Rising psa 15 years after radiation: Is cancer back?

Sounds very logical at this point to get a PSMA-PET scan to see if some prostate cells are somewhere . Now , when was you last PSA 's . What were they ? Gleason score is. ? Best of luck with it all , sounds like your doing the right thing and your Dr is on the ball ! God Bless . James on Vancouver Island.

The PCRI conference had doctors discussing what to do with reoccurrence. While salvage radiation has been the standard for quite a long time, the doctors there said that only 1/3 of the cases of reoccurrence were result of metastasis in the area where salvage radiation was done.

It was highly encourage that people who have raised PSA get PSMA Pet scans to find out where the metastasis actually are. 2/3 of people will not benefit from salvage radiation they claim. The doctors recommended finding the metastasis and zapping them with SBRT radiation. They feel that in many cases that can cure the patient.

Exactly. I'm not saying it's wrong; just that it's unvalidated (sort-of an inside tip that might or might not pan out after peer review).

We do know (I think) that PSE is mainly for reducing false positives: that is, it won't make the PSA test more sensitive for actually finding a problem, but it can help us filter out false alarms.

So if you've had a prostatectomy or radiation at some point in the past and your PSA is undetectable or stable, as far as I understand, PSE would add no benefit; but if your PSA has suddenly changed from (say) 0.2 to 1.5 over the past year, PSE might add some extra info to help you and your oncology team decide whether you need to do anything about it yet (again, not sure if this use has been peer-reviewed yet).

+1 here. I had my spinal metastasis radiated (even before the prostate itself), and one of my oncologists suggested that might be one of the reasons why I've been in remission so long. Of course, that's just their professional hunch, not scientific evidence.

It seems to be best practice now for treating oligometastatic prostate cancer to radiate the metastases as well as the prostate. For polymetastatic, of course, that's not practical, so that's where chemotherapy and/or Pluvicto and/or new emerging treatments like immunotherapy come in.

What all the new approaches have in common is hitting metastatic prostate cancer early and hard, instead of the old-school approach of using one treatment until it fails (e.g. radiation to the prostate), then the next (e.g. ADT), then the next (e.g. an ARSI), then the next (e.g. chemo), etc. We seem to be getting better outcomes from attacking the cancer hard and early, from multiple directions all at once.

Standard disclaimer: layperson writing here

Hi Jeff, building on another of your excellent posts, what benefit will a PSMA give if the smallest area of metastasis it can “see” is 2.7mm?
How can SBRT be done on micrometastases?
And how many men in this forum with rising PSA’s - some as high as double digits - have NO evidence of presence of cancer anywhere in their bodies.
It seems that the “experts” are speaking out of both sides of their mouths: have PSMA’s to spot the 66% of cancer that resides outside the salvage treatment area….oh, and by the way, PSMA can’t really find it anyway….WTF??

This is a real conundrum. People have their PSA rising, The test don’t find it, Salvage radiation can’t kill it. and people are left with anxiety because they have no idea where their cancer actually is.

The one positive thing about this issue is that ADT and ARSI’S will usually suppress the growth of those mini metastasis for many years. At least that leaves the people that are having this issue with a stopgap that can possibly allow them to live long enough for the next major cancer treatment discovery. Of course there is the health and lifestyle issue of taking those drugs, we need better options .

The other option is to listen to what Doctors Scholz and Moyad have to say.

1. When PSA rises but can’t be found in the PSMA Pet scan, do an MRI, it will be found in Retroperitoneum or lung with high frequency

2. Having a metastasis doesn’t mean you can’t be cured. He has people who’s metastasis were just Zapped, and when some came back, did it again. In some cases people don’t come back, Somethings he stressed a lot. Waiting for the metastasis to show up and zapping it was, in their opinion, more effective than salvage radiation.

I’m not recommending anything, remember folks I’m not a doctor, I am just pointing out a way of seeing these options.

https://airomedical.com/blogs/treatment-guides/what-is-better-actinium-radium-or-lutetium-for-prostate-cancer

Great explanation of the different bone mets drugs, Mel. They all work, more or less.
Phil

I understand that you are only the messenger, but what they’re saying is really SO different from what we’ve all been told. Basically, they’re saying that SBRT to a lesion is more effective than salvage radiation because you can see it - it’s targeted.
But if there is a mass (greater than 2.7mm since PSMA can detect it) that you CAN see, it has to mean that there are micrometasteses that you CAN’T.
Isn’t that the current thinking? Or not? Are they including ADT in the treatments? Salvage radiation, at the very least, will take care of residual cells in the prostate bed and pelvic nodes - a site which if left untargeted will be a cause for treatment failure.
I know these are two highly respected men and I’ve watched a few of their YouTube videos. Personally I’ve found Scholz very blase’ and somewhat wishy-washy in his approach - almost like, why treat at all? It’s weird…probably more my problem than his!
Phil

Yes I did radiation 39 times in 2017 March Make sure last 5 are RAPID arch to get the margins

Then get on Cosedex and later Zolodex injections to stop testosterone the fertilizer of PC

In 202 it metastases to my bones Then its Stage 4 and not curable Only controllable

I have been on Xtandi, Radium 223 , 2 sets of Chemo and now Abiraterone with Prednisone as well as Xgeva injection every 3 moths

Google all these

Next year LU 177 Pluvicto

Pray It does not come back @northoftheborder @heavyphil ill