PSA Rising after RP and Early Salvage Radiation

Welcome and sorry that your journey continues. The Dr. Kwon situation sounds odd but not totally unexpected for someone with his reputation and demands on his time. You might try contacting islandboy who just posted recently about starting a Dr. Kwon treatment from MA. His situation is much worse than yours though.
https://www.healingwell.com/community/default.aspx?f=35&m=4305295
Dr. Kwon will have an email address posted somewhere that you can also try.

My take on your situation is there is not really much that can be done quite yet. Dr. Kwon is big on imaging and your PSA is too low to show anything with a PSMA scan. After surgery and RT, there needs to be something to target for specific treatment if you want to have a chance at kicking the ball down the road for a long time. Going on hormone treatment does not allow that to be found and no one would prescribe aggressive chemotherapy for such a low PSA unless you can find a trial that is looking to do something aggressive.

I think most doctors will make you get up to 0.20 at the very least before taking any next steps. Some men have a PSA that just levels out and treatments have risks so there is little reason to hurry.

Take a few moments and complete a signature in your profile for future reference. It really helps the next person who is going to want to know your age, your history summary, and any thing else worth sharing. I assume you are a Hoosier from your HW name but that could be wrong so clear that up for me. There are well regarded cancer centers in Indiana if you want some opinions on your status.

Good luck

Thank you Mumbo and Pratoman for your replies. Here is my data from past procedures and PSA trend. I will add this information to my signature.

DOB: 10/1962

6-01-15 PSA 2.5
Having urination flow issue in first half of 2018
6/25/18 PSA 14.25; Cipro 14 days
8/1/18 PSA 17.44; rec. Urologist appt
8/15/19 First Uro appt. + for bacteria. Cipro 4 weeks
10/2/19 PSA 22.4; Still + for bacteria. Antibiotics 4wks
12/28/19 PSA 27.5
1/15/20 Biopsy results 6/12 cores positive - all left side; GS 4+3
1/18/19 Bone scan and CT scan both negative
2/15/19 Di Vinci RP
2/18/19 Path report pT3a, GS 4+3 (60%+35%) 5% GS5, SM +, EPE +; LVI -, SVI -, LNI(9) - ; Tumor size: 3.5cmx3.5cmx1.5cm; single foci left side; right side nerves spared; SM+ at apex limited <1mm; benign prostatic cells at spared right nerve bundle. Prostate size 45gm. Cath out at 7 days: 100% continent.
Decipher 0.73 (High Risk)
9/26-11/19/19 eSRT (70.2 Gy)

PSA Test Results
03/26/19 (6 weeks) 0.033
05/10/19 (3 months) 0.010
08/02/19 (6 months) 0.019
08/30/19 (7 months) 0.024
12/12/19 (10 months) 0.012
06/09/20 (16 months) <0.008
11/13/20 (21 months) 0.010
02/23/21 (24 months) 0.020
05/24/21 (27 months) 0.020
08/16/21 (30 months) 0.020
01/26/22 (36 months) 0.020
08/17/22 (42 months) 0.050
09/15/22 (43 months) 0.060
11/15/22 (45 months) 0.090

Thanks again, Mumbo. Congratz on the <0.10. I'm guessing I'll be blowing through that in short order. Hopefully it's just a hot node in the pelvic region that they can zap. Obviously, nothing can be done until we can see what we are working with on a PET scan - which can't happen until PSA is >0.20 and preferably >0.70.

Hello tumalo - sorry for your visit here. A PSMA scan with a low PSA of 0.04 should not show anything so don’t attribute much to that scan. G9 is high risk and a persistent PSA means that early salvage radiation is a usually a good idea. You can always wait and get another test or two before you pull the pin on eSRT to make sure your other items are under control. Early is always better and there is some evidence that ADT is not necessary at low levels so ask about that, 4 months is not much though.

Taylor,

I agree with Mumbo as eSRT is what I did, but no ADT. There are two schools of thought on this point though. On the one hand, some say to wait until your PSA hits 0.2 so you can do a PSMA-PET scan to determine (hopefully) exactly where the cancer is located. On the other hand, some like Mumbo stated, and like I did, get early treatment to the prostate bed/nodes - with or without ADT - while the cancer load is small. I was G7 (4+3) but had EPE and a tiny positive margin. My pre-surgery PSA was 27 too. I'm glad I got the radiation treatments early on but it appears the horse may have gotten out of the barn already. In any case, best of luck and best of health. I'll be sure to update everyone as I go along my path.

-IndyGuy