1. < Prostate Cancer

Rising PSA years after radical prostatectomy

Posted by olanordman @olanordman, Feb 22, 2021

I am 60 years and I had radical prostatectomy on 23rd Nov 2018. I was told out of the 15 lymph nodes taken only one was affected less than a millimetre. It was Gleason score 7B with PSA around 13 at time of surgery but 11 at time of diagnosis in June 2018.

The PSA been fluctuating between 0.09 and 0.18 since surgery on 23rd November 2018
I have no incontinence as well as Erectile dysfunction. I take hypertension medication – Norvask Amlodipine 5mg daily and Cetirizine 5mg for allergy. Below are some of the test results. I have many of these test results – a few below
Jan 2019: 0.11
April 2019: 0.11
June 2019: 0.09
August 2019: 0.12
December 2019: 0.12
April 2020: 0.12
August 2020: 0.11
October 2020: 0.17
December 2020: 0.15
February 2021: 0.18

I am worried the cancer may be returning or might have spread. I met my doctor today and expressed my concerns. He has agreed to refer me to the hospital where I had the surgery. Any suggestions based on this brief history?

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heavyphil | @heavyphil | 10 hours ago
In reply to @jackiepie "This is an update of a previous post that I submitted on Nov 12, 2023. Since..." + (show)
@jackiepie

This is an update of a previous post that I submitted on Nov 12, 2023. Since then I have had two more PSA tests: 0.11 on 1/02/24 and 0.10 2/07/24; my Decipher test score came in at 0.36 (suggesting low genomic risk).
I have consulted with a medical oncologist, two radiation oncologists and my urologist. All four feel that the PSA results suggest that there is, or will be, a biochemical recurrence depending on the definition of biochemical recurrence one uses. The medical oncologist said that based on the Decipher result, no hormone treatment is necessary with salvage therapy at this time.
This coming week I will undergo a PET/CT tumor PSMA(w/Dose) to see if the cancer can be detected. At this low level of PSA it seems unlikely to me that they will find anything. If that turns out to be the case and because I had (three) positive margins after the prostatectomy, I think the radiation would be mainly confined to the prostate bed.
My concerns are two:
1) Should I go ahead and undergo salvage radiation this spring, or wait a bit, perhaps, until the fall to do it? The Decipher score suggests that my cancer is not aggressive and the PSA doubling time does not appear to be that fast (see my Nov. 12 post for more PSA results). On the other hand, the sooner I get this treated the higher the probability of curing the cancer.
2) Should I do photon therapy (EBRT)or proton therapy? Both approaches appear to be of equal effectiveness but the proton therapy supposedly has less side effects. Proton therapy is expensive and I would have to check that it would be covered by my insurance. In addition, the nearest proton therapy location is about 60 miles (about 70 minutes) away while the nearest photon therapy is about 6 miles (12 minutes) away.
I mainly worry about the side effects from salvage therapy. I have no urinary incontinence nor bowel issues from the prostatectomy and I certainly want to avoid them. I do understand however that salvage therapy can cause such issues. I could not find any data on the percentage of people who have these issues after salvage therapy.
Any thoughts or advice from the many who have faced these issues would be greatly appreciated,

Jump to this post

Jackie, Just finished salvage radiation (25) and 6 mos Orgovyx. No major issues to report. Some extra BM’s first week or so after completion of therapy but all resolved now. No Urinary issues at all.
ADT is controversial - especially for G6’s and low Decipher scores; however, anything that “comes back” is tougher than G6 would imply, right?
Also, be absolutely sure you get radiation to the pelvic lymph nodes as well - something like 35% failure rate in salvage therapy if the nodes are not treated. Best.

REPLY
gkm | @gkm | 13 hours ago
In reply to @scotth22 "Recently (1 month) had a detectable PSA (.25) after 8 years of non-detectable. Met with oncologist..." + (show)
@scotth22

Recently (1 month) had a detectable PSA (.25) after 8 years of non-detectable. Met with oncologist who wants PET followed by radiation and hormone blocker (6 mo). Any thoughts on the importance of the hormone blocker?

Jump to this post

I believe the Standard of Care treatment when you encounter recurrence is to combine 6 months of ADT with salvage radiation.

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hbp | @hbp | 1 day ago

I would want another PSA test done by the same lab to confirm that there really is an increase

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scotth22 | @scotth22 | 1 day ago

Recently (1 month) had a detectable PSA (.25) after 8 years of non-detectable. Met with oncologist who wants PET followed by radiation and hormone blocker (6 mo). Any thoughts on the importance of the hormone blocker?

REPLY
1 reply
ddun1953 | @ddun1953 | Mar 5, 2024

I was told to have a PSMA Pet Scan done if the PSA reading was over .2. At that point, see where any spots are and if where the prostate was, Lupron Shots and if outside where the prostate was then use Targeted Beam Radiation at the spot location and poison the little bastar--
My Surgery RP was Aug. 3rf and first BW reading was .022 and the second one was. .061
My only son just got diagnosed with Paraganglioma at age 41 and healthy bumped out badly.

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jsh327 | @jsh327 | Mar 5, 2024

….there are also several online resources at PCF and PCRI that discuss treatment options for this specific situation.

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jsh327 | @jsh327 | Mar 5, 2024

I recommend getting an appointment with an oncologist that specializes in prostate cancer. You are presently below the recurrence threshold of 0.2 ng/ml, but the rising trend means it is time to discuss treatment options with a specialist that can talk you through them. With the slowly rising PSA, you have time to discuss and decide on your next treatment.

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Scottyrussell | @scottyrussell | Mar 5, 2024

You probably have read enough but here’s my take on your rising PSA from experience, your doubling factor is 2+ years and you are not yet at the lower threshold of a PSA of .2. From my experience this is a monitor situation. Good luck and don’t hurry the situation. Mine came back and diagnosed as an aggressive recurrent prostate cancer. I had 39 radiation treatments and the anti hormonal shot Lupron. I tell you that it is NO walk in the park. My best to you and the person who is your support person.

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bettwils16 | @bettwils16 | Mar 4, 2024

Need a PSMA PET Scan, might be a biochemical recurrence in the prostate bed. My PSA slowly climbed to .24 a few years after a Robotic Prostatectomy. PSMA was neg. I received 38 radiation treatments, PSA now .02 for a year now.

REPLY
michaelcharles | @michaelcharles | Mar 4, 2024
In reply to @jackiepie "This is an update of a previous post that I submitted on Nov 12, 2023. Since..." + (show)
@jackiepie

This is an update of a previous post that I submitted on Nov 12, 2023. Since then I have had two more PSA tests: 0.11 on 1/02/24 and 0.10 2/07/24; my Decipher test score came in at 0.36 (suggesting low genomic risk).
I have consulted with a medical oncologist, two radiation oncologists and my urologist. All four feel that the PSA results suggest that there is, or will be, a biochemical recurrence depending on the definition of biochemical recurrence one uses. The medical oncologist said that based on the Decipher result, no hormone treatment is necessary with salvage therapy at this time.
This coming week I will undergo a PET/CT tumor PSMA(w/Dose) to see if the cancer can be detected. At this low level of PSA it seems unlikely to me that they will find anything. If that turns out to be the case and because I had (three) positive margins after the prostatectomy, I think the radiation would be mainly confined to the prostate bed.
My concerns are two:
1) Should I go ahead and undergo salvage radiation this spring, or wait a bit, perhaps, until the fall to do it? The Decipher score suggests that my cancer is not aggressive and the PSA doubling time does not appear to be that fast (see my Nov. 12 post for more PSA results). On the other hand, the sooner I get this treated the higher the probability of curing the cancer.
2) Should I do photon therapy (EBRT)or proton therapy? Both approaches appear to be of equal effectiveness but the proton therapy supposedly has less side effects. Proton therapy is expensive and I would have to check that it would be covered by my insurance. In addition, the nearest proton therapy location is about 60 miles (about 70 minutes) away while the nearest photon therapy is about 6 miles (12 minutes) away.
I mainly worry about the side effects from salvage therapy. I have no urinary incontinence nor bowel issues from the prostatectomy and I certainly want to avoid them. I do understand however that salvage therapy can cause such issues. I could not find any data on the percentage of people who have these issues after salvage therapy.
Any thoughts or advice from the many who have faced these issues would be greatly appreciated,

Jump to this post

Additional and very personal/individual feeling to share about ADT.

As a PCa suffer, I worry about what I do, as well as what I do not do.

No one wants ADT. Side effects are reported on this site as anywhere from minor to significant.

My SEs from Orgovyx were mild to moderate.

Accepted my Rad Onc's recommendation of 4 mos of ADT. And did not ask for more/longer course.

And I worry if I should have asked to extend ADT by additional 2 months.

I would have worried if no ADT had been recommended.

Best wishes for your choices.

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