PSA detectable 18 mos after prostatectomy

Hey Perry, your situation, unfortunately, is all too common. You can get all the boxes checked off and still come up with a recurrence - I did too…
Mine took 5 yrs (Gleason 4+3 unfavorable) to recur; I did 25 tx IMRT with 6 mos ADT. Not bad at all. Diet, exercise and some SE’s were bothersome but totally do-able.
I just want to add to what chippy said about rectal spacer. I, too, wanted one but my RO said no because of the possibility of cancer cells near the rectum - he did not want the beams blocked by the spacer.
I know right now you are depressed and disgusted but please focus on the fact that this is your second chance to beat this. If you had radiation first (which many men have), you’d be facing a lot of ADT for a much longer time, possible doublet therapy, and risky salvage surgery as a last resort.
Also, be SURE to have your pelvic nodes irradiated as well - look up SPORTT trial for more info - not just the prostate bed.
Best,
Phil

Well, more bad news for me as my PSMA pet scan results came in. My bcr .24 3 years after prostatectomy resulted in this. Images of the prostate demonstrate a focus of increased uptake to the right midline in the inferior aspect of the prostate with a maximum SUV of 4.1 suspicious for malignant disease. Musculoskeletal: There is a prominent focus of increased uptake involving the left first rib with a maximum SUV of 6.3 for which metastatic disease cannot be excluded. This is associated with sclerotic changes, compatible with metastatic disease. My Urologist/surgeon wants to discuss rib finding with my Oncologist and pet scan reading physician to determine if rib finding may be a false positive!! I have meeting with Oncologist tomorrow.

Well, more bad news for me as my PSMA pet scan results came in. My bcr .24 3 years after prostatectomy resulted in this. Images of the prostate demonstrate a focus of increased uptake to the right midline in the inferior aspect of the prostate with a maximum SUV of 4.1 suspicious for malignant disease. Musculoskeletal: There is a prominent focus of increased uptake involving the left first rib with a maximum SUV of 6.3 for which metastatic disease cannot be excluded. This is associated with sclerotic changes, compatible with metastatic disease. My Urologist/surgeon wants to discuss rib finding with my Oncologist and pet scan reading physician to determine if rib finding may be a false positive!! I have meeting with Oncologist tomorrow.

I am so sorry that you have to deal with it again : (((. I am just little bit confused - did you have your gland removed initially ? If yes, how is there an " image of the prostate " (???) that demonstrates a focus of increased uptake of the ...(etc.) ? My husband is having RP soon so I am trying to understand your case. Thanks in advance for explanation.

Yes. I had my prostatectomy on Aug 4, 2022. The uptake was in the prostate bed, where the prostate used to be.

Thanks. Still trying to get Decipher test ordered. Doctors office lost it. My BCBS doesn't cover Orgovox supposedly but covers injectable ADT.......
Weird it's my first rib. A long way from prostate. Another question for Oncologist.

I am so sorry that you have to deal with it again : (((. I am just little bit confused - did you have your gland removed initially ? If yes, how is there an " image of the prostate " (???) that demonstrates a focus of increased uptake of the ...(etc.) ? My husband is having RP soon so I am trying to understand your case. Thanks in advance for explanation.

As he said in the prostate bed. Cells can leak out of the prostate and get left behind in the margins. It just isn't that uncommon for cells to get left behind and then radiation in 2 years once you hit BCR. Knowing what I know now I might have opted for proton radiation instead of removal. 2 friends just made this choice based on the number of men having to go back after RP for ADT and radiation due to this.