Failed IMRT?

My husband was diagnosed in Sept of 2015. His PSA was 9.3 at that time. First biopsy result: adenocarcinoma Gleason 5+3=8. He had a RP in Nov 2015. RP biopsy report result: 4+5=9. Prostate weight was 82 gm: 80% prostate involved: 5 positive lymph nodes. Staging: pT3b pN1.
After RP the first PSA in Mar of 2016 was: .185, June 2016: .313 He then started 3 month Lupron shots. With Lupron his PSA dropped down to <0.02 in Mar of 2017, then began to raise.
In Oct of 2018,when his PSA went to:.283 he began 6 month Lupron shot and MO added Erleada. Once again PSA dropped. This drop was to: <0.13., and that was Apr of 2019. There was then a climb up to:.53.in Oct 2019.
He had a choline11 PET scan at Mayo in Oct 2019. This showed 2 positive, and 1 questionable positive lymph node, in his pelvis. He stayed on 6 month Lupron shot and Erleada was stopped.
His last PSA in Dec, before IMRT was started was:.72. IMRT was done (not at Mayo) from Dec 2019 thru all of Jan 2020. His RO retired 1 week ago.
Yesterday he had his 1st PSA since radiation. It is now: 2.498! RO had stated that PSA can go up slightly after IMRT, and it could possibly take a year or more for a true PSA result. Is this raise considered a normal raise, or has the IMRT failed?
As luck would have it both MO and Urologist are out of the office today. Both nurses have said they will get back to us on Mon.
Anybody have any ideas on our next steps?

Post Edited (ourtime) : 7/17/2020 11:24:15 AM (GMT-6)

Since he doesn’t have a prostate, radiation should not cause an increase in PSA. With his ultra high risk diagnosis, I would not wait for a year on anything. It appears the disease was likely systemic at diagnosis and local therapy would not be curative. The PSA increases after two local therapies, surgery and radiation, support that.

Time for the medical oncologist to work to control the disease and keep him in a long durable remission. Many treatment options with chemotherapy, Provenge, second line ADT, etc. Please tell us that the oncologist is a PCa specialist that can show a great history of treating successfully men in your husband’s condition. Where are you located and who are you seeing?

He had a choline11 PET scan at Mayo in Oct 2019. If you are not currently being treated at Mayo I would consider that change.

Ourtime,
Your husband seems to have had an unusual treatment history. I don't understand why he didn't have radiation therapy back in 2016 when the post RP report indicated positive LNs. In any case, as suggested by JNF, he likely had systemic mets from the get go. I will also agree that the significant PSA jump to 2.95 has nothing to do with a PSA radiation bounce for a man without a prostate.

Your husband has already had a failure with one second line ADT medication (Erleada), but he could still get a good response from the addition of other second line ADT medications (Zytiga or Xtandi). As stated above, Lupron + Chemo will likely come into play at some point.

Good luck!

Good Luck

Where are you? Have you considered a consult with well known medical oncologists like Oliver Sartor at Tulane that will collaborate with your local doctors?

Hello, Ourtime ~

We are here to support you and your husband, as you begin planning new treatments.

All the things you mentioned as possibilities, we have members here who can share first-hand experiences with those medications and treatment approaches.

We're here for you ---- and we are here to share encouragement and experiences and helpful insight.

Stop by again --- let us know how you and your husband are faring.

With my best, from across the miles,

CYCLONE ~ # Iowa State University

Ourtime,
Your MO seems to be on the ball. Since Lupron plus Erleada stopped working, Lupron plus Taxotere seems to be the logical step. Let us know how things go.

Good luck!

Are you considering Provenge?