PSA rise

I had very little problem with ADT, mostly low energy. You are a little older than me but not by much. If I was in your situation I would give ADT and Androgen inhibitor ( ie Erleada ) a try and see what side effects you have. If you find that it is not worth it, then act accordingly. Good Luck young man!!

Congratulations on 17 year survivor! While the information and experience of you father-in-law is interesting and could be taken into consideration, just know that his genetics isn't yours, so I would discount that scenario. My grandfather caught his prostate cancer late when he was 69 and died 7 months later.

Early detection equates to options, that is good rule of thumb. I would be curious to learn the Gleeson Score of the post surgery pathology, but in either case your PSA increases are a sign that the small traces in the neck are likely growing and will continue to grow, and the fear is that it spreads into your bones and/or organs. When/if that happens, you are dealing with a different scenario.

Side effects of ADT are something that I only know from experience and also online interactions, and I don't think anyone gets a free-pass to no-side-effects, but it does come in ranges. Your age is awesome (I had surgery at 41 and now in ADT for the past 9 months and I'm 52) so it is hard to relate to your scenario.

What if you went on ADT for a few months, the PSA dropped to undetectable levels, and you had average side effects, then you would know what is possible for you, as you can always stop it.

Definitely seek out more input, you will make the right decision and truly awesome that you are 84 and kicking it!

hmm... When you have prostate surgery, PSa should be undetectable, amy increase after that above .2 is considered BCR and depending upon clinical data, GS, time to BCR, PSADT and PSAV, imaging results, co-morbidities and personal preferences - quality versus quantity of life, come into play,

Somewhat surprised when you say bounced from 4 to 7.1 that no imaging was done prior to that.

i expect you are consulting with a radiologist and oncologist.

I have no idea about whether radiation to the neck is a possibility, your radiologist should discuss that with you.

As to the ADT, if you and your oncologist determine it is something to do do, perhaps Orgovyx is an option, treat for six months, then see what the clinical data is, PSA, data if you decide to image again and decide whether to stop and monitor, or continue for another six months and assess...

I say Orgovyx because it has significant advantages over other ADT...

Faster castration
Higher sustained castration while on treatment
Lower CV side effect profile
Faster recovery of testosterone once stopped.

While the data of your father in law is interesting (my ex father in law lived to be a few days short of 100 after being diagnosed with PCa around age 90 but his PCa is not my PCa)

Kevin

I had spread of my PC to lymph nodes twice. First time I had three lymph nodes in pelvic region. Got 39 sessions of Radiation and did pretty well. After 4 years with an undetectable PSA, cancer is back . A PSMA PET SCAN showed a small nodule in paraortic region. Got radiation again. But only 5 sessions now. Getting repeat PSA in August. Bottom line: you need treatment. For sure. Wish you the best.

PSA

Note:
10/20/2023 PSA was 20
06/13/2024 PSA was 27
07/09/2024 PSA was/is 33

Digital exam: Prostate size not enlarged

Does anyone know what else can generate the above PSA numbers?

The next decision is the biopsy. If all else is normal with the prostate, I question the decision/option of the biopsy. If the decision is to go forward, the question moves to which biopsy format. Any thoughts/guidance would be appreciated.

Thank you in advance

* * *Final Report* * *

DATE OF EXAM: Jun 13 2024 12:00AM

OUT 0001 - MR OUTSIDE CD DICOM IMPORT -NBNR / ACCESSION # 154275465

PROCEDURE REASON: The previous report is inadequate.

* * * * Physician Interpretation * * * *

EXAMINATION: OUTSIDE IMAGING INTERPRETATION

Indication for the Request / Reason for Overread: Previous report is
inadequate.

Service Requesting Consult: Urology

Any specific Issue(s) to be discussed: PROSTATE BIOPSY TARGETING NEEDED
FOR TRANSPERINEAL BIOPSY

Images Reviewed: MR without and with contrast of the Pelvis performed on
6/13/2024 12:00 AM

Overread Date: 7/1/2024 9:41 AM

CLINICAL HISTORY: 76 years old being evaluated for prostate cancer. No prior biopsy.
Previous biopsy: None.
PSA: 20 ng/mL (10/20/2023) ;
Prior therapy: None.

COMPARISON: None

RESULT:

Prostate:

Dimensions: 4.6 x 3.8 x 3.4 cm corresponding to a volume of approximately
31 cc.

Post-biopsy hemorrhage: Absent

Peripheral zone: Diffuse mild T2/ADC map hypointensity (PI-RADS 2).

Transition zone: There is transition zone hypertrophy, without focal
abnormalities suspicious for clinically significant disease (PI-RADS 1).

Neurovascular bundle: Unremarkable.

Seminal vesicles: Unremarkable.

Adjacent Organ Involvement: Not applicable.

Lymph nodes: No enlarged pelvic lymph nodes.

Bladder: Unremarkable.

Pelvic bones: No suspicious pelvic osseous lesions.

Other Findings: There are bilateral moderate-sized fat-containing
inguinal hernias.

IMPRESSION:

1. No suspicious prostate lesion. Maximum PI-RADS category: 2.

2. Prostate volume is approximately 31 cc.

==========================================
Number of targets created for MR/US fusion biopsy:
Full gland segmentation performed in Koelis to permit nontargeted
transperineal fusion biopsy.
Peripheral zone: 0
Transition zone: 0

If present, targets were numbered in order of level of suspicion for
clinically significant prostate cancer (Gleason score 3 + 4 or higher).

PI-RADS v2.1 Assessment Categories:
PI-RADS 1: Clinically significant cancer is highly unlikely
PI-RADS 2: Clinically significant cancer is unlikely
PI-RADS 3: Clinically significant cancer is equivocal
PI-RADS 4: Clinically significant cancer is likely
PI-RADS 5: Clinically significant cancer is highly likely

(V.05.2019)

A biopsy really is indicated just to be certain. Go with the TRANSPERINEAL by an experienced urologist. Not only is it painless (when done properly with nerve blocks or sedation) but it is also more accurate since it can access more of the gland and get samples that might be missed by transrectal approach and give you a false negative result. Just my opinion based on my experience. Best of luck going forward!

Just a thought. I had my first PSA encounter in 2003ish. Bit concerning was the term used by the primary care doc, led to 5 years of visits at 6 months intervals. Then she quit being a doc and changed career paths, college professor. 2011ish, New Doc, BPH official diagnosis, watchful waiting for a couple of years. Watching stopped when that doc got himself fired from the hospital. New Doc, Covid, PSA rising, monthly checking labs; 4, 6, 22, 24, 134. Diagnosis stage 4 advanced, discovered in ER, oh the pain. six months of it. First Oncologist was wonderful, accompained by a VA Oncologist Saint. Radiation, Dox Chemo, ADT, PSA in steady decline for 3 years. Now it's back on the rise. Lots of lessoned learned along the way. First, Switched to OHSU (Oregon Health Science University), trusted DOCs, great research, they work with VA, epically helpful every step of the way. Like I said, my PSA is rising again, total confidence in the OHSU oncology team and oncologist. On deck for a trial in a few weeks. Exciting. Learning to live with cancer is the key. Yes some side effects, but these old bones are up for the challenge. Movement, Mild Exercise, Watchful Nutrition, Be Social, and Be Caring, help a lot. We've got this.

In my mind, this prostate has cancer until proven otherwise. Biopsies, even 12-20 random pokes, will be more sensitive than MRI. An MRI is basically shadows created by a computer based on the effect of changing the spin of hydrogen molecules in tissues ... pretty indirect, and level of resolution is less than the microscopic vision of the actual cells themselves which the biopsy obtains.

I'm not a doctor and I don't play one on TV but I would take lupron shot once every 6 months and boost it with medication called ztandi taking everyday. My PSA is zero. I also dropped any and all sugar for my diet. I am 68 and have not had any really noticeable side effects from doing that.