Any chance SRT might work?

SRT can take months/years to show effectiveness. As long as your PSA is low, you're golden. SRT PSA can also be bouncy like one of those bouncy houses.

PARTY!!!

Thank you, I am done,
Andrew

In the shop, wait, wait please , I never heard that. SRT psa can be bouncy EVEN after RP????????
someone here told me that it can ONLY be bouncy if it’s the main treatment not with surgery. Please explain if you have a moment moment. Thanks

Progressing, his name is James Lee

"Official" biochemical recurrence after SRT is 0.2. PSA progression can be slow and erratic for a long time, as the mets just put out more PSA sometimes than other times. But don't confuse it with a bounce that guys who've had primary radiation experience. Your PSA is higher a year after radiation than it was before radiation, so I think it's pretty clear that the radiation wasn't curative. The good news is that it's still very low and is not increasing rapidly - prognostic for a very long ride. You have lots of options about how or if you want to deal with it. You have some great MOs at MSK.

No, I do not think it is a good idea to radiate the pelvic LNs without some clear indication that that is where the cancer is. Unfortunately, 0.2 is at the lower limit for PET detection, unless it is rising very rapidly. The only scan that may be able to show any cancerous LNs at a PSA that low would be the Combidex MRI - but you'd have to go to Holland for that.

There's a better, more up to date table here:

/pcnrv.blogspot.com/2016/12/pet-scans-for-prostate-cancer.html

Probability is too low - it would cost a lot of money for very little chance of finding anything. If the range is 0.2 - 0.5, you can be sure that most of the detections were at the high side of that range All PET scans, whether in trials or approved, have a minimum requirement for recurrent patients of a confirmed PSA over 0.2. You'd have a hard time getting covered or into a trial.

Thanks Tomson,
I have noticed in your signature that you had a Decipher test which I have no ideas about which they give you 5 years to Mets and 10 to mortality. Is this test accurate? Do you plan your life based on it? Should I get it?

AK,

I don't think the Decipher test results have yet made the slightest difference in any of the recommendations for treatment from my radiation oncologist or medical oncologist. Perhaps it would be otherwise if the test had showed my cancer to be high or low risk but it merely reported it as intermediate risk. Perhaps Tall Allen could imagine a scenario in which this might have influenced my treatment plan, but, so far, I think it is more just another interesting data point. The test is performed on a specimen from the prostatectomy so it tells you something about the genetic makeup of what came out of you when you had your surgery. When the natural history of prostate cancer in all its variations is better understood, this kind of test may make a huge difference. But at this point, the risk factors calculated by the Decipher score are based on a computer sifting through tons of data and mechanically deriving the formula that best predicts outcomes.

When I got the test, the conclusion printed on the Decipher report was that I might benefit from SRT. Well, I didn't. I didn't have ADT at the same time, so the steady upward march of my PSA scores showed that the SRT accomplished nothing. I learned that, wherever the cancer may be, it is not in my, now vacant, prostate bed. I need to update my profile to reflect that I had a Ga68- PSMA PET Scan when I was near .5 PSA and it found no metastases for spot radiation treatment. Although TA has pointed to the lack of evidence that spot treatment of oligometastatic PCa delays metastasis or prolongs life, I would have considered it if the PET Scan had turned up some targets to shoot at. But no such targets presented themselves. I was left with the conclusion that I could wait until my PSA climbed higher and repeat the test or begin systemic treatment. My choice was to forward with systemic treatment, i.e., ADT, albeit ADT with a chance to try out some experimental addons. As it turned out, I wound up being randomized into the degarelix plus apalutamide arm of the trial.

My hope is that your doubling time (once there are more data points) will turn out to be way too long for you to be considered for joining the clinical trial I mentioned in my earlier post. Using the three data points in your latest signature, the MSK doubling time calculator reports a doubling time of 7.74 months, but DTs may slacken or accelerate. My DT is around 6 months, which is significantly worse than 7.74 months, but hugely better than, say, 3 months. If your doubling time remains the same, you would not reach .5 until next February. In my book, that means you don't need to rush into anything. I'd say your 5 years before reaching biochemical recurrence (PSA of .2) after your RP is a very good sign (I got there in less than 2 years). I had tertiary 5 reported in my pathology report after surgery. You don't mention that, so I would guess that's another factor favoring a calm approach.

But to get back to your question and, for the benefit of others who may follow this thread, you've already reached the 5-year mark without metastases. What good would it do to get a report that tells you your chances of doing so based on a tissue sample that is 5 years old? You've already passed that finish line and you are a winner! (Still, talk to your docs and consider carefully anything Allen has to say.)

Tomson

P.S. to Rob Lee: Thanks for your concern. It has been a challenge to keep my head on straight, but I have a lot of resources--a loving marriage, great friends, volunteer work that is very meaningful to me, great terrain for bicycling, and overall good health and fitness. For the reasons you can glean from my response to AK, we are not in exactly the same boat and I'd be delighted to swap my stats for his. We may both have a chance to witness miracles and wonders that put us back in the potentially curable column. He's got MSK in his corner and I've got UCSF so there's a factor in our favor that shouldn't be overlooked.

Thank you so so much Tomson for your long well written response. It did help to read it and it does make a lot of sense to me. Thanks again. I have an appointment with a first visit to see a MO al MSK next month and I think he is gonna say what you said.
Rob Lee, thanks for your wishes. All I can do at this point is to try to stay on cashless diet and see what happens. People in here are very kind and supportive