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Input on PSA rise 3 yrs Post RP
Radical Prostatectomy May 2020. Original Gleason Score at time of biopsy was 4+3. Post RP pathology report stated high risk, confirmed 4+3 score, positive margins, Perineural invasion, as well as invasion into the neck of the bladder. No salvage radiation post surgery. Post RP surgery I had PSA tests every 3 months for 2 years. All PSA results < 0.1. May 2023 PSA level rose to 0.1. I had other significant health issues happening that year, so regretfully I did not get PSA check again until May 2024. PSA level rose to 0.38. Retested a month later rose to 0.46. The most recent test, 53 days apart, PSA lowered lower at 0.42. My question. The fact that the PSA level was down the last test ( from 0.46 to 0.42) , should I wait and retest in a month (or longer?) to see what the trend is? Related to that is how often should one test PSA levels to get a good picture of the doubling time and overall trend? All my PSA tests have been done at the same lab so curious to know (given Post RP) if upward and or downward fluctuations of PSA results are common. Thank you in advance for your input and sharing your experiences.
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The doctors are not "wrong" that SRT is a treatment choice based on an increasing PSA in the absence of imaging showing where the recurrence is.
Have they discussed:
Including the pelvic lymph nodes?
Adding ADT and an ARi for a defined period, that could be anywhere from six to 36 months though 18-24 seems to be the sweet spot.
Why would you include the PLNs in the radiation treatment plan...given your high risk clinical data, there is a distinct possibility the PCa has spread there.
The same for adding the ADT and ARI, to deal with micro-metastases or systemic cancer.
SRT as mono therapy is circa 2016 thinking, especially to the prostate bed only.
Discuss doublet and triple therapy with your medical team.
Kevin
Thanks to all, prostate cancer stories help. I am 3.9 years in, stage 4, just turned resistant. PSA's been mildly rising for almost a year. It's at 2.26 currently. I am a big fan of consistent PSA exams guided/managed by an oncologist. They help with treatment planning and when needed, and I need, interventions. Looks like I'm headed towards a Pluvicto intervention. What's very noticeable is how when new players enter my treatment community (oncologist, oncology nurses, and cancer specialist like PSMA Pets-can providers they are all comment positively about my PSA graph provided on My-Chart page. Diligence
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Hug
1 ReactionI can understand your concerns . Your early to the party so to speak . Be positive and have trust . I wouldn't mess around with this , I would consult a Radiation Oncologist (RO) . In Canada we usually start to treat with external beam radiation at about 0.2 + ( EBRT) . Thats usual, but many methods from here. You could have much of the PSA from healthy cells too from the bladder neck .... but no more tests start action is my guess for yoru case and remain positive ! Whats yoru age ? any other health issues ? this will vary what type of radiation you can get I think . God Bless you . James on Vancouver Island .
Yes, you proceed and probably with ADT as well. My situation and scores are almost identical to yours. My PSA hit .18 Five yrs after surgery and I’ve been on ADT (Orgovyx) for one month today. Will be on that for 6 months total during which time I will have 25 radiation treatments. Both my MRI and PSMA were negative.
Catch it NOW before it catches you….this thing requires life long
Vigilance and it will surely pay off in the end. Best