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?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

I know this was for someone else but...my PSA was .091 (without a prostate) when I was referred for salvage radiation (SRT) treatment. 3/4s finished at this point

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@scullrower

I’m with kujhawk. Get the best imaging you can as soon as you can. I was fortunate enough to get the PSMA Gallium68 scan at PSA 0.10 and 4 cancerous lymph nodes were found. I got radiation and went on Nubeqa. Latest PSA <0.008. Good scans lead the treatment. Don’t treat blindly. If you can, get an opinion from Dr. Kwon at Mayo. He’s aggressive. I love his attitude.

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Hi, thank you for your response. A PSMA Pet scan is going to be ordered once insurance approves. PSA now 0.24 and Radiation Oncologist (met today) suggested 39 Radiation Treatments. Once the PSMA results in, would like to go to the Mayo for second opinion. How did you do with Radiation Treatments? Thank you!

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@web265

I know this was for someone else but...my PSA was .091 (without a prostate) when I was referred for salvage radiation (SRT) treatment. 3/4s finished at this point

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Hi, you only needed 4 SRT's?

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@bettwils16

Hi, you only needed 4 SRT's?

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Sorry about that, no, that was supposed to mean three quarters finished. I had 40 treatments, now finished.
Mike

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@bettwils16

Hi, thank you for your response. A PSMA Pet scan is going to be ordered once insurance approves. PSA now 0.24 and Radiation Oncologist (met today) suggested 39 Radiation Treatments. Once the PSMA results in, would like to go to the Mayo for second opinion. How did you do with Radiation Treatments? Thank you!

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Bettwils, getting a second opinion is often a good idea to discuss treatment and specifically radiation options. Hhere's more information about getting a second opinion at Mayo Clinic. http://mayocl.in/1mtmR63

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@bettwils16

Hi, thank you for your response. A PSMA Pet scan is going to be ordered once insurance approves. PSA now 0.24 and Radiation Oncologist (met today) suggested 39 Radiation Treatments. Once the PSMA results in, would like to go to the Mayo for second opinion. How did you do with Radiation Treatments? Thank you!

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I’ve had two rounds of RT: two years after prostatectomy-35 treatments and SBRT-5 rounds for pelvic lymph node metastasis, 4 nodes. My first go may have affected my bladder some but no other side effects. My second go was less than a year ago. So far so good. I once joked with the radiologist about whether the machine was turned on. I felt nothing but my PSA went from 1.0 to <0.008. The tumors sure felt it. I’m also taking Nubeqa.

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@web265

Sorry about that, no, that was supposed to mean three quarters finished. I had 40 treatments, now finished.
Mike

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Hi again, how bad was the treatment?

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@scullrower

I’ve had two rounds of RT: two years after prostatectomy-35 treatments and SBRT-5 rounds for pelvic lymph node metastasis, 4 nodes. My first go may have affected my bladder some but no other side effects. My second go was less than a year ago. So far so good. I once joked with the radiologist about whether the machine was turned on. I felt nothing but my PSA went from 1.0 to <0.008. The tumors sure felt it. I’m also taking Nubeqa.

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Where were you treated? We're in Ct at Hartford Hospital. Thinking of going to Mayo although we do have Yale few towns over

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@bettwils16

Hi again, how bad was the treatment?

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It's obviously an annoyance with regard to the way it's done, every weekday at the same time for 40 days (weekends and holidays off at my treatment center). Once you get fitted (tattooed, markers inserted if necessary) it only takes about 5-7 minutes to get the treatment. The issue here is they wan't your bladder "as full as you can stand it while still being able to stay still on the treatment table." It can take a little trial and error to figure out how much water to drink and how long before treatment. Mine was 24-28 ounces one hour before.

Side effects... different for everyone, mine were VERY minor I'm told...
At first it was actually hard to notice anything different, then by about #13/15 I started to get digestive changes/symptoms. I'm a "one a day guy" normally. Then the treatments seemed to aggravate my bowels somewhat to a point where it often took a couple bowel movements before I felt emptied. My anus seemed to be sore as well. There were maybe 3 or 4 bouts of diarrhea that I couldn't otherwise explain too. By about treatment 3O I experienced some fatigue issues, particularly a few hours after treatment (mine was at 9:20 AM). I found it took a herculean effort to get through workouts too. My normal 2 mile run was really tough to get through.

Now at one and a half weeks after ending, I can already feel the difference in energy levels, soar through the runs again and don't have to struggle to end the workout. Getting through the days with no naps again as well.

Really, the only reminder at this point, is the occasional hot flash from the orgovyx. It feels like those are becoming less frequent as well. It seemed daunting when getting ready to start of course, but, now it feels like it all went pretty quickly.

Good Luck to You!

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@bettwils16

Where were you treated? We're in Ct at Hartford Hospital. Thinking of going to Mayo although we do have Yale few towns over

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I had my treatments locally in Charleston, WV. For me, the second time, was the importance of the PSMA PET scan using Gallium 68. The better the pictures the easier to zap metastasis. I don’t know about good radiology departments. I’ve heard about Sloan Kettering in NYC and Cornell. Find someone with a track record and with whom you’re comfortable.

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