in the minority but that’s my early thought process.
I am curious as to what your Gleason score was and what your surgical pathology was: did you have any of the following - Extraprostatic Extension ("EPE"), "surgical margins", cribriform glands, seminal vesicle invasion, etc.?
I read a lot of posts like yours and wonder how many cases were lower level Gleason 3+3=6 and had none of the above, vs 3+4 = 7 or 4+3 = 7 (or 8 or 9) with one or more of the above?
My Gleason score after biopsy was barely a 3+4=7 with just 6-10% of cells being "4". My doctor was confident that "we caught it early, and you'll be alive in fifteen years or longer." That all changed with my surgical pathology report: I am classified a pT3b because I had slight invasion of my left seminal vesicle, plus all of the above. Even though I was barely a 3+4=7, my urologist now says that my cancer seems to have been a more aggressive form, and...even though the prostate is gone, along with both vas deferens and both seminal vesicles, cancers that are pT3b "always seem to come back within five years", especially when the urologist was incompetent to a degree by leaving cancerous prostate tissue behind (a.k.a. "surgical margins"). It is hard to believe that only 10-20% of all RP cases have "surgical margins", yet I read so many posts here that guys' cancer came back after 2-3 years. Were they all like mine with EPE, surgical margins, cribriform glands, and seminal vesicle invasion, or were they all "contained" cancers without all of that, yet still came back? Maybe I read a lot of this here because, we are the men whose cancers were the pT3b type or worse with seminal vesicle invasion, etc. Maybe men with Gleason 3+3=6 and none of the other pathology, just don't read and contribute here???
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Helpful -
Hug
1 ReactionYes, your last comment is absolutely true: why post here if your surgery was successful and you have not had BCR? A few men who were on the forum before surgery - and are still progression free - have stayed on to offer advice and
encouragement, which is wonderful.
But this is an absolutely bewildering disease which follows no rules; the more you try to understand the ‘whys’ and ‘hows’ the more confusing it becomes.
While most diseases have exceptions to the rule, PCa seems to be nothing but exceptions. Even so, Treatment invariably follows very limited parameters; do this…or that…maybe both and throw in a little ADT for good measure.
But expanded genetic and somatic testing (and hopefully better AI) will allow practitioners to offer customized treatment to their patients in the future and maybe recurrences will become the exceptions instead.
-
Like -
Helpful -
Hug
2 ReactionsG8, pT3a here & EPE ... BCR @ 6 years after surgery. I had several second opinions before my surgery at excellent cancer centers. Everyone (including an RO) believed from the MRI that the cancer was contained & surgery would remove it all. I was expecting T2 but upgraded to T3.
My cancer was in only 10% of the prostate. I find it odd that the profession consider G7 with "4" in only 10% of the prostate as less risky that G8 with all the "4" in 10% of the prostate & nothing in the other 90%. Today, if I was told I had any "4" I'd be just as worried regardless if it were 3+4, 4+3, and 4+4. Just my opinion.
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Helpful -
Hug
2 Reactions