No explanation yet for significant rising PSA

Could be what they call a PSA bounce / bump. Think this can happen even a year after finishing RT and then start going back down. Hope this is what you are experiencing. Best wishes

1) Lab error (have PSA retests been done to eliminate this as possibility?)
2) Prostate infection (antibiotics & retest)
3) Cancer that cannot be detected yet (should continue to increase; test PSA again in another month)
4) Bounce (although very high for that) should start to go down if that is the cause.

Thoughts:
> PSA bounce is much more typical with SBRT and brachytherapy than with photon or proton (but, can happen around 12-18 months post-treatment).
> Did the recent PSMA PET scan show any tracer uptake anywhere?
> Did you have a PSMA PET scan prior to your radiation treatments? What did it show?
> Have you had a genetic (germline) test?
> What was your testosterone level at your recent PSA test?

With those answers, there are then other places to look.

@brianjarvis Radiation type was photon. Pre rad PET showed uptake all over prostate, SV and 2 nodes. Recent PSMA PET scan no uptake. Testosterone suppressed since ADT started January 2023.

@shelby29 Did the first and recent PSMA PET scan show tracer uptake in any areas at all - even noncancerous areas (particularly in the lacrimal (tear) and parotid (salivary) glands, blood, liver, spleen, pancreas, ganglia, and more, as well as the kidneys, ureters and the bladder)?

If he had a PSMA PET scan while his PSA was suppressed by ADT, the PSMA PET scan might not see any cancers.

The rule for people that have had radiation is that once the PSA hits two points above the minimum it ever hit they need to start treatment again. It definitely looks like you are in that position.

It is very common for people to have a PSMA PET scan that finds nothing even though their PSA has risen. The problem is, there’s usually a lot of micro metastasis that the PET scan cannot see. Over time they will get even bigger and can finally be seen by the pet scan.

Normally, when somebody has a reoccurrence with such a high grade prostate cancer (T3b, 4+4) They would immediately be put on ADT and an ARPI. That is really the standard of care at this point. That can get you three or four more years without any more reoccurrences. If you leave it alone, more metastasis Will appear over time and the treatment will be more difficult. Some doctors do believe in waiting for the metastasis to show up and then zap them. With your aggressive case, I would not like to do that personally.

Are you being treated at a center of excellence? You are at the point where you need a Genito Urinary Oncologist, Not just a medical oncologist, one of the ones that specializes in prostate cancer. You’re starting a road to further treatment and you need to get it going so that you do not have this cancer become aggressive. If you mention where you live, I May be able to tell you some GU Oncologists in your area.

@brianjarvis Yes it show normal gland uptakes.
His testosterone is suppressed, not his psa

@jeffmarc We doctor at Mayo la crosse who works in tandem with rochester. I'm told they have morning meetings to discuss the patient case lineup for the day.
We see our PA on Monday and will question of option of getting back on lupron and adding a Nubequa (due to past bypass surgery.) Also read that not all cancer cells produce PSMA, therefore an older generation of PET may be needed. Knowing our PA, she is NOT going to recommend wait and see. Thanks for your expert advice!

@shelby29
Good to hear you’re working with a great center of excellence. It’s very important when cancer comes back.

Please do come back here and tell us what the doctor recommended.

You have a very high doubling rate. Getting that treated soon is going to be important.

Just putting you on an ADT plus an ARPI may be enough for a while. I would want Orgovyx and Darolutamide. People that have had Orgovyx Get their testosterone back quicker and some have fewer side effects. Nubeqa Has no side effects for most people. It really works well for me. It has been found that Lupron causes plaque to build up in your arteries.

There are multiple different radiation types they could pick
SBRT followed by IMRT.
Brachytherapy Before or after IMRT or SBRT.
SBRT alone
Even more

2 questions, is Orgovyx a substitute for Lupron?
What do you mean by radiation options? I'm confused. Isn't ADT+ARPI suffient?
Will let you know what is decided on Monday.
We really like our PA and she obviously cares about us, so we trust her for now! Thank you.