PSA levels started to rise again but negative PSMA PET

The standard is that if your PSA rises to .2 After a prostatectomy You should have salvage radiation. That’s because the most likely place for the cancer to grow is the prostate bed. You might have micro cancers grow there that can’t be seen on a scan.

I’m a little suspicious of your medical team. Why have they let this go so long without salvaged radiation?

Who is treating you? Are you going to a Center of excellent, Or are you working with a Genito urinary oncologist?

It would sure help to know what your Gleason score was, As well as other details that we’re in the biopsy following the prostatectomy.

You might be a statistical event. Kujayhawk previously posted a table on scan accuracy at undetectable or very low psa. Maybe only 10 or 20 percent accuracy. with higher accuracy as psa increases. Just a thought.

@thepilotusa

You might want to take the PSE test, which works before or after treatment for prostate cancer to determine whether you have a biological reoccurrence. The company that makes the test, Oxford, Biodynamics, and their VP of their clinical department Joe Abdo, is willing to be contacted to answer any questions. His email address is. Joe.Abdo@oxfordbiodynamics.com.

Here is a quote from him regarding the PSE test that he made on this website:
“Just to clarify, the EpiSwitch PSE test analyses immune cells in the blood that have been at interplay with prostate cancer (or not). Your PSA value only makes up a small portion of the results of the test. There are other very informative biomarkers assessing the presence or absence of PCa included in this test. So yes, EpiSwitch PSE can still be used with a very low PSA score, and can still detect prostate cancer without PSA shedding. Therefore, the test can be used before, after and during treatment - even after complete prostate resection. In your case, a 'low likelihood' result could potentially help you avoid things like PSMA scans if your PSA indeed rises over time. A 'high likelihood' result could be indicative of recurrence, irrespective of low PSA."

Imaging unfortunately is not perfect.
I had Salvage Radiation Treatment w/a short term of ADT after RP when PSA was .19 at the 3 mos postop test.
See SPPORT trial.
Best wishes.

Maybe switch agents?

2010 proton radiation for slow growth prostate cancer. PSA was 6.47; Gleason 3+3. Six years ago my PSA began to rise. I had a PET scan three weeks ago. As you know, the procedure includes injecting radioactive substance into the bloodstream. This radioactive substance binds to cancer cells in part because of the high protein cell configuration.

The result was nothing. The PET scan was from the knees to the eye area. The radiologist comments on the size of the heart (as normal), lungs, colon, and other organs as totally normal without any issues. It did detect a slight enlargement of the right thyroid gland.

Bottom Line: There is a natural increase in PSA during the aging process. Also, issues like BPH or an enlarged prostate can elevate the PSA readings. The PET scan is the most scientific research option for the discovery of prostate cancer. If cancer is a no go on the PET scan, then assume there is none.

This is where things get more complicated.
About 15% of prostate cancers do not express PSMA (or very little PSMA). (This is referred to as being PSMA-negative or PSMA-naive.) So PSMA PET scans won’t even see them even though you suspect something is wrong due to the rising PSA.

Has your doctor recommended using an older type of PET scan, one that isn’t dependent on PSMA - like the older Axumin or Choline C11 or FDG PET scans - which might be able to detect the location of the recurrence that is causing your PSA to rise? (Mayo Clinic often uses the older C11 Choline PET scan in these situations.)

Dr. Kwon (of Mayo Clinic) indicates that only 1/3 of men who have recurrence following prostatectomy have recurrence only in the prostate bed, and that they should not get salvage radiation there unless they’re absolutely certain of the location of recurrence. You always want to first confirm where the recurrence is. (See Dr. Kwon’s presentation about recurrence:

Sir , normally at 0.5 or 1.12 PSA targets should show up . Hmmmm I would discuss salvage radiation with your team . Maybe 20-25 sessions ? Some PC's dont show up with a high degree of PSA numbers but is there . Also remember this PSA reading could be from healthy cells too ! But I bet if you had pelvic radiation- you could benefit from it . Ask you team and get a second opinion on this . You have PSA producers somewhere .... 90% in the pelvic region usually . Let us know ! James on Vancouver Island .

You should ask for an MRI it may show what the PT Scan cannot see.?

The PSA rise could be due to cancer that doesn't show up on the PSMA PET. Not all prostate cancers display PSMA and therefore don't show up on a PSMA PET scan. Dr. Kwon at Mayo Rochester has had my husband with Stage 4 PC do C11 choline PET scans before and after negative PSMA PET scans to check for cancer that doesn't display PSMA, including during and after Pluvicto treatment. Ask your team about getting an alternative to the PSMA PET if it is negative but your PSA is rising.