we got our post RP PSA results today

Hello, some say that PSA less than 0.1 is undetectable.
I would get another PSA in a month. You should probably research radiation therapy and make an appointment with a Radiation Oncologist.
Good luck to you both.

We haven't spoken to the doctor yet. My husband has an appointment on Monday. At his one week post op appointment she said if he had psa she would send him to medical oncologist. I'm guessing that .19 is considered psa

What are some relevant questions to ask her at our appointment that i might not think of at the time? I'm writing questions down to take with me, but I always realize later that I missed some that I should have asked. Thanks

Its a bit early to have a PSA. My URO said lets wait for 3 months. Note, I had a PSA done a month later, which was < .01 (this was requested by my Endo). My Uro wanted my 01/14 reading, which I was happy to report was < .01

Wait!

But, should you need further treatment start the ball rolling NOW, in anticipation. Lets hope and pray that NO further treatment is then required.

Enjoy your holidays!

Sophie,

I would get another psa test in a few weeks and if it is still the same, I'd throw the kitchen sink at it. Gleason 9 should be treated as aggressively as possible. I would ask his doctor:

1. Are there other scans he can get that might be more sensitive? F18 bone scan, c11, etc.... (you want all the information you can get about where it might be)

2. Should he consider adj. Radiation and when?

3. Should he just radiate the prostate bed or pelvic areas as well?

4. Should we also do some form of hormone therapy at the same time as radiation?

Hang in there...I'm sure it's unsettling right now. Once you have all the information...then strike it back...

Jerry

I think your best bet right now is an RO, rather than an MO. MOs know about medicines, ROs are expert in radiation (often combined with medicine). I'm often surprised at how little MOs, even famous ones, know about radiation oncology. I suppose it goes both ways. While there is hope of a complete cure with radiation, that's where he needs to be.

Sooner is better than waiting. There were enough adverse findings from the RP (cancer on the bladder, bladder neck, and EPE), and with his high volume G9 cancer this isn't something to wait around for.

PSA of .19 at 7 weeks is high - it should be undetectable. Undetectable means just that - it is below what the lab test can detect. (BTW- toss the Walsh book as it's probably too outdated to be of much value). Adjuvant RT - meaning doing it now - increases the likelihood of met-free and cancer survival by about 30% compared to waiting, according to SWOG S8794.

A confirmed PSA of .2 (not on an ultrasensitive test) is the official definition of "recurrence" because when they set up that definition, .1 was as low as they could reliably measure. So they arbitrarily picked .2, which was the first number above the floor. All randomized clinical trials have concluded that adjuvant RT is better than waiting.

The adjuvant treatment will most likely include 2 months of prior hormone therapy, continued through the 7 weeks of radiation, and 1.5-2 years afterwards. The radiation should be about 70 Gy in 1.8-2.0 Gy daily treatments over 7 weeks. It's a judgement call whether to treat the pelvic LNs as well (did they do a PLND or an ePLND during the RP?).

I'm sorry your husband has to go through all this at so soon after his surgery ordeal.

- Allen

Sophie,

That's great that there was no cancer found in a lot of LNs, and it argues against treating the entire pelvic LN area with the adjuvant radiation. Treating the prostate bed only will likely have fewer complications.

- Allen

Jeff,

I don't recommend any, and I haven't read any. I think they're all outdated by the time they're published. Maybe if someone wrote an online edition that got continually updated, that would be more useful.

- Allen

Sophie,

I had a similar experience to your husband. Initial G10 with positive margins and lymph nodes. 6 weeks after surgery my PSA was 0.15. As noted above I took the route of being very aggressive. Lupron and Casodex 6 weeks after surgery and RT starting 2.5 months after surgery. Now after 23 months from diagnosis my MO has agreed to take me off of Lupron as my PSA has consistently stayed < 0.03 and now we will begin monitoring.

I believe aggressive is good in this situation given your husband is relatively young and presumably in good health and would encourage you to bias your decisions in this direction as that path is the one also encouraged by a second opinion at Cancer Centers.

Good luck,

Mike