Newbie pT3b with rising PSA after 7 years. Need advise.

Welcome to HW, Savinjames! I'm a very new member myself, and my first post started with a line very similar to yours below. I definitely understand the anxiety you're feeling right now. You don’t seem to be rambling at all, by the way, even though it’s tough to think clearly after receiving this kind of news – especially after seven years!

Others who are much more knowledgeable than I am will jump in soon, I know. I just wanted to say that my dh began radiation (IMRT) about one year post surgery after experiencing PSA increases similar to your hubby's. Although he tolerated it fairly well, his PSA really was not impacted by radiation. I have often wondered if we should have gotten an oncologist involved at the point to discuss other treatment options.

Welcome
Sorry you are here. Seven years with aggressive GS9 cancer certainly warrants attention. It is somewhat surprising you have not had to deal with this years ago. Yes, you do need to consult with a radiation oncologist. Find the best you can who specializes in PC. The new trigger for best results with SRT is .03. The old trigger was .2. Your husband's doubling time seems rapid from what you have written.

My cancer is not as aggressive as your husband's. I ended SRT six months ago. My PSA, after surgery in October 2007, started out at .005. it finally climbed to .06 in January 2015. Both my urologist as well as radiologist said time for SRT. 35 treatments- 70 gy's. Six months post SRT my PSA is <.006. could not do any better than that. Very grateful. No side effects or problems.

Good luck in your exploration and decision making. It would seem prudent not to take too long in the process.

Absolutely talk to a Radiation Oncologist. With his rapid PSADT, it might be a good idea to have a bone scan and CT, on the off chance that mets are detectable. Assuming that's clean, ADT+ salvage IMRT may get the rest. Sooner is better than later, of course.

- Allen

" the new trigger for SRT is .03 the old use to be .2" Says Octorobo and a few more. The overall consensus in the medical field of PCa is .2 and 3 consecutive increases from there. Be ware of internet cancer forums. "sooner is better than later" of course is a non medical doctor but an excellent researcher of studies ,opinion There are arguably just as many who hold that view as those who do not.
Caveat Emptor... intentions are good here, but we all get carried away by our own or lack thereof of knowledge. Medicos are your best bet, not internet "experts"
Good Luck savin James Ps it is also controversial among Pca medicos of the value of doubling times at such low values. I am 6year post op gl9 prostate contained undetectable until march 2014 at ,13. a year prior to that it was .07
6 mos post the .14 it held steady at .15. Granted the numbers are rising faster than mine but imo, notice I offer an opinion , not facts as the two other did with their advise, I would get ducks in a row but would hold off on the trigger.. un till you are sure it is a recurrence and even if rad is the way to go. Metrics particular to you r husband will help you and your medical team make the best decision. Certainly not an internet forum, where quite frankly imo most of their knowledge comes from studies and or hearsay. Studies are notoriously inaccurate and will admit that they are a step in a possibility. medical trials is something you can hang your hat on. For most studies there is usually another study. that will say just the opposite I have a son who is an epidemiologist fro Chapel Hill and the epidemiologist mantra is " all studies by definition are wrong. If they were right then problem solved , but obvious problem is not solved. Studies are a step to truth or false hood. are you feeling lucky. This will offend some, bur any engagement of ideas hopefully will do that or we will be rats on a treadmill.

Post Edited (logoslidat) : 11/13/2015 7:52:46 PM (GMT-7)

Hi, and welcome to our forum. You will find a lot of people here that are supportive, as you've already seen on this thread. Please stay with us, ask, vent, whine, complain, whatever you need. We're here for you!

As a fellow G9 5+4, I know the dark corner of the PCa universe we occupy. We have a thread for G9 folks, meant as a gathering place for those facing this diagnosis. If your glance through it (and the prior one that grew too long for the system, linked in it), you'll find many G9 folks and many that are doing well.

It's great that your husband has had such a good, long, remission with surgery only. It is unusual to have such success with the quite aggressive beast that a 5+4 case is. When considering my treatment options with a fairly similar diagnosis, I ended up going with radiation and hormone therapy as my primary treatment. Radiation was not too tough, it's more of an endurance contest, a marathon, but hormone therapy is a hard long road.

Here's a link to our G9 Crew thread, and I've added you to the rather smaller 5+4 group, and one of the earliest diagnosed that's on the list. Your husband is lucky to have you supporting him through all of this!

www.healingwell.com/community/default.aspx?f=35&m=3182035&g=3182504#m3182504

All the best to you as you consider what the next steps are.

Dr Menon is a great surgeon imo. My DH had PSA .4 4 weeks out of surgery. Because he is not satisfactorily healed yet he was given 4 month Lupron as advised by Dr M. We are exploring urologist/ oncologist now too. I will be watching this thread as our next appt is in January. I would like to be well prepared for what may be offered next.... Sorry your here for the obvious but glad you found the site!
Jen

Savinjames, you're outside of my expertise. But I do want to provide encouragement, keep up the fight. The docs are guessing more often than they like to admit. They, and we, just can't know how our individual cases may progress. We look at the numbers, try to find studies to guide us, and take our best shot.

The G9 types are notoriously aggressive, but he's had a good long run from surgery alone. It seems this may indicate good responses to whatever you choose to do next.

Others here have had some advanced scans to find the source of rising PSAs, some not common, and not always covered by insurance. It may be worth considering such.

In my case, my PSA was between 0.5-0.7 for years, then it slowly started to rise after 7 years, then jumped to 11.24. I had 2 bone and CT scans which was clear and showed nothing, then my radiation Oncologist, sent me for a PSMA-PET-CT which showed I had 5 positive lymph nodes, he said if it was not for this scan he would not have been able to find where the Pca was. So now I have started Casodex and Zoladex.

Don't know if the test I had is available in the US, but worth a discussion with your doctor, I am surprised with a G9 something has not been done sooner, my very best wishes for the future.

Regards Mal.

Good Morning

I would agree, you need to be finding a first rate prostate radiation oncologist at a recognized cancer institution. Your successive rise in PSA number indicates something is going on. I too finished SRT in May of 2015. I have had two great PSA readings of <.006 since then. My surgery was seven years ago in Oct 2007. My low after surgery was .003. I was at .06 in Jan. 2015 when RO said time to start SRT. No real side effects.