Psa Still rising

Not really sure what to say or do anymore, very disappointing result I just got despite me trying everything I can, psa stil rising. Can I wait a few months to start adt or it needs to start now. I was waiting and hoping for a pet scan trial in January or may be February to see if I can detect any Mets and treat it with targeted radiation before I go ahead with starting adt but not sure what to do anymore

I applied for the NIH clinical trial offered at Maryland but being put on the waiting list until January or February

you could wait for awhile before doing ADT. The higher the PSA the more likely a scan will find it.

The problem is, so you find it. If it's in the lymph nodes, RT might be an option. If it's a bone met, spot radiation is generally just for pain relief - if there's one met there's likely to be others. You're first line treatment post SRT is ADT.

Sorry you have to keep dealing with this.
Andrew

Thanks, Roblee,
What do you mean by saying “doing things early on night have helped”? Did I miss anything based on my situation?
The only thing that I could think of that I didn’t do is combining ADT with SRT which I didn’t. Unless you meant doing the RP earlier?

Thanks very much Roblee, no problem at all. I started my SRT at .07 but the RO didn’t offer me ADT and my surgeon never mentioned anything about ADT so it’s hard to say who dropped the ball, if not all of them including me

Im one of those guys, Rob, near perfect pathology.

AK, tough situation, but it just shows how crazy this disease can be, and it also shows how sometimes we can do all the right things, from pre diagnosis screening all the way to treatment and beyond, and still some things are just out of our control. I sometimes wonder, when my first biopsy was negative, and my URO wanted an MRI, which was refused by the insurance company, had I just paid out of pocket, would I have caught it sooner? Would I have not ended up with SRT & ADT?
But it doesn’t matter, water order the bridge.

So AK, it is what it is, don’t think what could’ve been. Move forward from here. See an MO. You likely can wait quite a while before you need to start ADT

I have not found second guessing a decision like this to be useful. Unless the decision can be reversed, changed, modified or otherwise altered - it's a lot of wasted emotional energy.

We start where we are and to the best with what we have at hand.

Andrw

AK,
I'm not sure from your posts if you are currently under care of an MO. If not already under care of a top-notch MO this is the time to find one for discussion of future treatments and possible clinical trials. I see you did SRT at MSK so I assume you have or will find an MO there.

When I first transferred my care to an MO at Dana-Farber he told me that given my history of very slow increases in PSA following RP and then again after SRT he would be inclined to let my PSA rise to maybe 5 or so before beginning ADT. He recommended a Prostvac trial which was then enrolling patients at Dana-Farber and MSK. It is still listed as "enrolling" at clinicaltrials.gov. It may be something to consider. It requires a PSA of at least 1.0 and a doubling time of greater than 5 months. Side effects are minimal and all enrollees get the Prostvac, though half start right away and half wait 6 months before starting. Side effects are minimal, though long-term benefit is unknown (hence the trial).

I ended up washing out as a candidate because, after years of slow increase, my PSA doubling time suddenly accelerated. I'm now in a different trial, though in the control group getting only Degarelix (Firmagon) which is standard treatment, though with extra monitoring - CT and bone scan, monthly blood tests, and consult with the trial team. Despite what I feared and most members here report, I've had virtually no side effects from the ADT - no fatigue, no hot flashes -- possibly (only possibly) some increased joint and muscle stiffness. But then again, I'm 72 and do a lot of outdoor work --maintain trails, fields, and woodlands on conservation land. Given the amount of time I spend walking behind a brush cutter or clearing fallen trees and limbs with a chain saw, I no longer have any idea what my joints and muscles are supposed to feel like at my age.
Jim

Yes, especially breath calmly. I'd also urge you to obtain some 3 Stooges videos. Nyuk, nyuk, nyuk.

My doc says my cut-off is at PSA = 2.0, then it is on to intermittent luprolide + a round 2 chem. PSA hit 1.58 Nov, doubling time has been all over the place with a 3 month freeze this past summer. It doesn't take a crystal ball to see my path, however.

I try to make sure that I hurt pretty much all over all of the time any more. That way, there is no single pain item that precludes my normal life activities.