PSA now .04. What might be next steps?

With a post-prostatectomy PSA of 4.7, what were the SUVmax scores from the PSMA PET scan of the cancers in the pelvic and abdominal nodes? That will let you know how serious the situation is and what you need to do next.

For now, you’re suppressing the cancer while coming up with a game plan to treat the recurrence.

@brianjarvis Thanks for your reply. The suvmax scores are high. Two index lesions in retroperitoneal nodes are 32 and 18. Two index lesions in pelvic nodes are 28 and 34.

@ucla2025 Has the discussion come up as to whether you’re a candidate from Pluvicto (Lutetium-177)?

That mix of drugs may last for many years without the cancer coming back. The drugs can actually shrink the metastasis down to where they can’t be found. I’ve had PC for 16 years and had four reoccurrences. I’m on the same drugs he is and I’ve been undetectable for 27 months. I have BRCA2, which makes my cancer very aggressive,

Your doctor may just want to wait until his PSA starts to rise again. What he’s doing now is working. There may not be a reason to do anything more for now.

I’m going to include a picture of someone that had multiple metastasis, went on ADT (Orgovyx), And the scan shows no metastasis . Your husband may be in the same situation and doesn’t need anything done right now. See what your doctor says, He may just be waiting until his PSA starts right And there’s something that visibly needs treatment. That could take years.

@brianjarvis Yes I mentioned it back in Nov. when we talked about chemo. The doctor said it could be a valid option but it wasn’t urgent. He wanted to watch the PSA going forward to see the response to the medications.

Hi...has your husband had a DXA scan yet? If not, that probably is in the cards shortly. As far as further primary treatment for PCa, you're most likely in a wait and watch mode until (unless) the PSA starts moving (or something whacky pops in the DXA) Hang in there & best wishes! 👍👍👍

There were 4 'visible' pelvic lesions by PSMA PETCT scans. Keep in mind the term oligometastsis. If less than 5 'mets' MAY allow the use of spot radiotherapy. (Stereotactic Beam RadioTherapy: SBRT) It may be more useful for 'mets' in other areas, such as bone. Medicine is an artfully application of science add to that fact is that there are several disciplines with differing training, and clinical experience, etc., ( surgeons (US), Physicians (MO), Radiation (RT) & occasionally interventional radiologists, and nuclear medicine docs.) Unseen in this mix are venal incentives which can becloud the clinical issues. I have even heard the expression, "... If you were my brother...." Have an advocate without a dog in the fight.

Listen to @jeffmarc. BTW in re: to his pre and post scan picture, the right image showed 4 areas in the neck that lit up after successful drug treatment. They are normal PSMA producing tissues, so not to worry there.

@mjp0512 Hi! Thanks for your kind response. Great tip re. the bone scan, I will ask about the DXA. Best wishes to you as well.

@jeffmarc Hi Jeff thank you so much for sharing your knowledge. That scan is remarkable. I assume at .04 PSA a scan wouldn’t show anything to radiate at this point? I wonder if insurance would even pay for one at this point. Anyway, seems like we are in a pretty good spot considering they did not want to radiate in the abdomen.

@thmssllvn Thanks so much for your thoughtful response. The RO we met with in Oct. did describe the situation as oligometastatic but wasn’t keen on radiating in the abdomen because of delicate structures nearby. Some members of this group suggested proton therapy which seemed feasible at that time but now I doubt if the lesions will appear on a PSMA. We have an appointment with the doc coming up this week so I will have lots to ask him. Thanks again for your help and encouragement.