Post-Surgery PSA and additional treatment question

I am hoping that someone here can clarify something for us, since I cannot seem to locate a definitive answer in my research. I have shared my husband's story here previously. He is now 2 months out from RALP, 3.5 week post-surgery PSA was 0.06. We met for the first time with the MO on Wednesday, PSA at that visit was 0.07 (different lab/machine so I guess we would consider this stable for now- we were hoping for lower since I doubt we will see much more of a drop this far out). In discussion with the MO, we covered the ADT and radiation treatment options. The doc mentioned that he wanted to get another PSA in 4 weeks to see the "trend" - to evaluate if it is rising is my interpretation of this plan. He also mentioned that sometimes if levels become undetectable, the preference is to wait before beginning additional treatment - I know this is because some men become "resistant" to the hormone therapy down the road. My question is - at what PSA levels do the docs typically start hormone therapy? I have read a couple of publications that indicated not until the PSA is 0.1 or greater. We have a pcPET scan scheduled for December 12th and have follow-up with the MO and a consultation appointment with the RO on December 12th. I am a little uncomfortable with what seems like a delay in getting things done - I know prostate ca is relatively slow to grow and spread compared to other cancers, but also know that the Gleason 9 is higher risk. I am going to push to get the PET scan scheduled sooner - his first bone and ct scans in July were clean and pray the PET will be as well. But, like many have said the waiting is the worst part and it seems like any prolonged waiting time just adds to the likelihood of mets.

Nytngale... That number for 3.5 wks out from surgery was really not that uncommon that is pretty quick for the first psa check there's always a little residual psa in the system that has to get worked out. Your husband and I had just about the same path report. Even with a number of .13 at 3 months that's the earliest Mayo checks after RP we waited one more month before the next one and then when it was .16 then we made a plan with the RO. They started me on Lupron two months before radiation I have to be on Lupron at least 2 years and then we will see how things are going right now I have been undetectable for the last 10 months so am very happy about that. Wishing the best for you guys in that hoping that number goes undetectable.

Larry

At that PSA level, it's unlikely the scans will show anything - it's not much PSA and any PC is microscopic. The wait isn't going to make that much difference.

You need to have a rising trend before any doc will think of more treatment. If the next PSA is up, then you move to the treatment phase, which in this case would be a HT shot followed by SRT in a month or two (to give the HT time to work). There is no fixed PSA number where this starts - it all depends on the PSA trend and rate of change.

I understand how difficult it is to wait, but that's the plan for now.

Andrew

good morning, Nytngale

With his pathology you might consider him in the adjuvent radiation category pretty much regardless of PSA. I understand the common protocol is to "complete" surgical healing before starting - especially continence.

Best to you -
Wilderness

Nytingale, you’ve gotten good advice above. There is no clear trend yet so I can understand why another PSA (maybe 2, depending on results) would be required before proceeding. Make sure the next PSA is at the same lab as the last one,

I don’t understand the logic of doing a PET scan at such a low PSA.

Nythgale...what I think makes your husband's situation different from most other guys making this call is the fact that he had a positive lymph node. In an ideal world, they removed the sonly cancerous one during the surgery. But I'd also guess that there's at least some greater likelihood of it spreading to other lymph nodes than the guys that didn't have any positive ones. I do know you have to heal and it would be good to get another PSA to see the trend, but I'd also be pushing to have things happen more quickly if you can.

Hello Nytngale,


My situation was somewhat similar to your husband's. For what it's worth, my positive lymph node was actually identified prior to my surgery and my doctors put me on Lupron immediately (before surgery) when they noted the positive node. Also, it was understood that because of the positive node, I would be following up with whole pelvis radiation after surgery. I waited close to six months to start the radiation following my surgery but it was easier to wait knowing that the Lupron would keep everything in check until I'd healed enough to do the radiation.

did your doctor ever discuss plan B in the event plan A failed? or was he pretty sure he got it all?

My scores were a bit lower but +SVI and +ECE. My RALP surgeon is following my case. I'm on the 3 month uPSA track right now and he discussed adjunctive radiation as a possibility should uPSA increase. If it stays undetectable, nothing else is needed. He was quite adamant about not doing PSA prior to the 3 month mark, I did it a few days after the 90th day post--op.

Uro group is quite large - 40+ MD's, I started out with the head of the group who did the DRE (-) and my Trus Biopsy before being referred to the RO and surgeon. So a lot of options here for additional opinions / discussions. Never hurts to ask a lot of questions.