Postop pathology to ChatGPT & asked about BCR. Anyone done this?

@surftohealth88 you make great points about taking it one day at a time. Thanks! Honestly though I don’t know if every month PSA tests are necessary but every 12 weeks is my guidance from my urology oncologist at Johns Hopkins. I will keep that regimen for the next 3-4 years. And your thoughts On when to take action is spot on too - I don’t plan to wait to the textbook defined 0.2 BCR. If I have three consecutive climbs and/or it ever reaches 0.1 I’m jumping on salvage treatment - there is no reason to wait if it’s confirmed after being non detect. Hopefully we all can manage to escape BCR indefinitely!

What causes you to have a psa of 3.26 10 weeks first psa test after surgery?

@wert1234
This would happen if there were more metastasis in your body than were found before the surgery. Did you have a PSMA Pet test before you were having a prostatectomy?

10 weeks after surgery your PSA should be Undetectable if it’s not then you need to speak to a doctor right away and get some testing done. The only possibility I can think of would be if your PSA were over 500 before surgery and has not gone down all the way yet, But I don’t think that really would happen anyway. Removing the prostate should’ve dropped it to undetectable.

A PSMA pet test would be the first thing Most doctors would. Your PSA is high enough that it should show whatever is going on.

What you were having is unusual, It just sounds like somebody did not do the proper testing to see what was really going on Before doing surgery.

@jeffmarc yes psa was 13.26 before surgery and now first check 3.26. Had nerve sparing RP. Gleason 4+3 - 7 , grade 3 , perinatal, seminal vessels, invasion , lymphatic invasion, and some crib pattern . Also had 19 lymph nodes taken out all neg for cancer

It is quite possible that all of the prostate cancerous tissue was not removed. It happens occasionally. It happened to me as well as a friend that worked with me.

@wert1234
You really need to get a PSMA Pet scan. Your PSA is so high that it should really light up what’s going on.

Your PSA should’ve become undetectable.

You are beyond even the high point where salvaged radiation would make sense. I’m gonna post the recommendations for salvage radiation after a prostatectomy just so you get an idea about what’s going on.

I’m one example, After my prostatectomy, my PSA did not rise for 3 1/2 years when it hit .2 my doctors gave me a Lupron shot and two months later I had salvage radiation. I can’t tell you how many people I know that I’ve had the exact same thing either less time or more time after the surgery. I’ve almost never hear about somebody having a PSA as high as yours after the surgery.

Here is that info on when to do salvage radiation after a prostatectomy. ASCO Is the American Society of clinical oncology.

From Ascopubs about what PSA to do salvage radiation.
≤0.2 ng/mL:
Starting at this level maximizes disease control and long-term survival. Patients treated at PSA < 0.2 ng/mL achieve higher rates of undetectable post-SRT PSA (56-70%) and improved 5-year progression-free survival (62.7-75%).
Delaying SRT beyond PSA ≥0.25 ng/mL increases mortality risk by ~50%.
0.2–0.5 ng/mL:
Still effective, particularly for patients with low-risk features (e.g., Gleason ≤7, slow PSA doubling time). The Journal of Clinical Oncology recommends SRT before PSA exceeds 0.25 ng/mL to preserve curative potential.
0.5–1.0 ng/mL:
Salvage radiation remains beneficial but may require combining with androgen deprivation therapy (ADT) for higher-risk cases.

This article discusses the above;
https://ascopost.com/news/march-2023/psa-level-at-time-of-salvage-radiation-therapy-after-radical-prostatectomy-and-risk-of-all-cause-mortality/

@jeffmarc I saw you had RARP & about 3.5 years later had BCR & SRT. Do you think or have read anything indicating BCR would have been prolonged or not at all if you had RT initially instead of RARP? I ask because RT gets prostate & surrounding tissue in case some adenocarcinoma has escaped.

@lyricw
My father had radiation to start with, He died of prostate cancer at 88, a very painful death. He did not have BRCA2, which I got from my mother.

The surgery gave me 3 1/2 years, I probably would not have gotten that much extra time if I had just had radiation I only got 2.5 years of remission after the radiation.

The way I figure it is that my regiment of one treatment after another gave me 16 years so far. I don’t think I would be so lucky if I had started with radiation. At this point Nubeqa Has given me 27 months undetectable. When that stops working, I can get a PARP inhibitor and then Move on to Chemo and/or Pluvicto. By that time, maybe they’ll have a cure or another major drug to extend life.

In my case, I think the BRCA2 would’ve continued to allow the cancer cells to Propagate No matter what I started with.

Your case may be very different. If you’ve got a low Gleason score radiation may work.

@harvey44 With your friends case . What did they find out ? Lymph nodes and left over prostate tissue?

@wert1234 Jeff Marchi’s reply below is as good as it gets.