Rising PSA post RRP and SRT (now lowering)

Well... Seems I have a rather pesky and persistent G6... 8 years post SRT and it has risen from 0.09 2/2017 to 0.24 4/2018. Short doubling time. Have advised oncologist for recommendations and I guess will be contemplating next steps...

History...

Biopsy Screening -12 points 3/13/2007
Left Core OK -- Right Core Gleason 3+3
Consisting of single less than 1mm focus at tip of 1 core.
Diagnosed as T1c cancer

4/24/2007 - DaVinci performed at Virginia Mason hospital in Seattle
5/2/2007 - Catheter Out! Final pathology of Gleason 6 T2c Nx Mx, approx 20% of prostate involved, positive margin, but only at 2 focal points.
7/18/2007 First Post-Op PSA... 0.01 !!!
6/26/2008 2nd Post-OP PSA at 14 months... 0.02
12/2/2008 3rd Post-OP PSA at 20 months... 0.03
10/30/2009 4th Post-OP PSA at 31 months... 0.13 (moved and diff lab)
11/3/2009 Retest at my original lab... 0.11 (followup with Doc sched 11/10)
11/10/2009 Discussion indicated biochemical recurrence and need for salvage radiation treatment.
1/21/2010 Another PSA test at 34 months... 0.14 at original lab

1/26/2010 IMRT Salvage Radiation Treatment started Virginia Mason Hospital in Seattle, WA
32 sessions for 64 gys total. Was told to have bladder full (over half) before each treatment.

3/12/2010 Finished 32 sessions... No side effects to date except a little
tiredness. Slight changes in bowel movements the last week...

4/8/2010 Some rectal proctitis, but no change in urgency. No urinary effects at all. Now just waiting for the upcoming PSA test in June.

6/7/2010 First 3 month PSA result after SRT = 0.02 WAHOO! as good as could ever be expected at the 3 month mark! Thank You Jesus! Plan next PSA test in 6 months... December... skip that! Plan for January 2011... Do not want to be worrying about the test during the holidays...

1/11/2011 10 month post SRT - PSA = 0.01 --- Looks to be confirmation back in the Zero Club!
8/26/2011 17 month post SRT - PSA = 0.01 -- and switched to a yearly monitoring.
8/31/2012 29 months post SRT - PSA = 0.01 - Hooray... Good for another year...
11/4/2013 45 months post SRT - PSA = <0.02 (undetectable - different lab than last year)
11/23/2014 57 months post SRT - PSA = 0.03 (same lab as last year)
4/21/2015 62 months post SRT - PSA = 0.04 (Virginia Mason lab)
2/11/2016 71 months post SRT - PSA = 0.06 (New local lab)
10/15/2017 79 months post SRT - PSA = 0.09 (Local lab)
2/3/2017 83 months post SRT - PSA = 0.09 (Local lab)
2/9/2017 AMS 800 artificial urinary sphincter installed
3/24/2017 AMS 800 activated
5/1/2017 Average daily leakage running 1-2 ml barely damp pad a day
Great improvement in lifestyle… no worries of overflow anymore.
4/18/2018 97 months post SRT - PSA = 0.24 (Local lab)

Not the result I wanted to see, but it is what it is.

pasayten

Tall Allen,

Thanks for the info... Lymph nodes were not looked at RRP... Not sure if included in SRT... Will try to get that info... Might be time to switch from Virginia Mason to Hutchinson. Updated... Made online appointment request with Dr. Celestia Higano at SCCA... will see what happens,

pasayten

Post Edited (pasayten) : 4/20/2018 9:51:21 PM (GMT-6)

Hi pasayten

Couple thoughts:

1. Have you confirmed the Gleason 6 pathology. Might be worth doing.
2. Perhaps look into a Decipher genomic test (which may instruct further treatment).
3. I am sure it has been done, but I have not heard of true gleason 6 being treated with ADT or other post-srt systemic treatments.
4. Investigating further local radiation treatments as per TA sounds like a very good plan.

Best of luck.

Ak123-

Knowing how good they are at MSK, they probably already treated you with the highest possible dose over the widest area.

Made appt with Higano at SCCA for July 9th...

Yeah, I suspected as much I think Medicare will cover the Axumin scan.

7/16/2018 PSA result came back 0.20... down a little from the previous 0.24 4/18/2018... strange as I thought is was going to be up from before...

hopefully the start of a downward trend. or at least a leveling off.

Andrew

Well, the Axumin scan is scheduled for Aug 8th at the SCCA... Be interesting to see if anything is found with a PSA level of only 0.20/0.24. But it will also serve as a basepoint if nothing else...

Sounds like a plan to me.

Andrew

Congratulations on your good results, Pasayten. All the best for continued success.

it will go back to nadir, the trend is very encouraging.

Pasayten,

I am really, really happy to see your PSA turning the corner and heading back down. That is a really good sign, and I hope it continues to go down. Glad the AMS 800 has worked so well--a real success story!

-------------------------------------------------

But now could someone explain a few things to me? This will help educate me about both SRT and rising PSA after SRT. Hope not highjacking the thread, but the answers may help me and others that are facing possible recurrence:

(1) Pasayten had prostatectomy 11 years ago for gleason 6. Path showed PT2c (capsule contained).

(2) He had two positive margins, which were focal, which I think means < 3mm. He had 20% PCa, which is not minimal, but not as much as others have reported here (e.g., I had 30%). His path indicated no EPE.

(3) Then, after seeing post-prostatectomy PSA rise, he underwent SRT and finished it 8 years ago. Now, his PSA has undergone the "typical" post-SRT path where it climbed and then is apparently falling (yeah!).

Discussion questions:

Q1: Isn't this about the most unusual case you've come across?

Q2: I understand what a PSA bounce post radiation is, but 8 years after SRT? I thought those bounces occur 1 - 3 years post SRT?

Q3: Pasayten doesn't even have a prostate anymore, except for a little prostate tissue from +margins, maybe. And gleason 6 doesn't do mets, supposedly. And though other body organs can produce some PSA, probably not in amounts he has been experiencing. So what is it that's even producing *any* PSA now?

Thanks in advance,
Robert