PET Scan or not yet?

Well, a reasonable question...

Perhaps a better question may be is if it show activity, eoujd it change the treatment plan?

That leads to another question, based on your clinical data, have you and your medical team discussed a decision to treat and if so, a plan?

There is a statistically strong probability at that PSA the scan shows nothing.

There is the possibility your insurance balks at the idea it if they approve, they are not do inclined to approve bother one anytime soon!

Is your PSA increasing?

Have you discussed adjuvant therapy with your medical team?

Have you looked at the guidelines such as NCCN and AUA, if so, what do they say?

You have choices...

Do nothing, continue to monitor, have decision criteria in place as when to image.

Generally you want to do SRT at a PSA of .2 to .3.

Even then you face decisions:

SRT to the prostate bed only?

SRT to the prostate bed and include the whole pelvic lymph nodes?

The choice may relate to GS, GG, PSADT, PSAV, any other data such as Decipher, Genetic testing...

Do you add short term systemic therapy to those choices?

What's the outcome you are seeking, curative, control...?

What would I do were I you? Well, nothing right now. I might discuss doing monthly PSA testing with my medical team instead of quarterly or semi-annually so as not to miss that .2-.3 window of opportunity.

All other things being equal, insurance...I would imagine at .2, as others have said, 30% chance it shows activity.

I would discuss with my medical team the options when your clinical data says it's time.

Finally, there's this- https://ancan.us14.list-manage.com/track/click

Kevin

@kujhawk1978

Kevin - isn't that AnCan link for patients who already had salvage RT ?

Thanks for the information. Very helpful. I’m seeking curative at this juncture. My urologist and radiation doctor both guess that it’s still only in the pelvic area. Even though I’m only at a .06 eight months post surgery it has gone from less than.01 to .06 the past five months. I’m just trying
To hopefully avoid it leaving the pelvic area.
I’ve heard of patients getting a Pet scan at .08. Why not target the pelvic lymph nodes since they found there already. ? Both doctors said I will eventually need the ADT and radiation. I’m just nervous waiting to get to a .2-.3 because it’s already in lymph nodes. What are the odds it can leave the pelvic area while I wait for PSA to go up?

@magicbearcat1 You will DEFINITELY target the lymph nodes - and if you are worried about further spread ( as I would), getting on Orgovyx now and not waiting for a scan (which will probably show nothing) is your best bet.
Mentally, I prefer being proactive and actually DOING something, rather than sitting on my hands squirming with anxiety.
Your PSA trend is pretty clear and pretty fast so adjuvant therapy would be my first choice; it’s convincing the RO which may take some doing…Best,
Phil

@surftohealth88 It is, I was thinking the concept was applicable, not acting at .08...

This is not an exact fit either - https://www.urotoday.com/recent-abstracts/urologic-oncology/prostate-cancer/168250-natural-history-of-untreated-prostate-cancer-a-comprehensive-review-of-long-term-progression-patterns-and-survival-outcomes-beyond-the-abstract.html

It goes to my point though about USPSA, just because we can measure to 2-3 decimal places, does it mean we have to do something? Certainly we understand at PSA .3 or less, statistically our chances of a cure are better., ,08 though, ok...nice to know, let's schedule our next labs and consult for...?

Meanwhile, the wife and I are going on a vacation...!

@heavyphil

Thanks again for comments. Anyone have any experience with lymph node metastectomy for curative approach? I’ve gotten mixed messages from doctors on this.

@kujhawk1978

I agree 100% with 0.08 not being of concern on it's own, it is just that this patient has one lymph node positive - I mean, one was found, who knows if there are more : ((( .
Also, I found some studies that discovered that once patient reaches 0.03 post op there BCR is going to happen sooner or later. I am so upset that I did not save the link but this is Google summery :

"The Clinical Meaning of 0.03 ng/mLPredictive Value: Research indicates that a uPSA level of \(0.03 \text{ ng/mL}\) or higher reliably identifies patients who will eventually experience BCR.
Lead-Time Advantage: Traditional BCR is typically defined as a PSA level rising to \(> 0.2 \text{ ng/mL}\). Using the \(0.03 \text{ ng/mL}\) cutoff provides an average "lead time" advantage of roughly 18 months, alerting your care team to rising levels well before traditional thresholds are met.
Independent Marker: Studies (such as the landmark UCLA study) show that achieving an undetectable uPSA (often \(< 0.01 \text{ ng/mL}\)) offers the highest chance of long-term remission, whereas crossing \(0.03 \text{ ng/mL}\) serves as an independent predictor of recurrence regardless of other risk factors."

Wishing you fantastic vacation 😎👍
Enjoy : )))) !!!!

@surftohealth88

Interesting...

So, a PSA of .03 is predictive of BCR around 18 months later.

In my case yes, it can.

The question remains, what is one's trigger for initiating treatment?

For me and my medical team, our criteria remains:

Three or more PSA tests spaced three months apart

AND/OR

PSA between .5-1.0

As I've said, those criteria ensure care acting in a trend, not a blip, and gives us a reasonable chance of imaging finding it thus informing a treatment decision. We do not feel it entails any risk in my PCa becoming unmanageable with definitive treatment.

It's hard making a treatment decision, guidelines, clinical trials, clinical data, choices - when, with what, for how long, de-intensification...

Kevin

My PSA is .03 now and has been for just about two years. My oncologist says my PSA is stable...

Will I see yet another recurrence, likely, given my clinical history and data, I am not cured.

So, my statement may have been too generalized, but I think my point holds true, exercise discretion about when to initiate treatment.

I've been off treatment for two years with a stable PSA of .03, hot flashes, fatigue, muscle and joint stiffness gone, weight back down, genitalia back to "normal...

@kujhawk1978
Oh, this study was done for RP patients and their FIRST BCR - it does not apply to you now by any means , I do not thunk so 🍀✨ !
May your low uPSA stay that way forever !
Actually I "forbid" you, Phil, Jef and North to have any BCR EVER - you are all our beacons of hope here 🥰 and your success and perseverance gives us strength to face this nonsense !!!