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Posted 1/19/2023 11:41 PM (GMT 0)
Well seems that all of us surgery guys don't just fade away. Have posted in a long time. Looks like my psa is on the rise and has been slowly increasing. Probably should have done something sooner but trusted my Urologist. Have a visit with the Oncologist on Feb. 7th.
8/15/17 <0.01
8/28/18 0.1
10/19 0.181
10/20 0.275
4/21 0.333
6/21 0.352
9/21 0.30
11/21 0.41
5/22 0.29
11/22 0.6
1/23 0.6
Posted 1/20/2023 1:24 AM (GMT 0)
Welcome back to the battle. Looks like the ship has sailed on early salvage radiation but the good thing is that now you should be able to get one of the newer PSMA scans that can possibly find where the PCa is lurking when your PSA is high enough which is where you are at in my opinion. Higher PSA is better for scans but these new PSMA scans are more sensitive and can find things at lower PSA levels. Based on the findings, a plan can be developed.

Sorry to hear about the apparent recurrence. Did you ever have radiation based you higher PSA in 2015?
Posted 1/20/2023 4:52 PM (GMT 0)
Is the February appointment with a radiation oncologist?
Posted 1/20/2023 5:15 PM (GMT 0)
It is good to hear from you, and you have had a nice run, with a slow rise of your psa. It will be interesting to hear the recommendation that you get from the Oncologist.
Michael
Posted 1/21/2023 8:08 AM (GMT 0)
Old but not forgotten.... Let us know how it goes.
Posted 1/21/2023 9:18 PM (GMT 0)
Good to hear from you guys to. Nothing has been done since surgery, the upcoming visit will be with a Medical Oncologist. The Urologist office wants to do a Pet Scan but I am having a hard time getting that approved through my health coverage. I will be going to Duke cancer center here in NC.
Posted 1/21/2023 9:47 PM (GMT 0)
I'm thinking it would be a PSMA PET scan to help on a decision for possible Salvage Radiation?

Your PSA tests seem to have unusual undulations for a surgery guy.
Posted 2/7/2023 12:28 AM (GMT 0)
Well I am off to see the Radiation Oncologist tomorrow to see what he has to say. Never got approved for the PSMA test. Feel like I did when I was first diagnosed in 2010. I will update tomorrow.
Posted 2/7/2023 1:17 AM (GMT 0)
Hmmm, any reason given for not approving the PSMA scan, what their criteria is, and is there an appeals process? I would think your RO would want to push for it as well. I can not speak for private insurance anymore but it seems Medicare has been covering PSMA scans for all sorts of situations recently. I know guys who have got a PSMA scan after a positive biopsy to see what is going on, but not before the biopsy.

You might want to check on cost to see if it is even close to being able to self-fund the scan. Good luck tomorrow.
Posted 2/7/2023 3:31 AM (GMT 0)

keysailfisher said...
Well I am off to see the Radiation Oncologist tomorrow to see what he has to say. Never got approved for the PSMA test. Feel like I did when I was first diagnosed in 2010. I will update tomorrow.

sorry man. that really sucks
Posted 2/7/2023 4:11 AM (GMT 0)

keysailfisher said...
Well I am off to see the Radiation Oncologist tomorrow to see what he has to say. Never got approved for the PSMA test. Feel like I did when I was first diagnosed in 2010. I will update tomorrow.

Let me guess, Medicare Advantage.
Posted 2/8/2023 1:43 AM (GMT 0)
First of all I really liked this RO. Don't have Medicare not old enough! I have health care coverage not insurance we have to pay up front and then get reimbursed. So that puts me in the category of self pay which sometimes I feel I get treated different. First hospital want $13,000 up front for the psma that's with a 30% discount for self pay. Spoke with Duke today and they $2100 for self pay with a $5000 discount. Looks like I'm going to Duke! This is his thoughts
"Pending the results of the PSMA PET/CT, I would favor pelvic node and prostate bed irradiation with 6 months of ADT." I read a study about this last night but I can't find it. So I would like to hear your guys thoughts.

Thanks
Neal
This is the article: https://www.health.harvard.edu/blog/promising-therapy-if-psa-rises-after-prostate-cancer-surgery-202208012792

Post Edited (keysailfisher) : 2/7/2023 5:51:49 PM (GMT-8)

Posted 2/8/2023 2:13 AM (GMT 0)
Hi and sorry your PSA is on the rise. I suggest watching the seminar "When Your PSA is Rising after Treatment" discussed in this thread.

Hope that helps,

Djin
Posted 2/8/2023 2:34 AM (GMT 0)
Clickable Link
https://www.health.harvard.edu/blog/promising-therapy-if-psa-rises-after-prostate-cancer-surgery-202208012792
Sounds like a reasonable plan at PSA = 0.60 although the test subject’s PSA was a little higher. The subject of when to use ADT and when to add the lymph nodes to salvage radiation scheme has been the subject of a number of studies. The balance between side effect potential and real treatment benefit is the balancing act.

As they mentioned, the key is with the newer PSMA testing where the source of PSA can possibly be located at lower PSA and treatment directed to those locations. So if your lymph nodes light up on the scan, targeting them is mandatory. If not, then the RO makes an educated guess based on confidence with the scan.

Your RO seems to be on the right track and Duke is doing the right thing for you. Good work…
Posted 2/9/2023 11:08 PM (GMT 0)
Thanks guys. My PSMA Pet is scheduled for 2/24. More waiting!
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