With regional lymph node metastasis what is the progression?

Forgot to mention that I am 70 years old.

Are you on ADT now?

Are you on ADT now?

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

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.

I have a difficult time responding to your comment, "why are you so concerned?" Where does that question come from? Does it come from some concern for me? I really can't tell from the chat.

After the first treatment failure I have been interested in developing a narative of the disease progression. This helps me wrap my head around the situation, and allows me to make informed decisions on how I want to live my life. Not in ignorance and fear, but with curiosity and courage.

The surgical removal of the prostate did not halt the cancer because it was more aggressive than what the biopsy suggested. Within a few months the PSA "quickly" rose to 0.15, and the doctor and I decided to do SRT. This is in line with the current research. The radiation treated the whole prostate bed, and any cancer there was eliminated, and so when the cancer did return it was probably in the regional lymph nodes. The doctor agreed with this analysis.

This is where the progression is today: oligometastatic lymph node Prostate cancer. I am interested in knowing what underlies the kinematics of the PSA now. The PSA is undetactable for 35 months, at 24 months they said I was clean. Now it has been level at 0.028 for 12 months. I certainly like that. There isn't much of the cancer and it isn't activing aggressively.

This is probably what is called micrometastatic Prostate cancer, which refers to the presence of cancer cells in other parts of the body that are too small to be detected by standard imaging techniques. These cells may have spread from the primary prostate tumor but haven't yet grown large enough to be seen on scans. The patients PSA levels may be quite low. The presence of micrometastatic disease can affect treatment decisions and prognosis.

Minimal residual disease is that not detected by conventional imaging studies and clinically the patient remains disease free. However, with time these dormant cells will awaken and disease progression occurs, resulting in clinically and radiological detectable metastatic disease.

So my quess is the next rise in PSA will tell me a lot about the cancer.

I have a difficult time responding to your comment, "why are you so concerned?" Where does that question come from? Does it come from some concern for me? I really can't tell from the chat.

After the first treatment failure I have been interested in developing a narative of the disease progression. This helps me wrap my head around the situation, and allows me to make informed decisions on how I want to live my life. Not in ignorance and fear, but with curiosity and courage.

The surgical removal of the prostate did not halt the cancer because it was more aggressive than what the biopsy suggested. Within a few months the PSA "quickly" rose to 0.15, and the doctor and I decided to do SRT. This is in line with the current research. The radiation treated the whole prostate bed, and any cancer there was eliminated, and so when the cancer did return it was probably in the regional lymph nodes. The doctor agreed with this analysis.

This is where the progression is today: oligometastatic lymph node Prostate cancer. I am interested in knowing what underlies the kinematics of the PSA now. The PSA is undetactable for 35 months, at 24 months they said I was clean. Now it has been level at 0.028 for 12 months. I certainly like that. There isn't much of the cancer and it isn't activing aggressively.

This is probably what is called micrometastatic Prostate cancer, which refers to the presence of cancer cells in other parts of the body that are too small to be detected by standard imaging techniques. These cells may have spread from the primary prostate tumor but haven't yet grown large enough to be seen on scans. The patients PSA levels may be quite low. The presence of micrometastatic disease can affect treatment decisions and prognosis.

Minimal residual disease is that not detected by conventional imaging studies and clinically the patient remains disease free. However, with time these dormant cells will awaken and disease progression occurs, resulting in clinically and radiological detectable metastatic disease.

So my quess is the next rise in PSA will tell me a lot about the cancer.