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Posted 12/20/2018 10:01 PM (GMT 0)
I was hoping never to ask this question but 8 years after my Prostatectomy my PSA measured 0.01 and it rose .03 at 9 years. 9 months later it was .038. My Uro wants me to test again at 10 years and to see a radiation oncologist. When should I start treatment? Should I wait till the PSA is .1? Can an AXUMIN PET detect the location of the tumor? Thanks
Posted 12/20/2018 10:13 PM (GMT 0)
Ed, sorry you are having to deal with this. You've had quite a run. An auxumin scan, or any other scan will not pick up anything at such a low PSA. I think the stats say something like 50% of the time an auxumin scan will find something at .2
UNFORTUNATELY there is no clear black and white answer as to when to start radiation, or if to start.
At .06 my surgeon advised me to do nothing until .2, and the do an auxumin scan, and if nothing showed, to wait until .4 even .5 and scan again. But at the same time, two top RO's both advised me to treat. And i took their advice and started ADT + SRT at .08.
In your case,it seems to me that your rate of rise is so very slow, and has taken such a long time after surgery to commence, that you can wait at least a while. With that said, i think considering your Gleason 8, its better to err on the side of caution. So perhaps wait for one more rise and see an RO for an opinion. (or maybe do that now).
The other thing to consider is age. Based on your signature, i'm thinking you are 77 years old. If your psa continues to rise at this pace, it will likely not get to .2 until you are 85 or 90, and even then may not be an issue. So consider that.
Just that G8 is what nags at me. Welcome to the world of neither here nor there. Many of us have been, and are, in that place right now, so you are not alone
Posted 12/20/2018 10:58 PM (GMT 0)
Hi, Ed--
There's no pat answer to what the PSA level to trigger SRT for you should be. Waiting for one more data point in 3 months, to give a better sense of PSA-DT, seems reasonable. I think if I were you, though, I'd want to hook up now with a good RO, both to get a second opinion and for the comfort of knowing who you'll be working with if/when you need to do SRT. I'd also want to get views on whether ADT should be added.
G8 is nothing to trifle with, but your 7 years before any hint of BCR is a favorable sign. For a recent review of the literature on BCR after RP, see Biochemical recurrence after radical prostatectomy: what does it mean?
Keep us posted, and keep your chin up!
Posted 12/20/2018 11:02 PM (GMT 0)
Thank you Prato, your advice is what I believe is the right way to go. I have a PSA test schedule for late Feb. I'm also schedule to see an Oncologist a week after that. hopefully the rise will be slow so I can wait it out like you suggested.
Posted 12/20/2018 11:24 PM (GMT 0)
Hi Ed,
Sorry you have to deal with this now. Much like Pratoman, my RO wanted me to start when my psa reached 0.09. My pathology after surgery was G9, and she mentioned that numerous times as to why she thought I should start when I did.
I had 7 months of ADT, and 38 treatments of RT. I tolerated both pretty well, with just hot flashes from the ADT, and more frequent urinating from the radiation.
If you do go with ADT, I would suggest you have a blood draw so you have a baseline Testosterone level.
Keep us posted on your decision and progress.
Posted 12/20/2018 11:33 PM (GMT 0)
Talk to your RO and or MO about including Casodex for the full course of your treatment.

I did at the recommendation of Dr. Andrew D'Amico, at Harvard, and I had much milder side effects than many report here. Of course, I can't say for sure that was the reason, but....

Good luck!
Posted 12/20/2018 11:49 PM (GMT 0)
Thank you all for your responses This forum is amazing. I have learned a lot from many during the last 10 years prior to my surgery. I will keep uou posted to my meetin with the Oncologist in March.
Posted 12/21/2018 12:23 AM (GMT 0)
I think you should have a conversation with an RO about your options soon.

If you had one more increase, I'd be thinking of treating with RT+HT.

Do let us know what the MO says.

Andrew
Posted 12/21/2018 12:44 AM (GMT 0)
It saddens me to see another thread like this...An older man who will never ever die from pca...telling his tale...getting the same old responses from the same old people...again..again...with same old fears...same old tears...it wears...it wears...throw the sink at it...be cautious...wear the yoke...ya can't be too careful...ya know...as they warn...their knowledge true...seeping thru...belie the word...worn...torn... forlorn...evidence none...scept kingdoms done... a flash of swords...smitten... who own the knight...its sad...its sad...not to be bad...not to be bad...its just so sad...the bold...the bold...where are the bold...who skim not life...so freely told...they are you...can't you see...let life enfold...be free...be free...light the cold...with comfort worn

A little bit of wow as we wait for the now....
Posted 12/21/2018 12:55 AM (GMT 0)
Consider your age (77) when deciding on options. I don't have any specific advice, but you've gotten opinions from other members.

It's good to see your name on the board again and hope that all is well Take care and hang in there.
Posted 12/21/2018 1:27 AM (GMT 0)
I was 70 when diagnosed with Gleason 3 + 3 prostate cancer in 2011. I had brachytherapy but the cancer came back in the form of an extra-capsular mass in 2016, which probably resulted from a Gleason 8 or Gleason 10 cancer missed by the biopsy in 2011 and not killed by the seeds. This time I had cyberknife and ADT. But unfortunately my PSA started rising very rapidly this years, from 0.2 in April to 4.48 in November (PSADT less than 2 months). A PSMA PET scan found metastatic cancer in about 10 pelvic lymph nodes (confirmed by biopsy of one of the lymph nodes). I have started treatment with Casodex and Lupron.

Suppose because of my advanced age I decided not to treatment, the aggressive metastatic cancer would spread quite soon to bones and distant organs.

We should not be too quick to advice someone against any treatment simply because of advanced age. Of course, in this case watching how the PSA behaves would be appropriate.
Posted 12/21/2018 3:27 AM (GMT 0)
Goingforbrachy, I think it’s not just an age issue, it’s age in the context of a PSA that is rising extremely slowly. Of course the final decision is up to Ed.
Posted 12/21/2018 4:54 AM (GMT 0)

logoslidat said...
It saddens me to see another thread like this...An older man who will never ever die from pca...telling his tale...getting the same old responses from the same old people...again..again...with same old fears...same old tears...it wears...it wears...throw the sink at it...be cautious...wear the yoke...ya can't be too careful...ya know...as they warn...their knowledge true...seeping thru...belie the word...worn...torn... forlorn...evidence none...scept kingdoms done... a flash of swords...smitten... who own the knight...its sad...its sad...not to be bad...not to be bad...its just so sad...the bold...the bold...where are the bold...who skim not life...so freely told...they are you...can't you see...let life enfold...be free...be free...light the cold...with comfort worn

A little bit of wow as we wait for the now....


I have a very low psa that is rising and am also 77. Agree with logoslidat post. Stay calm and watch it. Look at my new post, askdrmeyers.wordpress.com When recurrent PCa isn't cancer.
Posted 12/21/2018 4:55 AM (GMT 0)
ed. really sorry to hear that. my vote is: sooner is better. good luck man!
Posted 12/21/2018 9:28 PM (GMT 0)
I'm grateful for all your responses and will be asking my Uro and Oncho a lot of questions when I see them in March. Other than the rising PSA , I'm in very good health and exercise regularly. The only medication I take is a small dosage of Statin medication for cholesterol. This whole thing came unexpectedly out of nowhere at the wrong time of the year. I'm trying to stay positive and not let it ruin my Christmas get together with my 4 children and 13 grandchildren. I'll keep you posted when the time comes
Posted 12/21/2018 9:32 PM (GMT 0)
you can safely ignore the whole thing till March.

Enjoy your family and spoil the grandkids.

Andrew
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