Rise in Psa

That is a pretty big jump. If it rises next month (Hopefully, you are getting monthly tests) at the same rate, it’s rising now it is possibly a concern. The doubling rate is what they go by, If here is more than doubles next month, then having a serious discussion with your doctor is probably necessary. Hopefully, you are working with a GU Oncologist or a center of excellence. That’s what you need with your advanced cancer.

You did have a very aggressive cancer because of Seminal vesicle invasion. I also had surgery and radiation later. Mine came back because of BRCA2. It seems that people more frequently find prostate cancer in a bone at this point, If it comes back.

Your cancer can be controlled for a long time. Mine is very aggressive and I can’t stop the drugs, but I’ve been on them for eight years and my PSA has been undetectable for 20 months after 15 years. I was on abiraterone for 2 1/2 years, It kept my PSA down, but it was not really my friend, PSA kept jumping around from .2 to .7 and back., A lot of heart issues. I’m on Nubeqa Now and it really works well and no side effects for me.

Next month your PSA could settle down, That happens!

You went from 0.01 on a hundredth scale to 0.058 on
a thousands scale talk to
your doctor about assements on different scales.
Scott

As a layman with a similar history, I think that 1 or more tests are wise to see a trend. I'm sure that I would begin with my RO who delivered my SR, and likely ask to consult with a MO.
My understanding is that I would want to keep as many things constant as possible, including testing at the same lab, and personally all my quarterly PSA tests are at about the same time of day, in my case around 8:00 am.
Best wishes. I am a bit over 24 mos post Salvage Treatment for persistent PSA following RP. And of course you are asking about our fear, which is rising PSA.
Please have good luck and perhaps share your future results.

I guess I’m looking at two options. 1) Start back on ADT and over the years change drugs as they become ineffective and how for a break through somewhere down the line. 2) be aggressive now. Wait for PSA to rise a little more, have scans to locate legions then zap the with radiation, start ADT, and throw in chemo (ala Dr Kwon) and hope for long term remission or cure.

Thoughts?

Looks like you’ve been watching PCRI videos. Scholz and Moyad talk a lot About the best approach to metastasis. Scholz Said that he finds people can get their metastasis zapped and the cancer goes away (or is under control) for many people. Your PSA is too low for you to really benefit from a PSMA Pet scan. As you Mention, You gotta wait for your PSA to rise some more so they can see the metastasis. The problem is they can’t see them until they become larger than 2.7 mm and in some cases, even 5 mm is not enough to be able to find them (According to UCSF RO).

Yes, you can start with ADT and rotate the drugs in a way that reduces the chance of becoming castrate resistant. You could also stay on ADT and ARSI drugs for many years, I’ve been on them eight years and I’ve been undetectable for 20 months. Doing this stops the cancer from growing and shrinks it in most cases.

A lot of this depends on how aggressive your cancer is. If someone has multiple metastasis then that treatment plan may not work. In that case, getting on two different levels of drugs can stop your cancer from growing, but other treatment is necessary. Fortunately You are not in this position.

The question is, if I take the aggressive route, do i have a good chance of then having many years or maybe a lifetime of no more treatment necessary? If I go the lifetime of various drugs route I’ll have to live with the ADT limitations the rest of my life. I’m only 63, so if I could have 5-8 years of feeling like myself again, I’d take the risk if I thought i had at least a 50/50 chance of success.

The problem is you were in Gleason eight. Your PSA has already risen significantly in one month. You could wait and see what happens. Your PSA is not that high. You could wait till it reaches .1 to consider starting drugs.

As I mentioned the metastasis, don’t always show up on schedule. I know a few people who stopped there treatment after a year or two of .01, But they ended up with a lot of metastasis After taking a break. I know A few people this has happened to.

If you plan on holding off on the drugs, then getting a PSMA pet test once you hit around .4 that may work, but the metastasis may not wait.

If you are really insistent on doing this, you should consider contacting Doctor Scholz In Marina del Rey. Pay for a visit and find out what he thinks about your idea. He’s the biggest proponent of this technique. You are taking a chance with your cancer and you may want to get an expert opinion on it. He can review your case and tell you what he feels your best decision would be.