Rising PSA after SBRT - worrysome or to be expected?

Posted by markbaldridge @markbaldridge, Oct 13 4:59pm

Five years ago, I was diagnosed with Gleason-9 PC and had a prostatectomy.

Shortly thereafter, I had a biochemical recurrence and had 39 IMRT treatments on my prostate bed and pelvic region. I also had 18 months of Firmagon.

One year later, I had another biochemical recurrence and had SBRT on my Lumbar + Rib. In addition, I had 6 months of Eligard.

One year later, I had a PMSA/PET scan which revealed a metastasis on my sternum. I subsequently had SBRT on this lesion on my Sternum (but no hormonal treatment).

For my most recent SBRT on my sternum, my PSA was 0.75.
After 3 months, my PSA rose to 0.81.

Is it considered normal for my PSA to rise 3 months after my sternum SBRT?

How long would you expect my PSA to become undetectable or near-undetectable after receiving the sternum SBRT?

Thank you very much,
Mark

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jeff Marchi | @jeffmarc | Oct 13 7:11pm

Your situation is not normal, Unless you consider more metastasis occurring, that is causing your PSA to rise, normal.

You need to get a PSMA PET scan to find out where else something has come up.

Your PSA should slowly drop after having SBRT. You could wait three more months and see if it continues to rise but it’s almost definite you have another metastasis with a Gleason 9. They could be so small you can’t see them on a PSMA PET scan

You should have stayed on ADT after having the second Reoccurrence. You actually may Need to be on both ADT and an ASRI to keep your PSA dropping and stable for a while.

I’m not sure where you are getting treated, but the standard of care should’ve had you on both of those drugs after the second reoccurrence For at least two years.

Of course you can always follow the Mark Scholz Treatment plan where you just get continuous PET scans and keep getting the metastasis zapped. With two reoccurrences, your cancer is definitely in your bloodstream and you could find you will have metastasis all over your body If you don’t get aggressive treatment.

You are a Gleason nine, That pretty much guarantees you are going to have reoccurrence. It’s up to you how you want to handle it.

Colleen Young, Connect Director | @colleenyoung | Oct 27 9:04pm

@markbaldridge, when is your next follow-up appointment with your cancer team?

markbaldridge | @markbaldridge | Oct 28 5:59pm

My next scheduled PSA test is at the end of December.

I'm fearful what my PSA will be in two months.

jeff Marchi | @jeffmarc | Oct 28 6:45pm

In reply to @markbaldridge "My next scheduled PSA test is at the end of December. I'm fearful what my PSA..." + (show)

@markbaldridge
I was put on monthly PSA test eight years ago after recurrence. You might request that from your doctors.

ava11 | @ava11 | Oct 29 5:39pm

In reply to @jeffmarc "Your situation is not normal, Unless you consider more metastasis occurring, that is causing your PSA..." + (show)

@jeffmarc You are a Gleason nine, That pretty much guarantees you are going to have reoccurrence. It’s up to you how you want to handle it.
I am Gleason 9. I hope that doesn't mean Cancer Reoccurrence is inevitable in the next 10 years when I will be 100!!!

jeff Marchi | @jeffmarc | Oct 29 7:00pm

In reply to @ava11 "@jeffmarc You are a Gleason nine, That pretty much guarantees you are going to have reoccurrence...." + (show)

@ava11
Your case could be completely different. When you have multiple recurrences, it pretty much always comes back, If you live long enough. It’s just a matter of time.

Just being a Gleason nine alone, doesn’t do it. I know one guy with a Gleason nine that went 30 years before it came back. Another guy that went 20 years. Prostate cancer can go dormant. Neither of those had two reoccurrences, it came back once after many years.

ava11 | @ava11 | Oct 29 10:50pm

In reply to @jeffmarc "@ava11 Your case could be completely different. When you have multiple recurrences, it pretty much always..." + (show)

@jeffmarc
Thank you for that optimistic note. when I was younger, I used to think that I wanted to be disease free until 80 and after that I don't care. Now I know no one wants to get cancer at any age and no one deserves it!

whatthef | @whatthef | Oct 31 11:46am

Did you do a biopsy on the sternum? This is very rare for prostate cancer to metastasize to the sternum. In fact, I only know of one case I read where Where this Has happened. If you used a PSMAP scan with the F 18 tracer, there’s a much higher chance of this reading false positive than F 68 tracer. Shame very rare.

markbaldridge | @markbaldridge | Oct 31 12:47pm

In reply to @whatthef "Did you do a biopsy on the sternum? This is very rare for prostate cancer to..." + (show)

@whatthef Wow, I never heard this. I did have the PET CT F-18 PSMA DCFPyL (PYLARIFY).

Per my report,
"New moderate intense uptake in the manubrium just above the sternal angle with associated sclerosis on CT. SUV max of 8.4".

whatthef | @whatthef | Nov 2 11:20am

In reply to @markbaldridge "@whatthef Wow, I never heard this. I did have the PET CT F-18 PSMA DCFPyL (PYLARIFY)...." + (show)

@markbaldridge
My SUV on the sternum was 21. However, after biopsy and several CT scans for other reasons. Show stable and negative for cancer. There are a number of things that can cause you sternum to light up.