Post RP PSA .3; twelve weeks post RP, PSA .8

Recent studies have shown that people who have aggressive cases like you have and don’t get salvage radiation by .25 have a lower chance of progression free survival.

Then you have doctors like Kwon and Scholz Who feel that people should wait until the PSMA PET scan shows something and then zap it. While they discuss that at the PCRI conferences, I’m not so sure it really works as well for people that have aggressive cases like you have.

It’s pretty clear that surgery was not the answer for your Getting long-term remission.

I had surgery and then 3 1/2 years later my PSA started rising so I had a six month ADT shot and 40 Sessions of IMRT. I had the sessions early in the morning and would go to work all day every day, had no issues at all. Nowadays, they do it in fewer sessions and people usually have some urinary issues others have proctitis. And some people have no Real problems. When I had that ADT shot? I didn’t even notice it, But it was only six months and you were probably going to get one for 24 months because that is the standard of Care for your aggressive cancer.

You really have to consider the fact that yours is very aggressive. It came back quickly and it came back with a fast PSA rise.

Rick Davis talked about this type of decision in the recent ancan.org Weekly advanced prostate cancer meeting. Rick, who started ancan.org, talked about his friend who had a Gleason nine and decided that after a year of ADT he would stop because it Interfered with his running a big company. He encouraged the guy not to do it, But he did it anyway. Within a few years, he had to have chemo, it had spread considerably. He died not long after. Just something to think about. Weigh how aggressive your case is, what aggressive things were found.

Just some things to think about. Long-term survival with prostate cancer requires regular treatments that are parts of the standard of care. Sure, some people can get around them and still survive for a long time. Can you?

That's an aggressive rise in PSA. I never went below .03 after RP then up to .04 after next 3 month test. I saw the subtle look in my surgeon's face when he stated undetectable and silently called BS. Your PSA velocity is rising much faster than my Gleason 9 Grade 5 which is one of the measurements they use to gauge aggressiveness. After a year I started doubling every 6 months to .22 PSA BCR at 2 years. I did ADT and radiation at that point. It took me a while to work through the acceptance part of, "this is my new life" and have been dealing with a rather serious radiation proctitis situation which is slowly getting better with treatment. At 6 months I was still undetectable and will have my 1 year test in July. The GU I had my second opinion with at a CCC research hospital suggested that if I BCR again to wait for my PSA to get between 1&2 and he will be able to find it on the scans and treat it. Thinking about all that I have experienced over the 15 months after salvage radiation and even with the problems I've had, I feel I made the right decision to have prostate bed radiation with ADT and make the necessary lifestyle changes. If I BCR again I might wait until a higher number in hopes they can actually find where the cancer is and zap it. From looking at your velocity numbers, you will sadly have to make that decision sooner than later. These are tough decisions that will be life altering one way or the other. Best wishes on your journey.

@jeffmarc Kwon’s treatment isn’t limited to zapping discovered areas. Aggressive triple agent systemic therapies are often used when required (as explained in pcri.org videos) They are big on both MRI and PSMA PET/CT scans. They use both F11 and C11 (to discover cells that don’t present themselves with F11). My previous doctors at a major care center basically said to just go on ADT until it stops working. I appreciate Kwon’s thorough and aggressive approach—but everyone is different has to make their own choices,

G 9 w/ EPE post RP. All else clear.
90 day post-op PSA .19

Consulted with RO and initiated SRT w/ short term ADT

Over 2 1/2 yrs undetectable uPSA < .02 following completion of tx.

All tx at Johns Hopkins.

That's what I did and what I would do again.

Best wishes.

@zmarkv
Everything you just mentioned seems to agree with what I said about how Kwon treats cases. Rather than doing salvage radiation, he prefers to find metastasis and zap them. All those tests are used to find metastasis.

You might want to attend an ancan.org Weekly online advanced prostate cancer meeting, and ask about this.. Rick Davis who started ancan.org Has had people come in who want to Kwon And were under treated, and others who like his treatment. That might’ve been in the past because I’ve heard he’s now calling in more specialists in cases. He is a urologist, I know I would prefer having Dr. Heath a genito urinary oncologist making those decisions for me, With an advanced case.