With regional lymph node metastasis what is the progression?

Posted by transreductionist @transreductionist, 17 hours ago

From the following summary what should I expect going forward other than Androgen Deprivation Therapy (ADT)?

SUMMARY

2020-06 Prostatectomy

Pathology:
Gleason 4+3
T3
Positive surgical margins
Perineural nerve invasion
Invasive carcinoma (cancer in surrounding healthy tissue)

2021-04 Salvage radiation therapy (SRT) started
2021-06 Salvage radiation therapy ended
2024-07 Undetectable PSA end of SRT to here
2024-09 PSA at 0.02
2025-04 PSA at 0.03
2025-07 PSA at 0.03

I was told that the cancer is probably in the lymph nodes at this stage. With such low PSA levels, it would appear to me to be oligometastatic.

Other than Androgen Deprivation Therapy (ADT), what should I expect going forward? Are low PSA levels like 0.03 typical of the start of metastatic progression? Any other context someone might give would be appreciated. I have read that the 5-year survival rate for regional lymph node involvement is 100%.

Regards,

Aaron

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transreductionist | @transreductionist | 17 hours ago

Forgot to mention that I am 70 years old.

jsh327 | @jsh327 | 9 hours ago

In reply to @transreductionist "Forgot to mention that I am 70 years old." + (show)

Are you on ADT now?

kujhawk1978 | @kujhawk1978 | 6 hours ago

Well, there is some discussion that advanced PCa in its early stage, oligo-metastatic may be cured.

Put me in the other camp, no.

So, what to do with your clinical data. Were it me, nothing, continue to actively monitor, discuss with my medical team what clinical data would constitute sufficient data to resume treatment, then just live my life.

For my medical team and I, that criteria is:
Three (or more) PSA tests spaced three months apart that show an increase.
AND..,
PSA between .5-1.0

Why?

One, we want trends not isolated data points that can be unexplained.
Two, we feel PSA between .5-1.0 allows a statically significant chance of locating activity to inform our treatment decision, 2/3 vs 1/3 below that.
Three, we don't believe there is any risk involved on waiting to get that dara.

As to what's ahead? Well, that depends on the clinical data.

There is some discussion about the use of SBRT only to delay the need for systemic therapy.

It could be that you elect to do SBRT and systemic therapy -ADT + ARI for a defined period and come off and actively monitor again.

The latter is what I chose in my last treatment, SBRT + 12 months Orgovyx. We are 14 months since coming off that regimen, all quiet.

USPSA can give us early indication of treatment ahead, It can also lead us to excessive analysis...The data you describe were it mine would lead me to discuss with my medical team about "not now!"

Kevin

jeff Marchi | @jeffmarc | 4 hours ago

A PSA .03 is not notification that there’s something wrong, yet. I don’t understand why are you getting so concerned.

Going from .02 to .03 is nothing, And yours is growing so fast that maybe another 10 or 20 years you might have a problem. Yes, the PSA can go up and down a little bit, yours is barely moving.

I’ve had prostate cancer for 15 years and have been undetectable for the last 20 months. I don’t do those ultra sensitive tests because I don’t want to see these little bumps up and down like you are seeing and worrying about. My PSA has been < .1 and that’s good enough for me.

Eventually, on ADT, your cancer will become castrate resistant (Happened to me six years ago). At that point you start with an ARSI, And that should take you till the next big medical discovery. They’re working heavily on Drugs to take after ARSI fails. Some doctors will start you on an ARSI sooner, But with what you describe, they’re probably going to let you stay on ADT until your PSA really starts to rise.

Your doctor seemed to be doing the right things. Following their advice has definitely worked, up till now. Come back if your PSA starts to rise significantly.