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Post Surgery PSA update

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Posted 4/24/2019 1:58 PM (GMT 0)
Hi Folks,

12 month PSA results are in.

3 Months: .022
6 Months: .042
9 Months: .063
12 Months: .096

Had a couple interim uPSA's as well where each one has been consistently higher than the previous. Any chance scans can pick anything up at these levels to isolate location? My instinct is SRT but would prefer to know if we are zapping in the right place.

Hopefully my history shows below. Thank you for any observations related to next steps!
Posted 4/24/2019 2:06 PM (GMT 0)
Yup, time to talk to an RO. I think it's time to start planning your SRT stuff. The other question will be whether or not to add ADT to the treatment plan and for how long.

Sadly, at that PSA level, scans are unlikely to show where the remaining PC might be.

Keep us updated on your progress,
Andrew
Posted 4/24/2019 2:44 PM (GMT 0)
Yes, what ITS said. Time to see the RO. You have several data points of steady increase. No sense in waiting any longer.
Posted 4/24/2019 6:13 PM (GMT 0)
Thanks InTheShop and mattam.

On the ADT question I understand that it can make the radiation more effective if the cancerous cells are still in the prostate bed. On the other hand, by taking ADT, it will take longer to discover the cancer if it turns out it is not in the prostate bed as it will hold PSA down. Is that correct?
Posted 4/24/2019 7:03 PM (GMT 0)
i'd be worried about treating the prostate bed without dragging this out any longer. you should have been talking to an RO after the six month test.
Posted 4/24/2019 7:19 PM (GMT 0)
Fully aligned F8. I indeed met my RO @ 6 month reading and he recommended waiting another 3 months (and then another 3 months) as he would prefer to do some scans in advance of treatment....that is why I was questioning whether any scans would prove useful at this level

Post Edited (AJMan) : 4/24/2019 1:33:15 PM (GMT-6)

Posted 4/24/2019 9:14 PM (GMT 0)
I think after.2 your chances of SRT working is a coin flip. sorry but I would be pushing hard for treatment now. your case looks like classic BCR and it's getting late.
Posted 4/24/2019 9:46 PM (GMT 0)
I agree with F8. Also, I would want to do ADT. G7(3+4) presents a tossup for ADT. But with that Tertiary 5 I’d want to be as aggressive as possible.
Grade 5, even if it’s just a small piece of the picture, can be nasty mothers, and you should do anything possible to get them taken care of
Posted 4/24/2019 10:03 PM (GMT 0)
AJ - I have no idea what is going on but your signature indicated “extensive EPE” and a few other items that might indicate that something might be going on in the local prostate area that was missed that might explain the PSA rise from such a low value. Since you are only at 0.1 at 1 year, it would probably be too early to detect anything. Maybe your RO has some ideas to mandate SRT now other than early is better than late.
Posted 4/24/2019 10:13 PM (GMT 0)
I'm guessing the bladder neck invasion is part 'n parcel of the extensive EPE. not sure about that....
Posted 4/24/2019 11:40 PM (GMT 0)
I would be thinking ADT first then radiation. I was a G9 after surgery, and I had questionable bladder neck invasion. Per my RO we started when my psa was >09. I am in the sooner the better camp. Best of luck with your decision and please keep us posted.
One other note - if you decide on ADT, have your testosterone level checked before any shots.
Posted 4/25/2019 1:02 AM (GMT 0)
F8 and Pratoman: Thank you and I read you loud and clear!

Mumbo: Appreciate your thoughts, thank you. The extensive ECE was in the apex on both the right and left side. The BNI was additional. On a related note, I notice you have some high risk pathology outcomes and that your PSA readings referenced are <0.10. Guess this means your docs are not recommending you use an ultra-sensitive test?

Island Time: Thank you for commenting. The BNI was separate from the ECE in the apex but from what I understand it is the same kind of thing...tumor extrudes outside the prostate wall into the bladder neck..

CaptainG: Thanks for the comment on ADT and best wishes for a sweet outcome from your recent treatments! Are you on 6 months of Lupron or longer?
Posted 4/25/2019 1:35 AM (GMT 0)
Hi AJMan,
I was on Lupron for 7 months total and 1 month of Casodex. My last Lupron shot was a 3 month, and as of February I am now "recovering". I have an appointment with my RO in mid May for my first post radiation and ADT treatment followup. Thanks for the good wishes!
Posted 4/25/2019 1:46 AM (GMT 0)
AJ - I am in Twin Cities and have questioned both Uro and RO about the ultra sensitive testing and it seems they are not totally sold on the idea yet and it has not become the standard of practice here yet. Both are relatively young in doctor years and with large groups so not a matter of being out of touch. In my case, I decided on ART which I just started which makes the decision moot for me and I stopped thinking about it.
Posted 4/25/2019 2:09 AM (GMT 0)
Hi, AJMan--

Sorry I'm late to the party. You've gotten a lot of good advice already, I'll try to keep this short:

> Ask your RO whether he envisions limiting SRT to the prostate bed or treating the whole pelvis. It's a judgment call, features of your pathology cut both ways. Might as well find out the protocol, too -- number of Grays in how many fractions.

> ADT is probably in your future, it's just a matter of when to start. If you're still curable by SRT, ADT will weaken the nasties in the prostate bed/pelvis and make them more susceptible to death by zap. If the nasties have already taken up residence elsewhere, ADT will likely be your first line of defense.

> I can understand doing scans now -- if anything showed up, however unlikely at PSA 0.1, it would impact the choice of treatment -- but I can't understand why one would wait for something to show up before starting salvage tx.

Good luck!
Posted 5/1/2019 7:08 PM (GMT 0)
Thanks again for your responses...very helpful...

Met RO and we are proceeding with treatment. Casodex, Lupron, Radiation. Hope is that whatever is there is in the prostate bed and that this takes care of it. Will be back with more questions and updates as this takes off but thank you all for your wise counsel to date.
Posted 5/1/2019 8:07 PM (GMT 0)
Good plan. Kill those basturdies.
Posted 5/1/2019 8:30 PM (GMT 0)
Ajman,
Great plan. Finish off what’s left hanging around. Good luck!
Posted 5/1/2019 8:33 PM (GMT 0)
AjMan,

Sounds like a good plan and similar to what I had. Just s reminder, you may want to get your testosterone level checked before staring Casodex and Lupron.
Posted 5/2/2019 1:44 AM (GMT 0)
Thanks GoBucks and mattam and CaptainG!

They have been doing testosterone at each PSA reading and it has been up and down like a toilet seat. Latest reading is 266. Will the Casodex and Lupron, in addition to driving testosterone down, also affect PSA or will next PSA reading be only taken after the time it takes for testosterone to build back up after stopping Lupron?
Posted 5/2/2019 11:39 AM (GMT 0)
AJ, if the lupron is working it will knock your psa to undetectable which is the goal before you start SRT

Larry
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